Surgical Management of Recurrent Patellar Instability in the Pediatric Population

Surgical Management of Recurrent Patellar Instability in the Pediatric Population 1024 575 Mary Bates, PhD

Medial patellofemoral ligament reconstruction via the quadriceps turndown technique is safe and effective in young patients.

In a new study, researchers from Nationwide Children’s Hospital demonstrate the safety and efficacy of the quadriceps turndown technique for medial patellofemoral ligament reconstruction in pediatric and adolescent patients.

Patellar instability is a common knee condition in children and adolescents. Rates of recurrent instability following a lateral patellar dislocation approach 50%, and these patients often require surgical intervention.

Several surgical procedures have been described to help address recurrent patellar instability. Medial patellofemoral ligament (MPFL) reconstruction using the quadriceps turndown technique is one such procedure, performed to restore medial stability of the knee. While this technique has been studied in adults, data are lacking in adolescents.

In the new study, researchers reviewed the results of MPFL reconstructions via the quadriceps turndown technique in pediatric patients seen at Nationwide Children’s between 2011 and 2018. They evaluated the functional outcomes and instances of recurrent patellar instability following 36 MPFL reconstructions using the technique.

“We showed this operation works well and markedly reduces the risk of recurrent instability with resumption of daily living at two months or so post-surgery and a reproducible return to pre-injury levels of sport anywhere from three to five months after surgery,” says Kevin Klingele, MD, chief of Orthopedic Surgery and Surgical Director of Sports Medicine at Nationwide Children’s and the study’s senior author.

In addition to the positive functional outcomes, patients who underwent the quadriceps MPFL reconstruction also reported high satisfaction and low pain scores.

Dr. Klingele says the results confirm what he and his colleagues suspected from years of performing the procedure on children and adolescents at Nationwide Children’s: The quadriceps turndown technique is a safe and effective surgical management option for young patients with recurrent patellar instability.

“This technique has become our go-to for patients that require a more formal MPFL reconstruction,” says Dr. Klingele, who is also an adjunct assistant professor of orthopedic surgery at The Ohio State University College of Medicine.

“We have used it to take care of younger patients and it has resulted in good outcomes in terms of recurrent instability while avoiding some of the risk factors and potential problems that can occur with other types of reconstruction.

“These findings confirm that the quadriceps turndown technique for MPFL reconstruction is a good surgical management option for those who take care of adolescent or younger patients with patellar instability.”



Fisher M, Singh S, Samora WP 3rd, Beran MC, Klingele KE. Outcomes of MPFL Reconstruction Utilizing a Quadriceps Turndown Technique in the Adolescent/Pediatric Population. Journal of Pediatric Orthopedics. 2021 Apr 23. [Epub ahead of print] doi: 10.1097/BPO.0000000000001836.

Image credit: Nationwide Children’s


About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.