So You’ve Mastered MPFL Reconstruction: What Else to Add, and When? (AANA22)-Coronal/Rotational Malalignment and Anteromedialization Type TTO

Video Transcription

Video Summary

In this video, Dr. Seth Sherman from Stanford University discusses the topic of coronal and rotational malalignment in relation to patellofemoral instability. He introduces the concept of incorporating medialization or intermedialization type tubercle osteotomy into treatment algorithms for these patients. Dr. Sherman acknowledges that this is a challenging and confusing topic, but hopes to share his journey and provide some clarity. He discusses red flags for malalignment, such as apprehension, inflection, and J signs, and emphasizes the importance of understanding and correcting bony malalignments before considering soft tissue stabilization. He explores various anatomic considerations, including version, torsion, and dysplasia, and highlights the potential role of femoral rotation and valgus in driving patellofemoral instability. Dr. Sherman also discusses the limitations of using the Tibial Tubercle Trochlear Groove distance (TTTG) as a standalone measure for assessing malalignment. He suggests taking a comprehensive approach by considering multiple factors and using various measurements and imaging techniques. Dr. Sherman shares some case examples and highlights the potential of newer techniques such as biplane osteotomies and patient-specific instrumentation. He concludes by encouraging lifelong learning and involvement with the Patel-Femoral Foundation.

Asset Caption

Seth L. Sherman, M.D.

Keywords

coronal and rotational malalignment

patellofemoral instability

tubercle osteotomy

bony malalignments

femoral rotation