In a patient with lateral trochlea dysplasia, symptomatic articular lesion, or an excessive lateral tracking vector, failure to medialize the tibial tubercle will increase the risk of failure.

With a good look at these images, one gets a sense of how far lateral the patella is in extension and how far the patella must go to engage the femoral trochlea by 20° knee flexion.

Trochleoplasty aims to reshape the bony anatomy of the trochlea: it may involve deepening the groove or elevating the lateral wall of the trochlea (which should be higher than the medial wall).

Evidence-based recommendations on arthroscopic trochleoplasty for patellar instability. This involves reshaping the bony anatomy of the trochlea by deepening the groove or elevating the lateral wall.