Patellofemoral considerations in kinematically aligned total knee arthroplasty: Three‐dimensional anatomy and implant‐related mismatch

This Editor's Note considers how three-dimensional trochlear morphology, extensor mechanism alignment, patellar reconstruction and implant geometry interact in kinematically aligned total knee arthroplasty (TKA). Imaging studies suggest that personalised alignment may reproduce selected native trochlear parameters more closely than systematic mechanical alignment, although rotational and implant-related mismatch persists. Improved anatomical reconstruction has not consistently translated into less anterior knee pain or better patient-reported outcomes. Native-like trochlear restoration remains a plausible biomechanical target, but its clinical benefit has not been established consistently across phenotypes and implant designs.