Patellar instability: the Lyon experience

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Abstract
During the past 3 decades, the surgeons of Lyon have developed a vast experience dealing with patellofemoral problems. The “Lyon School,” as it may be called, addresses episodic patellar instability using anatomical principles based on the teachings of Dejour and Walch. Under this theory, trochlear dysplasia is the fundamental anatomical abnormality, without which recurrent patellar instability is very rare. Trochlear dysplasia causes a flat upper portion of the trochlear groove, usually because of a prominent floor as opposed to deficient sidewalls, so that joint reaction forces are increased but lateral constraint is reduced. But the dysplasia itself is rarely addressed directly. Instead, surgical treatment addresses each of 3 principal factors whenever it is present: tibial tubercle–trochlear groove offset, patella alta, and patella tilt. This article presents an algorithm for treating episodic patellar instability based on the teachings of the Lyon School. Although the specifics of the treatment protocol remain subjects of discussion, debate, and study, the protocol has been very successful in the hands of French surgeons.

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