Severe inwardly pointing knee after medial patellofemoral ligament reconstruction: a case report

We report the case of a 26-year-old woman who presented with a profound gait disturbance and total disability following a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. It is common knowledge that patellar instability is associated with multiple risk factors, including but not limited to loss of the MPFL, trochlear dysplasia, patella alta, an abnormally placed tibial tuberosity on the tibia, quadriceps contracture, genu valgum, excess of femoral anteversion, excess of external tibial torsion, and foot pronation. Since the relative importance of each is unknown, it is imperative that pre-operative evaluation considers these. Two additional surgeries failed to improve her severe disability. Subsequent evaluation, 8 years after her initial MPFL reconstruction, revealed the presence of an excess of external tibial torsion and genu valgum. Complete resolution of disability resulted following tibial osteotomy, suggesting the importance of torsional deformity contributing to patellofemoral instability. Gait disturbance is an unrecognised complication after MPFL reconstruction.