2025 AANA/ASES Specialty Day All-Access Pass-AANA Session II: Knee: Patellofemoral

Video Transcription

Video Summary

The session focused on patellofemoral instability and cartilage lesions, discussing reconstruction techniques and outcomes. Dr. Tanaka introduced the Medial Patellofemoral Complex (MPFC), emphasizing a single-bundle medial quadriceps tendon–femoral ligament reconstruction (MQTFLR) that avoids patellar drilling, reducing fracture risk. It’s particularly useful in revisions or cases with compromised patella bone. Dr. Scarpella advocated for isolated MPFL reconstruction to restore stability, highlighting that trochlear dysplasia, patella alta, and tibial tubercle–trochlear groove (TTTG) distance may not mandate bony procedures unless a significant “jumping J” sign is present, which predicts poorer outcomes. Prospective data indicate durable results at five years even with anatomical variations. Dr. Brady noted the importance of addressing chondral lesions alongside instability, endorsing tibial tubercle osteotomy (TTO) for focal unloading, especially in lateral or distal patellar cartilage injuries, and warned of the negative impact of postoperative J-sign and hyperextension. Dr. Dragoo reviewed cartilage restoration techniques like MACI and juvenile cartilage implantation, recommending cartilage repair be combined with stabilizing surgery, since ignoring instability may lead to graft failure. Panel discussions stressed individualized treatment considering overall alignment, instability patterns, and cartilage damage. In summary, coordinated approaches addressing anatomical risk factors, instability, and cartilage defects yield optimal, durable outcomes in patellofemoral disorders.

Asset Caption

Moderators: Elizabeth A. Arendt, M.D., Elizabeth R. Dennis, M.D., M.S.
Faculty: Miho J. Tanaka, M.D., Ph.D., Tamara A. Scerpella, M.D., Jacqueline M. Brady, M.D., FAANA, Jason L. Dragoo, M.D., FAANA

Keywords

Patellofemoral instability

Medial Patellofemoral Complex (MPFC)

Medial quadriceps tendon–femoral ligament reconstruction (MQTFLR)

Isolated MPFL reconstruction

Trochlear dysplasia

Tibial tubercle osteotomy (TTO)

Cartilage restoration techniques