Combined Distal Femoral Osteotomy, Tibial Tubercle Osteotomy, and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability
Background Recurrent patellar instability can result from a multitude of anatomic features, including but not limited to valgus alignment, increased tibial tubercle-trochlear groove (TT-TG) distance, and attrition of the medial patellofemoral ligament (MPFL). In patients with multiple anatomic risk factors, combined correction of each individual pathology may lead to decreased rates of failure of any single procedure alone. Purpose This video overview and case presentation demonstrates concurrent distal femoral osteotomy, tibial tubercle osteotomy, and MPFL reconstruction. Methods The examination, diagnosis and treatment options for recurrent patellar instability in a patient with concurrent significant valgus alignment, increased TT-TG distance, and MPFL attrition are discussed. A case of a 18-year-old man with recurrent dislocation episodes is presented. After failure of nonsurgical treatment, a decision to pursue concurrent opening wedge distal femoral osteotomy (DFO), tibial tubercle osteotomy (TTO), and MPFL reconstruction was pursued. Results Concurrent DFO, TTO, and MPFL reconstruction was performed successfully in a single surgical setting. Postoperative clinical follow-up demonstrated reduction in pain and resolution of patellar instability. Conclusion Patients with patellar instability due to valgus alignment, increased TT-TG distance, and MPFL attrition can be safely treated with concurrent DFO, TTO, and MPFL reconstruction.