Page 10 - JCTR-11-3

Journal of Clinical and
Translational Research Lateral patellar instability in deep flexion

Table 1. Selected studies and data for lateral patellar instability in deep flexion
Author Year Study Number of Age at onset of Clinical presentation Age at surgery Recommended
design subjects symptoms surgery
Bergman & 1988 Case series 35 (18 males and 5 – 12 years old Quadriceps muscle 6 – 15 years old Lateral release, medial
Williams 5 17 females) contractures and odd-looking plication, patellar
knee tendon, or patella
transfer
Eilert 60 2001 Case report Two (females) 2 months – Persistent/obligatory lateral 2 months or Recentering patella
6 years old dislocation 6 years old
Joo et al. 64 2007 Case series Six (females) At the start of Ligamentous laxity and aplasia 6.1 years old Lateral release,
walking trochlear groove (4.9 – 6.9 years semitenodesis, proximal
old) tube transfer, or patellar
tendon transfer
Shen et al. 65 2007 Case series 12 (five females 10.8 years old Patellofemoral pain, weakness, 25.4 years Lateral release,
and seven males) (average) crepitus, and effusion (18 – 50 years medial retinaculum
old) advancement, or
anteromedial tibial
tubercle transfer
(osteotomy for valgus)
Biedert 2 2012 Case report Two (one male 14 and 11 years Pain, crepitus, weakness, and 21 and 24 years Re-medialization
and one female) old restricted range of motion. old tibial tubercle, medial
patellofemoral ligament
reconstruction, or raised
lateral trochlea
Batra & 2014 Review - Children Lateral soft tissues and 25.4 years old Excessive lateral release,
Arora 3 quadriceps muscle advancement of vastus
contractures medialis obliquus
muscle, or distal
realignment
Sanchis- 2015 Review - - Increased tension in extensor - Lengthening lateral
Alfonso 19 muscles release, quadriceps
muscle, rectus lateralis
tendon, medial
patellofemoral ligament
reconstruction, or raised
lateral condyle
Mittal 67 2020 Case report 10 (two females, 5 – 9 years old Hypoplastic patellae 6.4 years old Excessive lateral release
eight males) or Goldthwait Roux
tibial tubercle transfer
Weitz 4 2020 Book - At the start of Extensor contractures, - Lengthening vastus
walking muscles, dysfunction, and false lateralis muscle tendon,
sulcus medial patellofemoral
ligament reconstruction,
or lifting false groove

Simultaneously, the iliotibial tract glides posteriorly are dynamized by the vastus lateralis, tensor fasciae lata
across the rotational axis and lateral femoral condyle, (iliotibial tract), and gluteus maximus muscle. This causes
changing the resultant force vector to lateral and posterior a posterolaterally oriented force on the patella during knee
aspects. The iliotibial tract has direct connections to the flexion. 43,45 In addition, tightness in the fascia lata and
lateral retinaculum. 43,44 The superficial oblique retinaculum the iliotibial band increases the quadriceps angle, thus
extends from the iliotibial tract, along with fibers of the exacerbating the lateral force vector.
vastus lateralis tendon, to the lateral aspect of the patella Close to extension, the lower third of the articular
and the patellar tendon (Figure 4). The deep transverse cartilage of the patella contacts the upper trochlea with
43
retinaculum fibers connect the fascia lata directly to the its high lateral facet and inclination. 46,47 At 45° of flexion,
lateral patella. Functionally, both parts of the retinaculum the midportion of the patella is in contact with the mid

Volume 11 Issue 3 (2025) 4 doi: 10.36922/jctr.7131