The patellofemoral joint has the highest contact pressures in the body during deep flexion activities — up to 8 times body weight in the squatting position. Trochlear dysplasia (shallow or convex trochlea) and patella alta are the primary anatomical risk factors for patellar instability and patellofemoral pain. Tibial tuberosity-to-trochlear groove (TT-TG) distance greater than 20 mm indicates significant lateral patellar tracking deviation.
The Dejour trochlear dysplasia classification (A-D) guides surgical correction: Grade C-D dysplasia with a supratrochlear spur requires trochleoplasty to deepen the groove. The TT-TG distance guides tibial tubercle medialization — values >20 mm warrant anteromedialization (Fulkerson osteotomy). Combined MPFL reconstruction, tibial tubercle transfer, and trochleoplasty addresses complex patellar instability.
Trochlear dysplasia and elevated TT-TG distance guide the surgical algorithm: trochleoplasty, tibial tubercle transfer, and MPFL reconstruction.
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