title: Medial Patella Subluxation: Diagnosis and Treatment.
abstract: Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity.
authors.affiliation: University of Iowa Hospitals and Clinics Department of Orthopaedics and Rehabilitation.
authors.forename: Mark A
authors.initials: MA
authors.lastname: McCarthy
authors.affiliation: University of Iowa Hospitals and Clinics Department of Orthopaedics and Rehabilitation.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Bollier
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D031222:Patellar Dislocation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D057071:Patellofemoral Joint / Q000293:injuries / Q000601:surgery*; D010808:Physical Examination / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D013524:Surgical Flaps / Q000637:transplantation; D058971:Tenotomy / Q000379:methods; D016896:Treatment Outcome