APEX Knee Navigating Pearls and Pitfalls-Alignment Options (HTO, DFO, Tibial Tubercle)

Video Transcription

Video Summary

The transcript presents two pediatric knee cases discussed by surgeons emphasizing careful diagnosis and alignment correction.<br /><br />Case 1: A 13-year-old female athlete with high BMI has six months of anterolateral knee pain and persistent effusion despite normal stability and ROM. MRI suggests lateral-sided pathology (possible partial discoid/meniscal tear with marrow changes). After initial arthroscopy and anterior horn lateral meniscus repair, she improves for a year but returns at age 15 with worsening pain, effusions, meniscal deficiency, and early degenerative changes. The panel highlights that in obese teens, malalignment is common and osteotomy is often the most powerful intervention. They debate staging vs combined procedures; given compartment deficiency, many favor valgus-correcting osteotomy plus possible meniscal allograft transplant, often performed together in young patients.<br /><br />Case 2: A 13-year-old male with recurrent patellar instability has severe patella alta and trochlear dysplasia. Prior isolated MPFL reconstruction failed. Surgeons argue this anatomy often requires trochleoplasty, revision MPFL, and selective distalization/TTO or patellar tendon imbrication based on intraoperative engagement.

Asset Caption

Moderator: Nikolaos K. Paschos, M.D., Ph.D.
Panel: Brian Chilelli, M.D., Justin J. Mitchell, M.D., James Lee Pace, M.D.

Keywords

pediatric knee pain

obesity-related malalignment

valgus-correcting osteotomy

lateral meniscus deficiency

meniscal allograft transplantation

recurrent patellar instability