The various conditions affecting the patellofemoral joint include cases of patellar pain even without the onset of joint instability in the form of dislocation or subluxation. These cases are often associated with malalignment of the knee extensor apparatus: while under physiological conditions the quadriceps tendon, the patella and the patellar tendon should lie on the same plane, in these patients one observes internal femoral torsion and external torsion of the tibial metaphysis. This leads to a) medial patella realignment, which engages on the trochlea at the start of the flexion, probably causing the lesions in the lower medial patellar facet that are often observed in these patients and b) excessive lateral compression when the flexion is more marked, which causes the pain felt by the patients during flexions downward extended over time or after prolonged sitting. Treatment of this pathology is surgical and aims at restoring correct alignment of the extensor apparatus. Among the various surgical options, there is the one introduced by Prof. De Nicola, entailing derotation of the tibial tuberosity in order to realign its frontal plane thus decreasing the external pressure on the patellofemoral joint.
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