# Revamping Stability: Tibial Tuberosity Transfer and Medial Patello-Femoral Ligament Reconstruction for Patella Alta and Recurrent Dislocation

## TL;DR

A 17-year-old patient with chronic knee pain and patellar dislocations underwent surgery to correct anatomical issues, resulting in successful realignment.

## Contribution

The case highlights a combined surgical approach using tibial tuberosity transfer and MPFL reconstruction for complex patellar instability.

## Key findings

- Surgical intervention corrected patella alta and trochlear dysplasia in a patient with recurrent dislocations.
- Postoperative imaging confirmed successful anatomical realignment and improved patellar tracking.
- A rehabilitation program enhanced recovery and functional outcomes.

## Abstract

This case report details the clinical evaluation, imaging findings, and surgical management of a 17-year-old female with a two-year history of persistent knee pain and recurrent patellar dislocations. Despite the absence of traumatic injury, the patient exhibited significant anatomical abnormalities, including a laterally dislocated patella, shallow trochlear groove, increased tibial tuberosity to trochlear groove (TT-TG) distance, and patella alta by calculating Insall-Salvati ratio. The Insall-Salvati ratio is a radiographic measurement used to assess the position of the patella within the knee joint. It is calculated by dividing the length of the patellar tendon (from the lower pole of the patella to its insertion on the tibial tubercle) by the length of the patella itself (from its superior to inferior pole). This ratio is commonly used in the evaluation of patellar tracking disorders and patellar instability. Typically, a ratio greater than 1.2 is considered indicative of patella alta (high-riding patella), while a ratio less than 0.8 suggests patella baja (low-riding patella). The surgical intervention involved a tibial tuberosity osteotomy (TTO), distalization, and medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon, resulting in successful realignment as confirmed by postoperative imaging. A postoperative rehabilitation program, including physical therapy and pain management, was initiated to optimize recovery and enhance quadriceps strength and proprioception. This case underscores the importance of a comprehensive surgical approach in addressing recurrent patellar dislocation associated with complex anatomical variations, providing insights into effective management strategies for similar cases.