Patellar tilt and maltracking after total knee arthroplasty are typically corrected by which approach?

• A. Proper component rotation and soft tissue balancing, with possible lateral release or patellar resurfacing
• B. Increasing tibial slope alone
• C. Patellar tilt is always harmless
• D. Patellar maltracking cannot be corrected surgically

Answer: (A)

Patellar tilt and maltracking after total knee arthroplasty are driven mainly by how the knee components line up and how the soft tissues around the patella are balanced. The most effective approach is to ensure the femoral component is rotated correctly so the trochlear groove and the patella track together smoothly, and to balance the soft tissues so there isn’t asymmetric tension pulling the patella off center. In cases where the lateral structures are tight or the patellar articulation isn’t ideal, a targeted lateral release can relieve that lateral pull, helping the patella sit in the groove more centrally. If the patella’s surface or articulation is suboptimal, resurfacing can be considered to improve contact mechanics and tracking.

Increasing tibial slope alone doesn’t fix maltracking and can worsen patellofemoral forces, while saying patellar tilt is harmless or that maltracking cannot be corrected surgically is inaccurate.