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Combined Tibial Tubercle Anteromedialization and Medial Patellofemoral Ligament Reconstruction

March 01, 2020

Contributors: Guang-Ting Cong, BS, MD; James N Gladstone, MD, FAAOS; Sheena Chandran Ranade, MD, FAAOS; Kevin C Wang, MD

Purpose This video demonstrates a technique for combined tibial tubercle anteromedialization and medial patellofemoral reconstruction. The video discusses the case presentation of a patient, including indications and imaging study findings, and summarizes current literature on combined tibial tubercle anteromedialization and medial patellofemoral ligament reconstruction. Case The case presentation of a 15-year-old boy with recurrent patellofemoral instability and an increased tibial tubercle-trochlear groove distance is discussed. Technique After an initial examination under anesthesia, anteromedialization of the tibial tubercle is performed via a tibial tubercle osteotomy and lag screw fixation. This technique decreased the tibial tubercle-trochlear groove distance and may correct patella alta or patella baja. Although the indications for combined tibial tubercle anteromedialization and medial patellofemoral reconstruction are not fully defined, the current literature reports a tibial tubercle-trochlear groove distance ranging from 15 mm to 20 mm as an appropriate cutoff value for combined tibial tubercle osteotomy and medial patellofemoral ligament reconstruction. Literature A paucity of current data are available on combined tibial tubercle anteromedialization and medial patellofemoral ligament reconstruction; however, a recent case series suggested that combined tibial tubercle anteromedialization and medial patellofemoral ligament reconstruction in appropriately indicated patients results in considerable symptomatic improvement and a low rate of recurrent dislocation.

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