Beyond the medial patellofemoral ligament: The role of concomitant bony procedures in recurrent patellar instability.

Recurrent patellar instability is a complex condition influenced by both soft tissue insufficiency and a spectrum of bony abnormalities. Although medial patellofemoral ligament reconstruction is the cornerstone of treatment, it may not address all contributing factors-particularly in patients with malalignment, trochlear dysplasia, or abnormal patellar height. This study explores the indications, techniques, and outcomes of adjunctive bony procedures including tibial tubercle osteotomy, trochleoplasty, and derotational distal femoral osteotomies. Ultimately, the goal is to integrate soft tissue and bony procedures in a patient-specific manner to reduce recurrence and preserve long-term joint function. This synthesis aims to offer an up-to-date framework for approaching a challenging condition with growing treatment complexity.