Patellar Instability

From an evolutionary standpoint, the patella appeared much later than the condyles, meniscus, and cruciate ligaments of the knee. Compared with lower animals, the patella gradually increased in size and function and gained more importance as a facilitator for the extensor mechanism in erect humans. Being low in the evolutionary chain and high in functional demand, the patellofemoral joint is indeed unique. In past decades, various patellar instability patterns have been described in the literature and so has the various surgical options to treat it, ranging from patellectomy to patellofemoral replacement. Recently, the medial patellofemoral ligament has been recognized as the most important contributor to patellar stability, and its reconstruction as the ultimate treatment. However, all patellar instability patterns are not the same, and all instability patterns cannot be managed by the same ligament reconstruction. In the article “Classification of Lateral Patellar Instability in Children and Adolescents,” the authors have first tried to define the common nomenclature related to lateral patellar instability. This is followed by a classification system to differentiate the four recognizable patterns of instability (types I–IV) with each higher type representing increasing severity and requiring more complex surgery. The classification system would help guide the medical decision-making process and decrease heterogeneity in the literature for research and communication purposes.

The second article in this series is on congenital anomalies of the hand and its management principles. The authors briefly describe the epidemiology, classification, and embryology of congenital hand anomalies and focus on three common anomalies (syndactyly, polydactyly, and hypoplastic thumb). Since several congenital hand anomalies are associated with systemic malformations, sometimes fatal, it is important to identify such associations. Each anomaly is discussed in detail, including its types, principles of management, technical considerations during surgery, postoperative course, and outcomes. The authors stress the importance of getting the family involved in treatment discussions because distinction needs to be made between the expected cosmetic and functional outcomes related to the anomaly. Also, there are various cultural and social differences between patients; hence, preoperative counseling and patient and family expectations play a big role in decision-making.

I am sure the readers would enjoy these informative articles. As a medical student and resident, I remember the Orthopedic Clinics of North America as the go-to reference for up-to-date information. It continues to be so. It has been an honor and pleasure serving on the editorial board of this prestigious series. Besides the authors, I would like to thank the office and support staff who worked tirelessly to get timely information to the readers. Best wishes to the new editorial board and to the future of this series.

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