Patellofemoral Instability Surgery Complications: How to Avoid Them

Both soft tissue and bone anatomy confer stability to the patella during the knee arc of motion. While high-energy trauma can result in damage to these constraints, low-energy forces can also result in recurrent patellar instability if there is underlying pathology to the basic architecture. Maltracking, or malalignment, of the patellofemoral articulation can not only contribute to potential instability but can also predispose to excessive cartilage wear, resulting in the progression of chondromalacia-related disease and pain. While there are a myriad of soft tissue, bone stabilization, and realignment procedures that can confer stability to the patellofemoral joint, these procedures also have inherent risks and potential complications. This chapter details the most commonly observed complications reported in the literature associated with patellofemoral surgery as it pertains to soft tissue and bony stabilization and realignment procedures. It will also review the technical causes of these complications and provide guidance on how to avoid and troubleshoot their occurrence in the operating room.