Stability restored, cartilage compromised? Revisiting patellofemoral outcomes after ACL reconstruction

Over the last decades, we have built an empire around the anterior cruciate ligament (ACL). We measure stability in millimetres and celebrate isokinetic symmetry and congratulate ourselves when the pivot shift falls silent. For decades, this has defined success—a stable knee that no longer gives way. Yet, while we were perfecting the graft choice, the technique, the fixation and the biology of the graft, another story has been quietly unfolding. The patellofemoral joint—the true translator of quadriceps power into motion—is the forgotten joint of the ACL reconstruction era.