Journal of Pediatric Orthopaedics - 2026-04-01 - Journal Article
Combined Tibial Tubercle Periosteum Sleeve Transfer (PST) and Medial Patellofemoral Complex Reconstruction (MPFC-R) for Patellofemoral Instability in Children and Adolescents.
Masquijo JJ, Carabajal Mattar M
Topics
Key Takeaway
Combined tibial tubercle periosteal sleeve transfer with MPFC reconstruction achieved Pedi-IKDC 90.9, Lysholm 96.9, and Kujala 92.7 at mean 46.7-month follow-up with one physeal arrest in 30 skeletally immature knees.
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Summary
This retrospective single-surgeon series evaluated combined PST for tubercle medialization/distalization plus MPFC reconstruction in patients under 18 years with patellofemoral instability and distal malalignment. Thirty knees in 24 patients (mean age 11.9 years) were assessed at minimum 1-year follow-up using Pedi-IKDC, Kujala, and Lysholm scores. Functional outcomes were high across all PROMs, Caton-Deschamps index and tibial slope remained stable radiographically, and surgical failure occurred in 1 knee (3.3%), with one physeal arrest of the lateral tibial tuberosity as the notable complication.
Key Limitation
The absence of preoperative patient-reported outcome scores makes it impossible to determine the magnitude of functional improvement attributable to the procedure.
Original Abstract
BACKGROUND
This study aimed to evaluate the safety and effectiveness of a combined tibial tubercle periosteal sleeve transfer (PST) for medialization and/or distalization, alongside medial patellofemoral complex reconstruction (MPFC-R), for treating patellofemoral instability (PFI) in children and adolescents.
METHODS
This was a retrospective review of a consecutive series of patients aged below 18 years who underwent PST combined with MPFC-R by a single surgeon between July 2012 and March 2023. Patients with <1 year of follow-up or those undergoing revision surgery were excluded. Outcomes were evaluated at a minimum 1-year follow-up using the Pedi-IKDC, Kujala, and Lysholm patient-reported outcome measures (PROMs). Patellar height and tibial slope were assessed at both immediate postoperative and latest follow-up. Surgical failure was defined as postoperative patellar dislocation or the need for revision surgery for recurrent patellar instability.
RESULTS
A total of 24 patients (30 knees) with a mean age of 11.9±3.5 years (range: 3 to 18 y) were included, with a mean follow-up of 46.7 months (range: 12 to 118 mo). Mean patient-reported outcome scores were Pedi-IKDC 90.9 (SD: 11.2), Lysholm 96.9 (SD: 6.7), and Kujala 92.7 (SD: 9.7). No statistically significant associations were found between outcome scores and age, sex, follow-up duration, PFI type, or graft type (all P >0.05). Radiographic analysis revealed no statistically significant differences between immediate postoperative and final follow-up for tibial slope (mean: 10.46±3.7 vs. 9.82±3.3 degrees; P =0.49) or Caton-Deschamps index (mean: 1.20±0.14 vs. 1.16±0.13; P =0.35). Two complications occurred in 2 knees, including 1 episode of patellar instability managed conservatively and 1 physeal arrest of the lateral tibial tuberosity.
CONCLUSION
In this retrospective series, the combined tibial tubercle periosteum sleeve transfer and medial patellofemoral complex reconstruction technique demonstrated effectiveness in restoring patellar stability in children and adolescents with PFI and distal malalignment, with or without patella alta. The procedure appears to facilitate favorable functional outcomes and prevent recurrent instability. While careful attention to physeal protection during dissection is paramount, this combined approach shows promise as a growth-respecting surgical solution for complex pediatric PFI. Further prospective studies with larger cohorts and extended follow-up are necessary to confirm these findings and better define the technique's long-term role.
LEVEL OF EVIDENCE
Level IV-case series.