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Although medial patellofemoral ligament reconstruction is the cornerstone of treatment, it may not address all contributing factors\u2014particularly in patients with malalignment, trochlear dysplasia, or abnormal patellar height. This study explores the indications, techniques, and outcomes of adjunctive bony procedures including tibial tubercle osteotomy, trochleoplasty, and derotational distal femoral osteotomies. Ultimately, the goal is to integrate soft tissue and bony procedures in a patient-specific manner to reduce recurrence and preserve long-term joint function. This synthesis aims to offer an up-to-date framework for approaching a challenging condition with growing treatment complexity.<\/jats:p>","DOI":"10.1097\/bh9.0000000000000054","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T22:00:09Z","timestamp":1779919209000},"page":"105-109","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the medial patellofemoral ligament: The role of concomitant bony procedures in recurrent patellar instability"],"prefix":"10.1097","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5748-2344","authenticated-orcid":false,"given":"Lauren H.","family":"Schoof","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Health, New York, New York"},{"name":"Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8903-8376","authenticated-orcid":false,"given":"Abigail L.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"R1-20260626","first-page":"1204","article-title":"High incidence of acute and recurrent patellar dislocations: a retrospective nationwide epidemiological study involving 24,154 primary dislocations","volume":"26","author":"Gravesen","year":"2018","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"R2-20260626","doi-asserted-by":"crossref","first-page":"2552","DOI":"10.1177\/0363546519888467","article-title":"Factors associated with an increased risk of recurrence after a first-time patellar dislocation: a systematic review and meta-analysis","volume":"48","author":"Huntington","year":"2020","journal-title":"Am J Sports Med"},{"key":"R3-20260626","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1177\/0363546517704178","article-title":"Risk factors and time to recurrent ipsilateral and contralateral patellar dislocations","volume":"45","author":"Christensen","year":"2017","journal-title":"Am J Sports Med"},{"key":"R4-20260626","doi-asserted-by":"crossref","first-page":"3806","DOI":"10.1007\/s00167-022-07255-1","article-title":"Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review","volume":"31","author":"Danielsen","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"R5-20260626","doi-asserted-by":"crossref","first-page":"2642","DOI":"10.1016\/j.arthro.2024.08.009","article-title":"Anatomic risk factors for lateral patellar 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