# Surgical Management of Combined Patellofemoral and Proximal Tibiofibular Joint Instability in a Patient With Ehlers-Danlos Syndrome

## TL;DR

This paper presents a surgical technique for treating combined patellofemoral and tibiofibular joint instability in patients with Ehlers-Danlos syndrome.

## Contribution

A novel combined surgical approach is introduced to address dual joint instability in Ehlers-Danlos syndrome patients.

## Key findings

- The surgical technique includes medial patellofemoral ligament reconstruction and tibial tubercle osteotomy.
- PTFJ stabilization is achieved using an adjustable-loop cortical suspension device.
- Postoperative rehabilitation improves functional outcomes in patients with complex joint instability.

## Abstract

Ehlers-Danlos syndrome often presents with patellofemoral instability and, less commonly, proximal tibiofibular joint (PTFJ) instability, leading to compounded symptoms and functional impairment. This Technical Note describes a combined surgical approach for managing dual instability in patients with Ehlers-Danlos syndrome, involving medial patellofemoral ligament reconstruction and tibial tubercle osteotomy, in conjunction with PTFJ stabilization using an adjustable-loop cortical suspension device. This technique addresses biomechanical abnormalities and improves joint stability. Postoperative rehabilitation emphasizes controlled mobilization and progressive weightbearing. This comprehensive approach optimizes functional outcomes in patients with complex patellofemoral instability and PTFJ.