Arthroscopic Approaches to Proximal Realignment of the Patellofemoral Joint

Abstract: Instability and pain from the patellofemoral joint continues to be a difficult problem for the orthopaedic surgeon. Numerous nonoperative modalities and operative procedures have been described with unpredictable and variable results. The natural history of patellar instability includes a high rate of recurrence, patient dissatisfaction, functional deficits, and subsequent surgical intervention. Unfortunately, the operative procedures are associated with unpredictable results and morbidities which may be severe. As new arthroscopically assisted procedures continue to be described, can these prevent recurrence or pain while limiting morbidity? This is particularly a concern in the skeletally immature patient or patient with normal femorotibial alignment where distal osteotomies may not be indicated. We present a literature review on the techniques and clinical results of arthroscopic approaches to proximal realignment, their relative indications, and an illustrated case example