MPFL reconstruction and tibial tubercle osteotomy for treating recurrent instability of patella associated with high grade trochlear dysplasia

The aim of this study is to observe the results and complications of medial patellofemoral ligament reconstruction with a modified Fulkerson osteotomy, in patients with recurrent instability of patella associated with high-grade trochlear dysplasia. A minimal lateral release was performed whenever tight lateral structures leading to an excessive patellar tilt were encountered after completion of bony realignment. We hypothesized that MPFL reconstruction with modified Fulkerson osteotomy would efficiently treat patellar instability associated with high grade trochlear dysplasia, by realigning the extensor mechanism and recreating the check-rein effect of the MPFL on the medial side. A prospective observational study of 26 knees (21 patients) who underwent simultaneous MPFL reconstruction and distal realignment with modified Fulkerson osteotomy from June 2014 to February 2019. Surgery was performed at a single center by the senior author. Radiological outcomes were measured by X-ray images at monthly follow up and an MRI scan at 6 months post-surgery to re-evaluate CD ratio, TT-TG distance and patellar tilt. Patient outcomes were measured with Kujala, Lysholm & International Knee Documentation Committee (IKDC) subjective knee evaluation form preoperatively, at 6 months, 1 year and 2 year follow up visits