Medial Patellofemoral Ligament Reconstruction With Growth Modulation in Children With Patellar Instability and Genu Valgum

Patellar instability is common in the second decade, and genu valgum is a risk factor for patellar instability. In skeletally immature patients, genu valgum can be gradually corrected using less-invasive, well-established, growth-modulation techniques. For skeletally immature patients with patellar instability and genu valgum, it would be desirable to address both instability and deformity. We describe our technique of physeal-respecting medial patellofemoral ligament reconstruction in skeletally immature patients using hamstring autograft and simultaneous transphyseal screw hemiepiphysiodesis to gradually correct genu valgum. The medial patellofemoral ligament reconstruction technique features posteromedial hamstring graft harvest, single patellar tunnel fixation without implant, and femoral attachment just below the distal femoral physis. The technique of growth modulation features percutaneous insertion of a single transphyseal screw through the distal medial femoral physis without interference with medial patellofemoral ligament graft placement. Our preliminary results have been encouraging with successful correction of genu valgum and satisfactory patellar stabilization without growth disturbances.