APEX Knee Navigating Pearls and Pitfalls-Alignment Options (HTO, DFO, Tibial Tubercle)

Video Transcription

Video Summary

The speaker presents two pediatric knee cases to discuss when to add osteotomy and how to sequence procedures. Case 1 is a 13-year-old high-BMI female athlete with 6 months of anterolateral knee pain and effusion. MRI suggests lateral meniscal pathology with marrow signal; alignment films are emphasized because obese adolescents often have malalignment. They perform staging arthroscopy, repair an anterior horn lateral meniscus tear, and note minor chondral injury. She improves for a year but returns at 15 with worsening pain/effusion and MRI showing lateral compartment deficiency and early degeneration, prompting discussion that earlier osteotomy might have been beneficial. The panel debates revision repair vs meniscal allograft, generally prioritizing osteotomy and often combining osteotomy with meniscus/cartilage procedures in young patients despite elevated BMI.<br /><br />Case 2 is a 13-year-old male with recurrent patellar instability, severe patella alta, and trochlear dysplasia who previously had an isolated MPFL reconstruction that failed. Faculty argue isolated MPFL was inappropriate given anatomy; recommended treatment is trochleoplasty with MPFL revision, with selective distalization/TTO based on engagement and intraoperative assessment.

Asset Caption

Moderator: Nikolaos K. Paschos, M.D., Ph.D.
Panel: Brian Chilelli, M.D., Justin J. Mitchell, M.D., James Lee Pace, M.D.

Meta Tag

Alignment Options 1

DFO 1

HTO 1

Tibial Tubercle 1

Keywords

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pediatric knee osteotomy indications

adolescent lateral meniscus repair and degeneration

high BMI adolescent knee malalignment

meniscal allograft transplantation with osteotomy

recurrent patellar instability patella alta trochlear dysplasia

trochleoplasty with MPFL revision and tibial tubercle osteotomy