The Patellofemoral Foundation (PFF) was proud to participate in the International Patellofemoral Study Group (IPSG) 2026 meeting in Lyon, France. Bringing together leading clinicians, surgeons, researchers, and educators from around the world, the conference highlighted the latest advances in patellofemoral research, diagnosis, and treatment. Members of the PFF Board of Directors attended the meeting and identified several important research findings, emerging trends, and consensus recommendations that may help shape the future of patellofemoral care.
Research Highlights from IPSG 2026
- Medial PF reconstruction: JUPITER study demonstrates favorable long-term outcomes (>10 years), despite trochlea dysplasia.
- Anteromedial tibial tubercle transfer (AMTTO) with distalization is preferable to isolated medial TTO (MTTO).
- Understanding the patella entry point to the trochlea in 3-D requires understanding of the medial and lateral ridge ends in 3-D. 3-D understanding of the PFJ is necessary for full understanding of this complex joint and AI decision making.
- Anteriorization with distalization bypasses a proximal spur and unloads while moving a patella into stable relationship with a trochlea.
- Three-dimensional (3-D) characterization of the patellofemoral joint provides more accurate diagnosis and optimal surgical planning. 4-D further characterizes tracking.
- Statistical Shape Modelling is helpful in understanding trochlea dysplasia and J sign in particular. The future of patellofemoral surgery planning will likely involve 3-D imaging.
- Rotational femoral osteotomy can help restore patellofemoral stability in selected cases with excessive femoral anteversion.
- Post-op PROs demonstrate positive results following tibial derotation for anterior knee pain, and 86% would have the surgery again.
- Increased posterior tibial slope is associated with patellofemoral cartilage lesions.
- Weight-bearing alters TT-TG values. TT-TG is not reliable as a sole criterion for surgical planning.
- PT-LTR is useful in surgical decision-making and characterization of patella tracking.
- There was a general consensus that a Jumping J sign is a relative contraindication to isolated MPFL reconstruction.
- A tibial tuberosity distalizing osteotomy, or rarely a trochlear osteotomy, are usually necessary in patients with a Jumping J sign and recurrent instability.
- TTTG is a composite measurement influenced by multiple anatomical factors including knee rotation and flexion angle, making it unreliable in isolation. We should not make decisions based on this measurement alone.
- Anteromedial tibial tubercle transfer, when appropriate, improves outcomes of patella instability surgery and results further improve with headless screw fixation.
- Isolated medialization osteotomies (MTTO) are rarely performed in the group’s practices.
- The ESSKA consensus proposes a paradigm shift for first-time dislocations: individualized risk assessment for each patient, with conservative treatment reserved for low-risk cases. Better tools now exist to estimate recurrence risk, consistent with findings from the HSS PAPI study.
- Terminology consensus within the group will improve communication and we should spread this message, though anterior knee pain of patellofemoral origin remains a controversial and poorly defined area.
- Murphy’s method is a preferred approach for femoral version measurement, advocating for group consensus and formal recommendation of this technique. This should be an aim for us, so that research aligns and studies can be comparable.
- Tibiofemoral rotation is gaining relevance as a topic, though its determinants and implications are not yet well understood.
- Ultrasound may be useful to identify trochlear dysplasia in neonates, is associated with hip dysplasia, and may be modifiable with knee flexion, suggesting a patella-trochlea developmental relationship and opening possibilities for early screening and treatment, analogous to developmental hip dysplasia.
- Ultrasound is useful for characterizing patella instability.
- Habitual patellar dislocations in flexion, more commonly seen in the pediatric population, were addressed with a consensus treatment algorithm. Techniques for proximal and lateral lengthening presented were particularly interesting.
- TAT osteotomy with wedge-type specific guides showed good outcomes and low complication rates similar to traditional methods.
- HSS PAPI study, a randomized control trial, showed benefits of MPFL reconstruction compared to non-operative treatment in first-time patella dislocators. This information, along with the JUPITER study report that increasing numbers of dislocations are associated with increased cartilage damage to the patellotrochlear joint, may swing the pendulum toward operative treatment for first-time patellar dislocation.
- Prediction models are increasingly used to counsel patients on risks of future dislocation, not just for the ipsilateral knee but also for the contralateral knee.
- JUPITER study has shown satisfactory results of MPFL reconstruction in skeletally immature patients, but the rate of redislocation is higher when compared to skeletally mature patients.
- Postoperative J-sign and apprehension sign are predictors of suboptimal outcomes after patellar stabilization surgery.
- There is a lack of high-level evidence on timing for return to sports after MPFL reconstruction, but there is a trend toward earlier return to sports at 4–5 months.
- Radiographic patellar height measurements should be supplemented with patellotrochlear engagement on MRI to evaluate for functional patella alta.
The IPSG meeting continues to serve as a valuable forum for advancing the understanding and treatment of patellofemoral disorders. The research presented in Lyon reinforced the growing importance of individualized treatment planning, three-dimensional imaging and analysis, and evidence-based decision-making across the spectrum of patellofemoral care. PFF remains committed to supporting research, education, and collaboration that improve outcomes for patients worldwide, and we look forward to helping share and apply these important insights in the years ahead.