Approach to Patellar Dislocation Treatment: Review and Prospects

Abstract

Lateral patellar dislocation (LPD) is a musculoskeletal condition characterized by a complex etiology. Despite significant advancements in management strategies, it continues to pose considerable challenges. Critical anatomic risk factors previously identified include trochlear dysplasia (TD), patella alta, and elevated tibial tubercle–trochlear groove (TT-TG) distance, with TD being the most significant. A thorough risk assessment using predictive models is primarily recommended to assist in patient counseling and to identify high-risk cases, for whom early surgical intervention may be considered. Controversies persist regarding the indications for combined surgical procedures, including tibial tubercle osteotomy (TTO), derotational distal femoral osteotomy (DDFO), and lateral retinacular release (LRR) with medial patellofemoral reconstruction (MPFLR). Moreover, emerging evidence suggests that a deeper understanding of the interplay between anatomic factors may optimize surgical prioritization and improve clinical outcomes. The combined surgical approach should be reserved for meticulously selected cases with substantial anatomic risk factors, while isolated MPFLR may prove adequate for cases with milder grade risk factors. To enhance individualized treatment strategies and improve outcomes for patients with LPD, deeper insights into the interaction of anatomical factors, supported by higher-quality clinical research and advancements in biomechanical modeling, are essential.