In this PCO 2026 Live Clinics session, international faculty evaluate a 20-year-old profession-al dancer presenting with recurrent patellar dislocations despite prior isolated medial patello-femoral ligament (MPFL) reconstruction. The consensus identifies severe combined torsional malalignment, excessive femoral anteversion (45°) and external tibial torsion (40°), as the root cause of persistent instability.
Key Takeaways:
- Dynamic imaging analysis: Patellar tilt and elevated TT-TG (24 mm in extension vs. 13 mm at 15° flexion) normalize upon knee flexion, confirming external tibial torsion rather than true tubercle lateralization.
- Double-level osteotomy rationale: Correcting femoral anteversion alone risks painful gait impairment; combining distal femoral and tibial derotational osteot-omies with MPFL revision restores biomechanical tracking.
Balancing stability and joint preservation
Surgeons debate protecting concomitant hip micro-instability while avoiding patellofemoral overconstraint, emphasizing advanced cartilage MRI and discrete element analysis to validate long-term joint preservation.
Matthieu Ollivier is currently a Professor of Orthopaedic Surgery at the Institute of Movement and Locomotion (Chairman: Pr Jean-Noel Argenson) at Aix-Marseille University Hospital, in Marseille, France. His clinical practice is dedicated to knee-related procedures, with a special focus on sports injuries (cartilage, meniscus, ligaments) and osteotomies. He is engaged in an academic field at Aix-Marseille University, teaching medical students, interns, orthopedic residents and fellows.
Vikas Khanduja is a Consultant Orthopaedic Surgeon specialising in both sports surgery and arthroplasty aspects of hip surgery and has a particular interest in arthroscopic surgery of the hip. He has been instrumental in setting up the tertiary referral service for Young Adult Hip Surgery in Cambridge for the East of England.
Mr. Khanduja qualified as a Doctor in 1997 and then completed his Basic Surgical training in London. Following this he received his Higher Surgical Training in Trauma and Orthopaedics on the North Thames circuit in London, gaining the FRCS (Orth) in 2005. Subsequently, he undertook his sub‐specialty training fellowships in knee and hip surgery with eminent surgeons in the field in London, Cambridge, Zurich and New York.
Complementing his clinical practice, his research interests centre around Optimisation of arthroscopic management of femoroacetabular impingement. In particular, he has been working on disease stratification of FAI using novel imaging techniques, better pre-operative planning tools using dynamic analysis of the hip and optimisation of arthroscopic management of FAI via precision surgery using navigation to improve outcomes.
Mr. Khanduja sits on the Executive Board of the British Hip Society ** as the President, the ESSKA Board as Chair of European Hip Preservation Associates, the SICOT Board as President Elect, the NIHR MSK NSG as the Orthopaedic Lead for the Eastern Region and is the Trustee and Past Chair of the Non Arthroplasty Hip Registry.
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