Journal of Pediatric Orthopaedics - 2026-04-01 - Journal Article; Comparative Study
Medial Patellofemoral Ligament Reconstruction in Adolescent Patellofemoral Instability With High Tibial Tubercle-Trochlear Groove Intervals: A Comparison of With or Without Tibial Tubercle Osteotomy.
Grewal RS, Berger GK, Pennock AT, Bomar JD, Edmonds EW
Topics
Key Takeaway
In adolescents with TT-TG ≥20 mm, adding TTO to MPFL reconstruction produced no difference in recurrent instability, Kujala scores (91.4 vs. 88.5), or SANE scores (84.3 vs. 86.8) at mean 5.7-year follow-up.
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Summary
This study asked whether adding TTO to MPFL reconstruction improves outcomes in adolescents with TT-TG ≥20 mm. Thirty patients (31 knees) were retrospectively stratified into TTO (n=15) and non-TTO (n=16) cohorts and followed a mean 5+ years. No significant differences were found in PROs, complication rates, recurrent instability, or revision rates, despite the TTO group having higher baseline TT-TG (22.6 vs. 20.8 mm) and Insall-Salvati ratios (1.7 vs. 1.5).
Key Limitation
The small, non-randomized cohort with baseline anatomic differences between groups (higher TT-TG and Insall-Salvati in TTO arm) makes it impossible to determine whether TTO was unnecessary or simply corrected the anatomic excess that would have otherwise driven worse outcomes.
Original Abstract
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.