Combined Tibial Tubercle Periosteum Sleeve Transfer (PST) and Medial Patellofemoral Complex Reconstruction (MPFC-R) for Patellofemoral Instability in Children and Adolescents.

Abstract

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. 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. 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. 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 IV-case series.