APEX Knee Navigating Pearls and Pitfalls-When is an MPFL Enough, when do you Need a TTO in Addition?

Video Transcription

Video Summary

Adam Yankie from Rush University discusses when to opt for isolated medial patellofemoral ligament (MPFL) reconstruction versus adding a tibial tubercle osteotomy in treating patellar instability. Tibial tubercle osteotomies, which carry greater risk and recovery time, are mainly reserved for revisions, cartilage damage with pain, or significant anatomical abnormalities like patella alta and tuberosity lateralization. Key risk factors for patellar instability recurrence include age under 25 and trochlear dysplasia, while patella alta alone is less predictive. Successful MPFL reconstruction relies heavily on accurate anatomical positioning, especially femoral tunnel placement, more than tibial tubercle alignment alone. Tibial tubercle osteotomy is beneficial when correcting global or local tracking abnormalities, especially in complex cases involving patella alta or significant lateralization. Case studies illustrate tailored approaches where isolated MPFL reconstruction suffices or combined surgery is necessary due to anatomical complexities, prior surgeries, or persistent instability. Overall, tibial tubercle osteotomy should be used cautiously and primarily in select patients with revisional need or marked anatomical risk factors.

Asset Caption

Adam B. Yanke, M.D., Ph.D.

Keywords

MPFL reconstruction

tibial tubercle osteotomy

patellar instability

patella alta

trochlear dysplasia

femoral tunnel positioning