APEX Knee Navigating Pearls and Pitfalls-Challenging Cases

Video Transcription

Video Summary

A sports medicine panel discusses several challenging knee cases and how to balance symptoms, natural history, and surgical risk.<br /><br />Case 1: A 14-year-old boy has an apparent congenital patellar dislocation with marked quadriceps atrophy but full extension and minimal symptoms. The family wants reassurance and declines further workup. The surgeon clears him to play and recommends PT and annual follow-up. Two years later, MRI shows patella alta and a redundant patellar tendon, but because the extensor mechanism functions and symptoms remain mild, the group largely favors continued nonoperative care; concern centers on unknown long-term natural history and the risk of making things worse surgically.<br /><br />Case 2: A 14-year-old girl has severe recurrent patellar instability with high BMI, genu valgum, trochlear dysplasia, patella alta, elevated TT-TG, and a large lateral femoral condyle osteochondral defect. Options debated include weight loss, MPFL reconstruction alone, osteotomy, and trochleoplasty. The presenting surgeon performs cartilage debridement/biopsy, tibial tubercle osteotomy with distalization, and MPFL; she later sustains a tibial fracture felt related to distalization and stress riser/thermal bone damage.<br /><br />The panel then reviews trochleoplasty: strong stabilization and patient-reported improvements when done well, but technically demanding and with arthritis concerns in some long-term series.<br /><br />Finally, revision ACL topics include the value of CT for tunnel assessment, single-stage tunnel grafting with fast-setting polymer, graft choice (BTB vs quad vs hamstring), and growing support for adding LET and/or internal brace to reduce failure in high-risk athletes.

Asset Caption

Moderator: Nicholas A. Sgaglione, M.D.
Panel: Jason L. Koh, M.D., Joseph D. Lamplot, M.D., Eric Matthew Berkson, M.D., Sherwin S.W. Ho, M.D.

Keywords

sports medicine panel

congenital patellar dislocation

patella alta

recurrent patellar instability

MPFL reconstruction

tibial tubercle osteotomy distalization

trochleoplasty

osteochondral defect lateral femoral condyle

revision ACL with LET/internal brace