Physeal-Sparing Medial Patellofemoral Ligament Reconstruction With Quadriceps Turndown and Patellar Tendon Transfer

Patellar instability is a common problem in the pediatric population. When surgery is indicated, skeletal immaturity poses unique challenges due to the risk of deformity or limb length discrepancy if the physis are injured. Therefore, the optimal combination of procedures in prepubescent patients with patellar instability remains unclear. Several stabilization procedures have been described for the treatment of patellar instability. The medial patellofemoral ligament (MPFL) or similar structures are commonly reconstructed, as they function as the primary restraint to lateral translation in early flexion and are commonly incompetent after lateral patellar dislocations. Traditional MPFL reconstruction can pose a risk to the distal femoral physis in skeletally immature patients because of the proximity of the insertion of the MPFL to the physis. Therefore, modified techniques are necessary. Distal realignment procedures have been used as accessory operations and, when necessary, must consider the presence of the proximal tibial physis. This article describes physeal-sparing MPFL reconstruction with quadriceps autograft and patellar tendon transfer for the management of patellofemoral instability in the skeletally immature patient.