Medial patellotibial ligament reconstruction concomitant with medial patellofemoral ligament (MPFL) reconstruction in fixed and obligatory patellar dislocation: A consecutive case series.

INTRODUCTION

Patellofemoral instability (PFI) is a common knee injury in the pediatric population, and medial patellofemoral ligament (MPFL) reconstruction is common surgery to minimize risk of chronic PFI. Medial patellotibial ligament (MPTL) reconstruction may be subsequently performed, providing more lateral stability to reduce rotational instability and tilt. Recent literature has described MPTL reconstruction in adults and nonpathologic pediatric patients; however, little literature has discussed this procedure in pediatric patients with underlying abnormal patellofemoral morphology.

METHODS

All pediatric patients ≤21 years of age undergoing MPFL reconstruction with concomitant MPTL reconstruction from January 2016 to July 2025 were included. Patients' demographic information, dislocation type, surgical details, preoperative radiographic parameters, and follow-up were recorded.

RESULTS

Sixteen extremities in 14 patients were included in this analysis. Mean age at time of surgery was 14.5 ± 3.6 years, and mean body mass index at time of surgery was 22.8 ± 7.8 kg/m2. Ten patients reported a past medical history of genetic, syndromic conditions or hypermobility syndromes. Fixed patellar dislocations were present in 9 out of 16 extremities, and obligatory patellar dislocations were present in 7 out of 16 extremities. Postoperative follow-up averaged 25.0 ± 23.9 months. Preoperative radiographs revealed a mean mechanical axis deviation of 6.4 ± 15.8 mm and a mean hip-knee-ankle angle of 2.5 ± 5.4° (where varus is represented by a negative value). Preoperative magnetic resonance imaging revealed a mean tibial tuberosity-trochlear groove (TT-TG) distance of 19.4 ± 11.2 mm and seven extremities demonstrated TT-TG distance >20 mm. All patients underwent simultaneous MPFL reconstruction. Only one patient displayed recurrent patellar dislocation postoperatively.

CONCLUSION

MPTL reconstruction is a favorable adjunct procedure providing favorable outcomes in pediatric patients with PFI. This consecutive case series demonstrates that MPTL reconstruction is a favorable adjunct procedure for pediatric patients with underlying abnormal patellofemoral morphology.

LEVEL OF EVIDENCE: IV.