<![CDATA[Patellofemoral maltracking remains a major cause of pain, instability, poor function, and dissatisfaction after total knee arthroplasty (TKA). Despite advances in implant design and surgical technique, patellofemoral complications continue to contribute to revision surgery and inferior outcomes. This review summarizes the etiology, diagnosis, prevention, and management of patellofemoral tracking abnormalities after TKA, including a comparison between conventional and robotic-assisted techniques. The most common causes of maltracking include internal rotation of the femoral or tibial component, excessive valgus alignment, soft-tissue imbalance, patella baja, anterior overstuffing, and implant design mismatch. Internal femoral malrotation is consistently identified as the leading factor causing lateral patellar tilt, subluxation, and instability. Clinical evaluation includes anterior knee pain, crepitus, apprehension, and extensor lag, while radiographs and computed tomography are important for assessing patellar tilt, shift, and component rotation. Treatment depends on the underlying cause. Revision of malrotated components, lateral release, tibial tubercle transfer, medial patellofemoral ligament reconstruction, and secondary patellar resurfacing may be required. Robotic-assisted TKA improves component alignment and intra-operative assessment, but current evidence has not shown superior functional outcomes compared with conventional TKA.]]>
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