So You’ve Mastered MPFL Reconstruction: What Else to Add, and When? (AANA22)-Patella Alta and Distalizing Tibial Tuberosity Osteotomy

Video Transcription

Video Summary

Dr. Andy Pazgarria discusses patella alta and distalizing tuberosity osteotomy, emphasizing individualized treatment of patellar instability. He presents a case of a young athlete with patella alta and soft tissue insufficiency, treated with MPFL reconstruction combined with distalizing tuberosity osteotomy to improve patellar height and engagement. He highlights the importance of accurate measurement and identifying anatomic risk factors, like alta and lateralized tuberosity, which can predispose to recurrent instability. Tuberosity osteotomy, a versatile procedure allowing distalization, medialization, and anteromedialization, remains the workhorse osteotomy. Outcomes show high return-to-sport rates but acknowledge risks such as delayed union, particularly in distalizing osteotomies, recommending three bicortical screws for fixation. He concludes most instability cases primarily need soft tissue reconstruction, but a distalizing osteotomy is warranted in substantial patella alta with poor trochlear engagement. Careful patient selection, thorough preoperative assessment, and personalized surgical approaches optimize stability and function.

Asset Caption

Andrew J. Cosgarea, M.D.

Keywords

patella alta

distalizing tuberosity osteotomy

patellar instability

MPFL reconstruction

tuberosity osteotomy techniques

patient-specific surgical treatment