Patellofemoral instability: surgical treatment of soft tissues.

Instability of the patella is a relatively frequent occurrence in adolescents. Its pathogenesis, which is multi-factorial, is still much debated. Stability of the patella is guaranteed by a delicate balance of a series of factors (osteo-cartilaginous, ligamentous and muscular), and it is not surprising that alteration of one or more of these can lead to pathological conditions that can range from simple anterior pain associated with a hypermobile patella to recurrent dislocation. The aim of surgical treatment is to correct these anatomical abnormalities. Surgical procedures on the soft tissues comprise reefing, realignment and reconstruction of the medial stabilizing structures, and release of the lateral structures. These procedures, although having precise indications, provide the surgeon with the instruments necessary to deal with almost all these anatomo-pathological conditions. Furthermore, preserving the osteo-cartilaginous components results in less morbidity than is associated with traditional surgical procedures, such as trochleoplasty and transposition of the anterior tibial tuberosity.