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Current management differs for these 2 groups. The accepted \u201ccommon denominator\u201d of patellar instability is the medial patellofemoral ligament, or medial patellar restraints, to be more all\u2010encompassing. These patients often have multiple contributing comorbidities (e.g., trochlear dysplasia, patellar alta, excessive lateral position of tibial tubercle). Historically, the recommended treatment for a first\u2010time patellar dislocation was nonoperative because medial soft tissue repairs had not been proven more effective. Indications for primary repair of the medial patellar restraints are a single discrete tear identified on magnetic resonance imaging. In the case of recurrent patellar instability, medial patellofemoral ligament reconstruction, rather than repair\/reef, has been the recommended approach. The keys to reconstruction remain: honor the anatomy and avoid overconstraint of the patella. For first time dislocation patients with trochlear dysplasia, patellar alta, and age &lt;25\u00a0years, recurrent instability is common.<\/jats:p>","DOI":"10.1016\/j.arthro.2018.08.046","type":"journal-article","created":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T11:08:04Z","timestamp":1541070484000},"page":"3094-3097","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"title":["<i>Editorial Commentary:<\/i>\n                    What Is the Optimal Management of First and Recurrent Patellar Instability? 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