2025 ISAKOS Biennial Congress ePoster
Medial PatelloTibial Ligament Reconstruction in Pediatric and Adolescent Patients with Patella Dislocation in Flexion
Olivia C Tracey, BA, New York, New York UNITED STATES
Joshua T Bram, MD, New York, NY UNITED STATES
Emilie Lijesen, BS, New York, New York UNITED STATES
Akshitha Adhiyaman, BS, New York, New York UNITED STATES
Ruth H Jones, BS, New York, New York UNITED STATES
Shae K Simpson, BS, New York, New York UNITED STATES
Ryann Davie, MD, New York, NY UNITED STATES
Yasir Alabdulkarim, MD, Riyadh SAUDI ARABIA
Daniel W. Green, MD, MS, New York, NY UNITED STATES
Hospital for Special Surgery, New York, New York, UNITED STATES
FDA Status Not Applicable
Summary
This case series of patients who underwent concurrent medial patellofemoral ligament reconstruction (MPFLR) and medial patellotibial ligament reconstruction (MPTLR) demonstrates the utility and safety of performing MPTLR in pediatric cases, particularly in the setting of severe patellofemoral instability (PFI).
ePosters will be available shortly before Congress
Abstract
Background
Patellofemoral instability (PFI) is common in pediatric and adolescent populations and is typically treated with medial patellofemoral ligament reconstruction (MPFLR). Medial patellotibial ligament reconstruction (MPTLR) is a valuable adjunctive procedure to MPFLR in treating PFI, as cadaveric studies have demonstrated that the MPTL is an important contributor to patellar stability in deeper flexion. Few studies have examined the outcomes of MPTLR in pediatric patients. The authors prefer the addition of an MPTLR in cases of 1) fixed lateral or obligatory patellar dislocation with deficient medial retinacular tissues or 2) syndromic patients with abnormal patellofemoral morphology.
Methods
This was a retrospective case series of patients ≤ 21 years who underwent MPTLR with minimum 3-month follow-up at a tertiary care orthopaedic hospital between January 2016 and June 2023. Mechanical axis deviation (MAD) and tibial tubercle-trochlear groove (TT-TG) distance were measured on preoperative imaging for all patients. Patellar dislocations were classified using previously defined clinical categories: syndromic, obligatory, fixed lateral, and traumatic. Complications including surgical site infection (SSI), re-operation, and recurrent PFI were noted.
Results
Eleven extremities in 8 patients who underwent concurrent MPFLR and MPTLR were included (mean age: 14.6 ± 4.3 years; mean BMI: 23.7 ± 9.0 kg/m2). Seven patients reported a past medical history of genetic / syndromic conditions or hypermobility syndromes. Fixed patellar dislocations were present in 6 extremities and obligatory patellar dislocations in the other 5 extremities. Preoperative imaging revealed a mean MAD of 12 ± 9 mm (positive MAD represents valgus) and mean TT-TG of 20 ± 13 mm (45% of extremities had elevated TT-TG greater than 20 mm). Ten knees received concurrent lateral release, 9 received quadriceps lengthening, and 5 received tibial tubercle osteotomy (TTO) procedures. No cases of recurrent PFI were reported postoperatively and no patient returned to the operating room. One patient sustained a superficial wound infection over the anterior knee incision that resolved following antibiotic use, and one patient had bilateral distal femur valgus and bilateral tibia vara prior to surgery, which persisted after MPTLR.
Conclusions
This case series describes concurrent use of MPFLR and MPTLR in 11 knees of 8 pediatric and adolescent patients with severe PFI. MPTLR can be performed safely in adolescents and may contribute to surgical success in cases of fixed and obligatory dislocation.