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Surgical treatment is preferred over nonoperative treatment, as this reduces redislocations or subluxations and potential cartilage damage, and is associated with increased quality of life. There are several risk factors for patellar instability, which include demographic risk factors (age, gender), soft\u2010tissue imbalances (weak core stability, dynamic valgus, patellar tilt), and underlying anatomic abnormalities (patella alta, increased tibial tubercle trochlear grove distance, coronal malalignment, rotational malalignment, trochlea dysplasia). These risk factors should be routinely assessed in all patients with patellofemoral symptoms using history, physical examination (tracking, J\u2010sign, Q\u2010angle, rotation), and with imaging (standard and long\u2010leg radiographs, magnetic resonance imaging, computed tomography). The cornerstone of surgical management of patellar instability consists of medial patellofemoral ligament reconstruction, and if needed an additional medializing or distalizing tibial tubercle osteotomy and\/or lateral retinaculum release or lengthening. In rare cases, additional osteotomies (distal femoral osteotomy, trochleoplasty, rotational osteotomy) are required. Distal femoral osteotomy carries significant risk of complications and could be indicated, rarely, in the setting of patellar instability and severe valgus alignment, and is often considered in revision situations.<\/jats:p>","DOI":"10.1016\/j.arthro.2025.01.018","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T16:36:41Z","timestamp":1738168601000},"page":"2938-2940","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"title":["<i>Editorial Commentary<\/i>\n                    : Distal Femoral Osteotomy Leads to Excellent Outcomes in Patients With Patellofemoral Instability and Valgus Alignment but Should Be Used With Caution"],"prefix":"10.1002","volume":"41","author":[{"given":"Jelle P.","family":"van der List","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503260788"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2021.01.004"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.08.009"},{"key":"e_1_2_3_5_1","first-page":"229","article-title":"Patella alta sees you, do you see it?","volume":"46","author":"Magnussen R.A.","year":"2017","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"e_1_2_3_6_1","first-page":"831","article-title":"Examination of the patellofemoral joint","volume":"11","author":"Manske R.C.","year":"2016","journal-title":"Int J Sports Phys Ther"},{"key":"e_1_2_3_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510384233"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01552649"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519866452"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519835800"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516652894"},{"key":"e_1_2_3_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519838405"},{"key":"e_1_2_3_13_1","article-title":"When should bony correction be considered in addition to medial patellofemoral ligament reconstruction? Results of a clinically derived 2\u2010group classification of lateral patellar instability based on 122 patients at 2\u2010 to 5\u2010year follow\u2010up","volume":"11","author":"Zimmermann F.","year":"2023","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_3_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.10.109"},{"key":"e_1_2_3_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.05.019"},{"key":"e_1_2_3_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.12.016"},{"key":"e_1_2_3_17_1","article-title":"Small, short, oblique patellar tunnels for patellar fixation do not increase fracture risk or complications in MPFL reconstruction: A retrospective cohort study","volume":"8","author":"Deasey M.J.","year":"2020","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_3_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2024.100994"},{"key":"e_1_2_3_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-024-05113-z"},{"key":"e_1_2_3_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06140-z"},{"key":"e_1_2_3_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05736-4"},{"key":"e_1_2_3_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06114-1"},{"key":"e_1_2_3_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2021.01.027"},{"key":"e_1_2_3_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2023.10.040"},{"key":"e_1_2_3_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jisako.2024.02.002"},{"key":"e_1_2_3_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1417-4"},{"key":"e_1_2_3_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.09.015"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806325000362?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806325000362?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2025.01.018","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2025.01.018","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2025.01.018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:29:31Z","timestamp":1773566971000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2025.01.018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1016\/j.arthro.2025.01.018"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2025.01.018","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Editorial Commentary: Distal Femoral Osteotomy Leads to Excellent Outcomes in Patients With Patellofemoral Instability and Valgus Alignment but Should Be Used With Caution","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2025.01.018","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2024.12.016","name":"associatedlink","label":"CrossRef DOI link to the associated document"},{"value":"simple-article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}