Distal alignment procedures for patellofemoral instability: comprehensive review of the literature

Eur J Orthop Surg Traumatol. 2019 Oct;29(7):1579-1588. doi: 10.1007/s00590-019-02451-1. Epub 2019 May 23.


Patellofemoral disorders are a common cause of complaint in adolescent patients. Several distal realignment procedures performed in isolation or combination with proximal alignment have been described. To clarify the role of distal alignment for patellofemoral instability, a systematic review of the literature was conducted. Two independent reviewers accessed the following databases: PubMed, Medline, CINAHL, Cochrane, EMBASE and Google Scholar. A total of 1478 patients with a mean age of 22.78 years were included. The mean follow-up was 86.53 months. The average Kujala score improved from 57.66 to 82.73. The average Lysholm score improved from 63.25 to 87.87, and the average Tegner score from 3 to 4.16. VAS score improved from an average 8 to 2.56. We account a total of 46 major complications, 45 minor complications and 95 recurrences. The risk of a recurrence is 6.42%. A total of 122 additional surgeries were performed during the follow-up. This systematic review of literature suggests the importance to identify the pathological background that predisposes patients for developing patellofemoral instability and its implications for the decision-making process. The optimal treatment for patellofemoral instability should be individualized to address the specific anatomical abnormalities that contribute to patellofemoral dislocations. Distal alignments are a feasible solution to restore correct patellar biomechanics and tracking, leading to an improvement of patients' quality of life.

Keywords: Bony procedure; Dislocations; Failure; Patellofemoral instability; Tibial tubercle transfer.

Publication types

  • Systematic Review

MeSH terms

  • Humans
  • Joint Instability / surgery*
  • Orthopedic Procedures / adverse effects
  • Orthopedic Procedures / methods*
  • Patellofemoral Joint*
  • Postoperative Complications / etiology
  • Recurrence
  • Reoperation