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Medial Soft-Tissue Imbrication With Lateral Release for Pediatric Patellofemoral Instability

March 01, 2020

Contributors: Folorunsho Edobor-Osula, MD, FAAOS; Zuhdi Abdo, MD

Pediatric patellofemoral instability may result from various underlying pathologies and can be subclassified as syndromic, fixed, traumatic, or obligatory dislocation. Although several surgical techniques for the management of pediatric patellofemoral instability have been described, such as medial patellofemoral ligament reconstruction and distal realignment procedures (eg, modified Roux-Goldthwait procedure), a patient's growth potential may limit reconstruction options. This video discusses the case presentation of a 7-year-old patient with bilateral trochlear dysplasia (obligatory dislocation), bilateral attenuation, and MPFL loss who would benefit from one of the aforementioned procedures. However, the patient's growth potential will result in failed reconstruction over time. After a bony procedure is performed, secondary reconstruction options are limited. Therefore, we elected to perform medial knee soft-tissue imbrication with lateral soft-tissue release. Although this soft-tissue procedure is associated with the same risk for attenuation and failure as other procedures, it does not preclude conversion to a bony procedure after the patient reaches skeletal maturity. In this manner, the patient is afforded immediate symptomatic relief and has options available for future reconstruction.