Factors to Consider in Cartilage Treatment Associated With Patellar Instability: Tibial Tubercle Osteotomy and Soft Tissue Management

Concomitant cartilage injury is commonly associated with patellofemoral instability. While nonoperative treatment remains the gold standard for first-time dislocators, there has been an increased trend toward addressing patellar instability when symptomatic cartilage disease is present. Both osseous distal realignment and soft tissue reconstructions have demonstrated excellent clinical outcomes; however, surgeons must be aware of the relevant aspects of evaluation and surgical indications for the various procedures. Assessment of tubercle lateralization with the tibial tubercle-to-trochlear groove and tibial tubercle posterior cruciate ligament distances, axial alignment of the patella with the patellar tilt, and underlying trochlear dysplasia are critical in determining the appropriate treatment options to address patellar instability. The purpose of this article was to review the relevant evaluation and surgical indications for cartilage surgeons treating patellofemoral instability.