Medial Patellotibial Ligament Reconstruction Concomitant with Medial Patellofemoral Ligament (MPFL) Reconstruction in Fixed and Obligatory Patellar Dislocation: A Consecutive Case Series

INTRODUCTION: Patellofemoral instability (PFI) is a common knee injury in the pediatric population, and medial patellofemoral ligament (MPFL) reconstruction is common surgery to minimize risk of chronic PFI. Medial patellotibial ligament (MPTL) reconstruction may be subsequently performed, providing more lateral stability to reduce rotational instability and tilt. Recent literature has described MPTL reconstruction in adults and nonpathologic pediatric patients, however little literature has discussed this procedure in pediatric patients with underlying abnormal patellofemoral morphology. METHODS: All pediatric patients ≤ 21 years of age undergoing MPFL reconstruction with concomitant MPTL reconstruction from 1/2016-7/2025 were included. Patients' demographic information, dislocation type, surgical details, pre-operative radiographic parameters, and follow-up was recorded. RESULTS: . Ten patients reported a past medical history of genetic, syndromic conditions or hypermobility syndromes. Fixed patellar dislocations were present in 9/16 extremities, and obligatory patellar dislocations were present in 7/16 extremities. Postoperative follow-up averaged 25.0 ± 23.9 months. Preoperative radiographs revealed a mean mechanical axis deviation (MAD) of 6.4 ± 15.8 mm and a mean hip-knee-ankle (HKA) angle of 2.5 ± 5.4 degrees (where varus is represented by a negative value). Preoperative MRI revealed a mean TT-TG distance of 19.4 ± 11.2 mm and seven extremities demonstrated TT-TG distance >20 mm. All patients underwent simultaneous MPFL reconstruction. Only one patient displayed recurrent patellar dislocation post-operatively. CONCLUSION: MPTL reconstruction is a favorable adjunct procedure providing favorable outcomes in pediatric patients with PFI. This consecutive case series demonstrates that MPTL reconstruction is a favorable adjunct procedure for pediatric patients with underlying abnormal patellofemoral morphology. LEVEL OF EVIDENCE: IV.