Editorial Commentary: Isolated Medial Patellofemoral Ligament Reconstruction Affects Patellar Height, but Quadriceps Dysfunction Is a Potential Modifiable Factor That Influences Patellar Biomechanics.

Abstract

Recurrent lateral patellar instability is a complex pathology that requires orthopaedic surgeons to consider a variety of factors with an à la carte approach to surgical solutions. In cases of isolated medial patellofemoral ligament reconstruction, patellar height is known to reduce significantly, and in some cases even normalize from a preoperative patella alta status. This becomes particularly important to consider through the lens of direct attachments to the patella, such as the vastus medialis oblique and retinacular tissues, and the influence of patellar height on quadriceps activation and vectors of pull. As surgical reconstructions often aim to restore bony relationships with radiological indices, it is paramount to consider restoring soft tissue relationships to optimize the dynamic forces influencing patellar mechanics. Several patient factors, pathoanatomic morphology, dynamic influences, and biomechanical principles govern the stability of the patellofemoral joint. It remains unclear how these factors compound with one another to correlate to a singular radiographic measurement, which is why patellar stabilization surgery continues to require careful examination, arthroscopic assessment, and an individualized approach.