Combined Trochleoplasty, Tibial Tuberosity Transfer, and Medial Patellofemoral Ligament Reconstruction in Recurrent Patellar Instability: Indications, Surgical Strategy, and Outcomes – A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.72.74862Keywords
patellar instability, MPFL reconstruction, tibial tuberosity transfer, trochleoplasty, patellofemoral joint, combined surgeryAbstract
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.
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Copyright (c) 2026 Leon Miller, Aleksandra Majewska, Wiktoria Michalska, Karolina Gaweł, Emilia Dedio, Aleksandra Kozik, Weronika Matera, Klaudia Dziuba, Gabriela Augustynowicz, Wiktoria Podlasiewicz
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