Combined Trochleoplasty, Tibial Tuberosity Transfer, and Medial Patellofemoral Ligament Reconstruction in Recurrent Patellar Instability: Indications, Surgical Strategy, and Outcomes – A Narrative Review

Abstract

Background. Recurrent patellar instability is a multifactorial condition associated with trochlear dysplasia, abnormal extensor mechanism alignment, and medial patellofemoral ligament (MPFL) insufficiency. Isolated procedures may not address all anatomical abnormalities, leading to persistent instability. Therefore, combined procedures such as trochleoplasty, tibial tuberosity transfer (TTO), and MPFL reconstruction are increasingly used. Aim. To evaluate the evidence on indications, biomechanical rationale, and outcomes of combined trochleoplasty, TTO, and MPFL reconstruction in recurrent patellar instability. Material and methods. A narrative review of PubMed-indexed literature was conducted, including clinical studies, systematic reviews, and biomechanical analyses. Data were synthesized qualitatively due to heterogeneity in patient populations, surgical techniques, and outcomes. Results. Combined procedures are associated with low redislocation rates and generally favorable functional outcomes in selected patients. MPFL reconstruction restores medial soft-tissue restraint, TTO improves patellar tracking, and trochleoplasty enhances osseous containment in high-grade trochlear dysplasia. Combined approaches appear more reliable than isolated procedures in patients with multiple anatomical risk factors. However, functional outcomes and return to sport remain variable, influenced by cartilage status and chronicity of instability. Conclusions. Combined surgery is a logical and effective strategy for complex recurrent patellar instability when based on careful anatomical assessment. Success depends on appropriate patient selection rather than routine use. Further prospective studies are needed to refine indications and optimize surgical strategies.