Dear Dr. Medhat Maaty,

As you mentioned there are many operations for the recurrent patella dislocation. Most commonly used operation is MPFL Reconstruction (18 years or Older) and Arthroscopic Medical Reefing with lateral release (younger). However the long term outcome better with the MPFL Reconstruction.

thank you Dr. 

Saroj Rai for your interesting answer

Exact etiology should also be clear as sometimes additional procedures are also done like tibial tuberosity shifting. Along with that if trochlear dysplasia or shallow trichlea are present then sometimes we might require described osteootomies to deepen the groove. In simple words , it is vast topic with individualised care and evaluation.

There is probably no single  best operation. It depends on many factors that must be defined before the operation. Among the most important factors are: the patients constitution, type of trauma responsible for the dislocations, the number of dislocations and the age of the patient. The patients constitution include dysplasia of the trochlea, the femoral condyles and the patella. Rotational malalignment, varus/valgus malalignment as well as the patellar height (baja or alta) and the horisontal tuberosity-trochlea distance (TTTG) are important factors. Hyperlaxity and abnormal mobility must be considered as well as the patients general health status, ability to cooperate and eventual patello-femoral arthrosis. My suggestion is that in a case with normal anatomy and a significant trauma one should repare the damaged structures (most frequently the MPFL). In the case of constitutional abnormalities, the anatomy has to be modified according to the most important abnormalities. This often leads to a combination of procedures, for example medialization of the tibial tubercle, lateral release and MPFL-reconstruction or medial raffing. Trochlea plasty and patello-femoral prosthesis combined with soft tissu procedures may be indicated in a fiew cases. Do not forget that many patients are well off with conservative treatment. Finally, the preoperative evaluation of the patient and the surgery must be done by a surgeon with special interest in this field. Failed surgery may result in a very unhappy patient.

thank you DR,Eirik Aunan 

I agree entirely with Dr. Aunan. There is no single best operation. It should be decided from case to case depending on the individual pathology. I have had excellent clinical results with the classic Ali Krogius procedure when only soft-tissue repair is needed.