{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:22:54Z","timestamp":1790713374410,"version":"4.1.0"},"reference-count":145,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\u27a4 Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Cartilage or osteochondral lesions and\/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (&gt;20 mm), and\/or in the setting of patella alta.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of &gt;30\u00b0 to improve patient outcomes and reduce recurrence rates.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.22.00756","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T13:57:48Z","timestamp":1675346268000},"page":"397-409","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":50,"title":["Lateral Patellar Instability"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-8993","authenticated-orcid":false,"given":"V\u00e9ronique","family":"Drapeau-Zgoralski","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-7040","authenticated-orcid":false,"given":"Brendan","family":"Swift","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5239-5022","authenticated-orcid":false,"given":"Andrew","family":"Caines","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-1395","authenticated-orcid":false,"given":"Alicia","family":"Kerrigan","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, The Children\u2019s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8180-9770","authenticated-orcid":false,"given":"Sasha","family":"Carsen","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, The Children\u2019s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9695-0403","authenticated-orcid":false,"given":"Michael","family":"Pickell","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"issue":"4","key":"bib1-20250430","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."},{"issue":"3","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.knee.2006.01.005","article-title":"Epidemiology of athletic knee injuries: a 10-year study","volume":"13","author":"Majewski","year":"2006","journal-title":"Knee."},{"issue":"2","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s40141-018-0187-8","article-title":"Patellar dislocations: review of current literature and return to play potential","volume":"6","author":"Gao","year":"2018","journal-title":"Curr Phys Med Rehabil Rep."},{"issue":"10","key":"bib4-20250430","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":"bib5-20250430","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/17453678309154170","article-title":"The dislocating patella. 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