Physeal-Sparing Medial Patellofemoral Ligament Reconstruction With Patellar Tendon Shortening and Guided Growth

In skeletally immature patients, alternative surgical approaches should be undertaken for the treatment of patellofemoral instability that respect the open physis. Remaining growth can be exploited for correction of genu valgum, a known anatomic risk factor of patellofemoral instability.

A skeletally immature 14-year-old boy with bilateral genu valgum and patella alta presented with symptomatic, recurrent left knee patellar instability precluding sports participation and causing dysfunction in his activities of daily living.

A midline approach to the knee was used. Medial patellofemoral ligament reconstruction (MPFL-R) was completed up until the point of femoral-sided allograft fixation. The socket for femoral-sided graft fixation was reamed with an all-epiphyseal technique. Next, growth modulation with temporary hemiepiphysiodesis of the medial distal femoral physis was undertaken with an 8-plate bilaterally. Patellar tendon shortening was completed. Femoral-sided graft fixation for the MPFL-R was then completed.

There were no acute complications associated with surgery. Surgical management led to resolution of the patient's patellar instability. The patient is being followed for timing of hemiepiphysiodesis plate removal.

In skeletally immature patients, a physeal-sparing MPFL-R is a viable treatment option to address recurrent patellar instability. Other anatomic risk factors, such as genu valgum and patella alta, may be concomitantly addressed using techniques that are respective of the open physis.

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