MPFL Reconstruction, 3 Years After the Goldthwait Patellar Tendon Hemi-transfer and Vastus Medialis Oblique Advancement, Performed to Treat Recurrent Patellar Instability: A Case Report

Abstract

The treatment of patellar instability in skeletally immature patients is challenging for an orthopedic surgeon. We report a case of a 14 years old girl who after an acute traumatic dislocation of the left patella and the failed initial conservative treatment underwent medial patellofemoral ligament (MPFL) reconstruction, using the fascia lata as an autograft. At the age of 10, the Roux-Goldthwait patellar tendon hemi-transfer combined with lateral retinacular release and the advancement of the vastus medialis oblique was performed for the treatment of the recurrent patella dislocation of both her knees. The patient evaluated for re-dislocation risk factors using the patellar instability severity score proposed by Balcarek et al. The clinical evaluation of the patient included the modified Cincinnati rating system and the Kujala score. The imaging assessment included knee MRI for the identification of anatomical risk factors. The four anatomical risk factors, trochlear dysplasia, increased tibial tubercle to trochlea groove offset, patella alta, and patellar tilting > 20°, were identified on MRI. At the final follow-up, the mean modified Cincinnati score increased from 49 to 90 points 6 years postoperatively. The mean Kujala scores increased from 49 to 91 points postoperatively. The MPFL reconstruction is an effective treatment to restore patellar stability in skeletally immature patients who underwent less successful surgeries to treat a recurrent patella dislocation.