Current Concepts in Diagnostics and Treatment of Patellar Instability: Review

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Abstract

Background. Patellar instability is one of the most common pathologies of the musculoskeletal system, predominantly observed in physically active young individuals. It ranks third in the structure of knee joint injuries after anterior cruciate ligament and meniscal injuries.

The aim of this review — to present modern perspectives on the diagnosis, principles, and surgical treatment techniques for patients with patellar instability based on an analysis of the literature.

Methods. Publications were searched in the PubMed/MedLine and eLIBRARY databases. A total of 112 foreign articles published between 1984 and 2023 and 12 domestic publications from 2011 to 2022 were found. During the analysis, 68 articles were selected, which had full texts or abstracts containing sufficient information on diagnostic methods, commonly used standard and modified surgical correction methods for patellar instability, and treatment protocols considering patient age structure, instability characteristics, and functional demands.

Results. A qualitatively new stage in the reconstructive and restorative surgery of patellar instability is the in-depth examination of patients to determine the extent of damage to the medial retinaculum and the presence of dysplastic changes in anatomical structures that provide normal biomechanics of the knee extensor apparatus. A strictly individual approach to the selection of surgical treatment methods considering risk factors contributing to the development of chronic patellar instability becomes of particular importance.

Conclusion. Precise restoration of the medial patellofemoral ligament, supplemented by the correction of identified dysplastic changes in anatomical formations of the knee joint area, allows for better functional outcomes in patients with acute and chronic patellar instability.

About the authors

Vladimir V. Khominets

Kirov Military Medical Academy

Email: khominets_62@mail.ru
ORCID iD: 0000-0001-9391-3316
SPIN-code: 5174-4433
Scopus Author ID: 6504618617

Dr. Sci. (Med.), Professor

Russian Federation, 6, St. Petersburg, Akademika Lebedeva st., 194044

Dmitry A. Konokotin

Kirov Military Medical Academy

Author for correspondence.
Email: konokotin.dmitry@yandex.ru
ORCID iD: 0000-0003-3100-0321
SPIN-code: 1625-0543

адъюнкт кафедры военной травматологии и ортопедии

Russian Federation, 6, St. Petersburg, Akademika Lebedeva st., 194044

Oleg V. Rikun

Kirov Military Medical Academy

Email: rikoleg@yandex.ru
ORCID iD: 0000-0002-2027-8996
SPIN-code: 7508-2541

Cand. Sci. (Med.)

6, St. Petersburg, Akademika Lebedeva st., 194044

Alexey O. Fedotov

Kirov Military Medical Academy

Email: alexfedot83@gmail.com
ORCID iD: 0000-0002-9953-9385
SPIN-code: 3639-4352

Cand. Sci. (Med.)

Russian Federation, 6, St. Petersburg, Akademika Lebedeva st., 194044

Alexey S. Grankin

Kirov Military Medical Academy

Email: aleksey-grankin@yandex.ru
ORCID iD: 0000-0002-4565-9066
SPIN-code: 1122-8388

Cand. Sci. (Med.)

Russian Federation, 6, St. Petersburg, Akademika Lebedeva st., 194044

Aleksandr S. Vorobiev

Kirov Military Medical Academy

Email: aleks.vorobev2000@mail.ru
ORCID iD: 0009-0006-8878-0145

cadet

Russian Federation, 6, St. Petersburg, Akademika Lebedeva st., 194044

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2. Fig. 1. Calculation of the Caton-Deschamps index: AT — line connecting the lower edge of the patellar articular facet to the anterior edge of the tibial plateau; HA — line corresponding to the articular surface of the patella; CDI — Caton-Deschamps index, the ratio of the length of the AT line to the HA line

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3. Fig. 2. Scheme for calculating the TT-TG index in the axial plane: AB — tangent line to the femoral condyles; CD — perpendicular from the center of the tibial tuberosity to the line of the femoral condyles; EF — perpendicular from the center of the articular surface of the femoral block to the line of the femoral condyles; GH — distance between the center of the articular surface of the femoral block and the center of the tibial tuberosity

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4. Fig. 3. X-ray of the knee joint with signs of trochlear dysplasia in the lateral projection:

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5. Fig. 4. D. Dejour classification of trochlear dysplasia

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6. Fig. 5. Scheme of tunnel formation for fixation of the MPFL graft in the femoral condyle: A — satisfactory tunnel positioning; B — correct tunnel location

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7. Fig. 6. Scheme of medializing transposition of the tibial tuberosity according to Elmslie-Trillat

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8. Fig. 7. Scheme of distalization and medialization of the tibial tuberosity (DMTT)

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9. Fig. 8. Scheme of trochleoplasty according to D. Dejour (2010)

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3. Цель обработки персональных данных: анализ пользовательской активности с помощью сервиса «Яндекс.Метрика».

4. Категории субъектов персональных данных: все Пользователи Сайта, которые дали согласие на обработку файлов «cookie».

5. Способы обработки: сбор, запись, систематизация, накопление, хранение, уточнение (обновление, изменение), извлечение, использование, передача (доступ, предоставление), блокирование, удаление, уничтожение персональных данных.

6. Срок обработки и хранения: до получения от Субъекта персональных данных требования о прекращении обработки/отзыва согласия.

7. Способ отзыва: заявление об отзыве в письменном виде путём его направления на адрес электронной почты Оператора: info@rcsi.science или путем письменного обращения по юридическому адресу: 119991, г. Москва, Ленинский просп., д.32А

8. Субъект персональных данных вправе запретить своему оборудованию прием этих данных или ограничить прием этих данных. При отказе от получения таких данных или при ограничении приема данных некоторые функции Сайта могут работать некорректно. Субъект персональных данных обязуется сам настроить свое оборудование таким способом, чтобы оно обеспечивало адекватный его желаниям режим работы и уровень защиты данных файлов «cookie», Оператор не предоставляет технологических и правовых консультаций на темы подобного характера.

9. Порядок уничтожения персональных данных при достижении цели их обработки или при наступлении иных законных оснований определяется Оператором в соответствии с законодательством Российской Федерации.

10. Я согласен/согласна квалифицировать в качестве своей простой электронной подписи под настоящим Согласием и под Политикой обработки персональных данных выполнение мною следующего действия на сайте: https://journals.rcsi.science/ нажатие мною на интерфейсе с текстом: «Сайт использует сервис «Яндекс.Метрика» (который использует файлы «cookie») на элемент с текстом «Принять и продолжить».