Dr. John Fulkerson of the Patellofemoral Foundation (PFF) highlights the critical role of 3D computerized tomography (CT) in precision planning for patellofemoral instability surgery. He emphasizes that understanding the complex geometry of the patellofemoral joint is impossible without 3D imaging, making it essential for surgical planning. Key to this approach are 3D proximal metrics, which allow surgeons to visualize the entire trochlea and ensure the patella remains congruent within the joint. By obtaining 3D CT scans at specific flexion angles and considering factors like the entry point (EP) and transition point, surgeons can gain a comprehensive understanding of the knee’s biomechanics.
Dr. Fulkerson recommends a thorough evaluation of proximal metrics such as the entry point to transition point (EPTP) angle and the entry point to tibial tuberosity groove (EPTG) angle, as well as indicators of patella alta. These measurements, combined with a visual assessment of the trochlea’s shape and alignment, provide valuable insights into the patella’s stability. By spinning the 3D knee and evaluating it from different angles, surgeons can develop a holistic understanding of the joint and identify the optimal surgical approach.
Ultimately, the goal is to keep the patella in the trochlea, ensuring joint preservation and long-term stability. Dr. Fulkerson advocates for anterior medial tibial tubercle transfer as a technique that aligns and preserves the joint, minimizing damage to the subchondral bone. By leveraging 3D imaging and careful surgical planning, surgeons can improve outcomes for patients with patellofemoral instability and help them maintain healthy joints for years to come.