In 2008, conditions such as hemarthrosis, medial facet fracture and medial patellofemoral ligament (MPFL) injury occur in almost all patients after traumatic patellar dislocation, in addition, osteochondral fracture can be observed in 25% of the cases. The clinical picture consists of complaints of feeling of falsehood, severe pain and secondary effusion. However, they can also occur after low-energy trauma in people with predisposing factors.Ībout 93% of traumatic patellar dislocations occur during flexion with valgus movement of the knee without direct contact, while medial dislocations are exclusively traumatic or iatrogenic. Patellar dislocations are mainly lateral, and the main mechanism of injury during physical activity is the internal rotation of the femur with the foot planted, valgus component and a sudden lateral displacement of the patella, or a direct impact that displaces the patella from the joint. Patellofemoral joint instability is multifactorial, the presence of predisposing factors such as femoral anteversion, external tibial torsion, internal femoral torsion, geno valgus, patellar dysplasia, trochlear dysplasia, high patella, oblique medial vastus atrophy, flat foot, and generalized hyperlaxity may influence the occurrence of recurrent dislocations.
This condition can cause significant morbidity since it is associated with high recurrence rates, lesions and fractures of the patellofemoral cartilage, injury of adjacent soft tissues, which result in pain, decreased function and possible development of patellofemoral arthrosis. Patellofemoral dislocation is a disabling lesion that represents ∼ 2 to 3% of all traumatic knee injuries and affects 5 to 43 cases per 100,000 young people and adolescents per year. Anatomical factors such as trochlear dysplasia, patellar morphology, tibial tuberosity localization, and soft tissue rupture have been associated with primary dislocation and recurrent secondary instability. Patellar instability is a common and disabling clinical condition that mainly affects young individuals. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment.
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