Concomitant Medial Patellofemoral Ligament Reconstruction, Tibial Tubercle Osteotomy, Trochleoplasty, and Osteochondral Autograft Transfer to the Patella

Abstract

Recurrent patellar instability increases the risk of developing patellofemoral arthritis, among other complications. Chronic patellar instability frequently evolves into a debilitating issue that necessitates surgical intervention. Lateral patellar dislocation caused by a torn medial patellofemoral ligament (MPFL) is commonly addressed with an isolated MPFL reconstruction. Risk factors of MPFL graft failure and further patellar instability include patella alta and elevated tibial-tubercle trochlear-groove distance, which are addressed by a tibial tubercle osteotomy with distalization and/or medialization. Trochlear dysplasia is addressed through a sulcus-deepening trochleoplasty. An osteochondral autograft transfer is used to transfer healthy cartilage from a lesser-articulating surface to address areas of small cartilage defects. We describe a concomitant MPFL reconstruction, tibial tubercle osteotomy, trochleoplasty, and osteochondral autograft transfer to address chronic recurrent lateral patellar instability, patella alta, trochlear dysplasia, and a full-thickness patellar osteochondral defect.