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The patellofemoral joint (PFJ) is a highly complex structure. The clinical presentation of PFJ instability contains a spectrum of manifestations (with symptoms like pain, subjective instability, pseudolocking and true dislocation) that can be subtle and very difficult to correctly diagnose and treat. In 1987, in an edition of the Journees Lyonnaises de Chirurgie du Genou, Henri Dejour and Gilles Walch precisely set the basic principles and diagnostic rationale for patellar instability, describing four major anatomical factors leading to instability: trochlear dysplasia, abnormal patellar height, high tibial tubercle to trochlear groove distance and high patellar tilt. In addition to these major predisposing anomalies, secondary instability factors had been identified, such as torsional and lower limb alignment anomalies and muscular weaknesses or imbalance. In PFJ instability a complete and careful analysis of the patient’s medical history, clinical and imaging evaluation is essential to properly assess the presence of anatomical anomalies, instability predisposing factors and subsequent surgical indications. After collecting all information, it is of a paramount importance to correctly select which patients are eligible for surgical interventions. Surgical treatment often includes a combination of procedures rather than any isolated one to correct each of the detected abnormalities as described in the algorithm ‘le menu a la carte’ presented by Henri Dejour in 1987. The main objective of PFJ surgery is the prevention of recurrent dislocations. Therefore the treatment algorithm consists of a list with each etiological anatomical abnormality (with correspondent thresholds) and its individual corrective procedures. The surgeon will need to combine soft tissue and bony procedures to address all the involved factors, each corrected individually. |
