Clinics in sports medicine
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Surgical treatment of patellar dislocations, acute and chronic, has evolved significantly over the past decade with the advance of biomechanical knowledge of patellofemoral restraints and injury patterns identified by physical examination and improved imaging techniques. There continues to be no consensus on treatment parameters. Despite the presence of predisposing factors, such as dysplasia or generalized hyperlaxity, medial retinacular injury associated with primary (first-time) patellar dislocations represents a ligament injury, which may result in residual laxity of the injured structure. ⋯ A practical approach to surgery after patellar dislocation is the minimal amount of surgery necessary to re-establish objective constraints of the patella. Correcting dysplastic factors, in particular tibial tubercle transfers and trochleoplasties, are best reserved if more minimal surgery has failed. This failure is defined as continued functional instability of the kneecap.