Management of Bilateral Chronic Patellofemoral Instability with Medial Patellofemoral Ligament Reconstruction, Tibial Tubercle Osteotomy, and Cartilage Restoration

Case: A 14-year-old adolescent girl with bilateral chronic patellofemoral instability (CPFI), trochlear dysplasia, elevated tibial tubercle to trochlear groove distances, and generalized ligamentous laxity presented with recurrent dislocations despite prior hemiepiphysiodesis and Roux-Goldthwait procedure. Examination revealed bilateral J-sign, four-quadrant patellar glide, and Beighton score of 9. Imaging confirmed bilateral CPFI with cartilage damage. She underwent staged bilateral medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), and right patellar cartilage restoration using particulated juvenile allograft cartilage. At 1-year follow-up, she was pain-free, with no recurrent instability and return to sport. Conclusion: Combined MPFLR and TTO can successfully treat bilateral CPFI, even after prior failed surgeries.