Jordy van Sambeeck

Summary, general discussion and future perspectives 9 157 − Epidemiology and natural course of impact on quality of life for non- operative treatment of patellofemoral instability. − What is the additional value of a surgical treatment decision tool? Based on the current knowledge and topics discussed in this thesis we propose a schematic treatment flowchart for patients with recurrent patellofemoral instability for whom surgical treatment is considered (figure 1). The goal of this workup is to select the most optimal surgical treatment for every individual patient for who surgery is indicated. In the workup, we advise to implement a standardized radiological workup, as outlined in the discussion on ‘imaging’. The data that is collected during workup, is the input for a decision tool that includes dynamic imaging and computational simulations of patellar tracking. This tool can guide the choice for which surgical procedures to perform. Future opportunities to optimize measurement of correction during surgery should be sought for and implemented when available, for example patient specific instrumentation or 3D-navigation assisted surgery. Outcome of surgery should be measured by objective measurements as well as subjective patient reported outcome measurements. The scheme illustrates that the key to a satisfiable outcome is a complete diagnostic workup and a well-considered decision, ultimately aided by a decision tool that includes all available clinical and scientifical information and is able to simulate patellar tracking after adaption of patient specific anatomy.