Medial Patellofemoral Ligament Reconstruction in Adolescent Patellofemoral Instability With High Tibial Tubercle-Trochlear Groove Intervals: A Comparison of With or Without Tibial Tubercle Osteotomy

Background: Patellofemoral instability is common in adolescent patients and is frequently associated with increased tibial tuberosity–trochlear groove (TT-TG) distances. Medial patellofemoral ligament (MPFL) reconstruction is a standard treatment; however, the role of tibial tubercle osteotomy (TTO) remains debated. Methods: A retrospective chart review was performed of patients with TT-TG distances ≥20 mm who underwent MPFL reconstruction between 2012 and 2022, with a minimum 2-year follow-up. Patients were stratified into 2 cohorts: MPFL with TTO and MPFL without TTO. Demographic, radiographic, and operative variables were collected, including TT-TG, Insall-Salvati ratio, trochlear dysplasia index (TDI), and tibial tubercle–posterior cruciate ligament (TT-PCL). Outcomes included complications, recurrent instability, and patient-reported outcomes (PROs): Single Assessment Numeric Evaluation (SANE), Kujala, pain, and satisfaction. Results: Thirty patients (31 knees) were analyzed (15 TTO, 16 non-TTO). The cohort’s mean age was 15.3 years, with a mean follow-up of 5.7±2.8 years (TTO) and 4.8±2.1 years (non-TTO) ( P =0.40). The TTO cohort had higher TT-TG distances (22.6±2.3 mm vs. 20.8±0.8 mm; P =0.01), elevated Insall-Salvati ratios (1.7±0.2 vs. 1.5±0.3; P =0.04), and longer tourniquet times (83.4±29.0 vs. 56.9±22.1 min; P =0.01). TDI and TT-PCL were not significantly different. No differences were observed in PROs: SANE (84.3±9.3 vs. 86.8±7.2; P =0.42), Kujala (91.4±8.0 vs. 88.5±10.9; P =0.48), pain (1.2±1.6 vs. 1.6±2.1; P =0.88), or satisfaction (9.1±1.1 vs. 9.4±0.8; P =0.56). Complication rates ( P =1.0), recurrent instability ( P =0.64), return-to-sport ( P =1.00), and revision rates ( P =0.39) were similar between groups. Conclusions: The addition of TTO to MPFL reconstruction in adolescents with elevated TT-TG distances did not result in significant differences in complications, PROs, or recurrent instability compared with MPFL alone. TTO may not be required in all cases and should be reserved for select patients based on individual anatomic and clinical factors.