AANA Lab Course 910 - Patellofemoral Joint Preservation-OLC Patellofemoral Course Cases-Dr. Jacqueline Brady, M.D.

OLC Patellofemoral Course Cases-Dr. Jacqueline Brady, M.D.

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This document presents two pediatric cases of patellofemoral (PF) instability treated by Jacqueline Brady, MD.<br /><br />Case 1 involves a 13-year-old female with a first-time right patellar dislocation six months prior after a minor trauma (rolling on knees while playing). Family history is positive for PF instability. She exhibits ligamentous laxity (Beighton 8/9), patella alta (Caton-Deschamps index ~1.38-1.39), trochlear dysplasia, and medial patellar chondral injury. The tibial tubercle-trochlear groove (TT-TG) distance is low at 8.5 mm. Her bone age is 15 years. Initial management included extensive physical therapy, but residual apprehension persisted. Surgical treatment comprised tibial tubercle osteotomy (TTO) with distalization by 8 mm and medial patellofemoral ligament (MPFL) reconstruction. One year post-op, she reports no dislocation recurrence, participates in swimming and track, has stable patellar tracking with mild residual apprehension.<br /><br />Case 2 describes a 13-year-old girl with recurrent lateral patellar subluxations starting at age 8, accumulating nearly 20 episodes. She has profound apprehension, a dramatic J sign, no endpoint upon lateral patellar translation, and full range of motion. Imaging finds severe trochlear dysplasia, a TT-TG distance of 19 mm, femoral anteversion of 32°, 5° valgus alignment, and Caton-Deschamps index 1.13; bone age is 15 years. The plan included a 15° femoral derotational osteotomy, lateral retinacular release, MPFL reconstruction, and tibial tubercle osteotomy with 1 cm anteromedialization (AMZ). Post-op, osteotomy healing was slow but ultimately successful; 1.5 years later, the patient exhibits stable patella with no instability or apprehension and resumed sports activity.<br /><br />The document references literature supporting the relationship between femoral anteversion, trochlear dysplasia, and outcomes of MPFL and TTO surgeries, emphasizing the importance of addressing rotational deformities to optimize PF stability.<br /><br />In summary, these cases highlight the multifactorial etiology of PF instability including ligamentous laxity, bony morphology, torsional deformities, and the role of combined surgical procedures tailored to underlying pathology to achieve stable, functional outcomes in adolescents.

Keywords

patellofemoral instability

pediatric orthopedic cases

patellar dislocation

ligamentous laxity

trochlear dysplasia

tibial tubercle osteotomy

medial patellofemoral ligament reconstruction

femoral derotational osteotomy

patellar subluxation

rotational deformities