Modified Grammont procedure with MPFL reconstruction using ipsilateral quadriceps tendon autograft for chronic patellar instability in a child: a case report
- 1Department of Orthopaedic and Traumatology, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
- 2Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Abstract
Introduction and importance:: Chronic patellar instability in skeletally immature patients presents a significant surgical challenge, and the modified Grammont procedure offers potential advantages over other soft-tissue techniques. We present the early clinical and functional outcomes of a skeletally immature patient treated with a modified Grammont procedure (a medial transfer of the patellar tendon) combined with arthroscopy-assisted medial patellofemoral ligament (MPFL) reconstruction using an ipsilateral quadriceps tendon autograft.
Case presentation:: A 10-year-old girl presented with recurrent right patellar dislocations over the preceding 1.5 years, with persistent instability while walking that frequently resulted in falls, following failure of conservative treatment. She was diagnosed with chronic patellar instability and trochlear dysplasia (Dejour type A). The patient underwent MPFL reconstruction using an ipsilateral quadriceps tendon autograft combined with a modified Grammont procedure. Functional outcomes were evaluated post operatively using the Kujala Knee Score and the International Knee Documentation Committee (IKDC) 2000 knee score.
Discussion:: In patients with open epiphyses, surgery near the growth plate risks premature physeal closure, and MPFL reconstruction is the treatment of choice. However, in patients with predisposing anatomic geometry, such as trochlear dysplasia or an increased tibial tubercle–trochlear groove (TT–TG) distance, reconstruction alone may be insufficient. We performed a modified Grammont procedure using a periosteal flap to achieve medialization of the patellar tendon. This soft-tissue technique avoids the growth disturbance associated with bony tibial tubercle osteotomy and showed favorable early functional outcomes.
Conclusion:: The modified Grammont procedure combined with arthroscopy-assisted MPFL reconstruction using an ipsilateral quadriceps tendon autograft improved early clinical and functional outcomes in this skeletally immature patient, with restored patellar stability, a Kujala score of 92, and an IKDC 2000 score 88 at the third postoperative month. Long-term follow-up for at least 1–2 years is essential and is planned for this patient.
Related
- Autograft Selection in Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Patellar Tendon versus Hamstring Tendon Outcomes in Randomized Controlled Trials
- Aneurysmal Bone Cyst of the Radial Diaphysis Managed by En Bloc Resection and Fibular Strut Autograft Reconstruction in a Young Adult Female: A Rare Case Report
- The Boston All‐in‐One Medial Patellofemoral Complex Reconstruction: A Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament Dynamic Tensioning Technique Using Allograft
- Effects of chronic ankle instability on ipsilateral knee cartilage degeneration in mouse model
- Outcomes of Revision Modified Broström Procedure with Periosteal Flap Augmentation in Patients with Recurrent Chronic Ankle Instability
BibTeX
@article{ivansyah2026modified,
title = {{Modified Grammont procedure with MPFL reconstruction using ipsilateral quadriceps tendon autograft for chronic patellar instability in a child: a case report}},
author = {Muhammad Deryl Ivansyah and Garry Gabe J Saragih and Aryadi Kurniawan},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000001019},
url = {https://doi.org/10.1097/rc9.0000000000001019},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Modified Grammont procedure with MPFL reconstruction using ipsilateral quadriceps tendon autograft for chronic patellar instability in a child: a case report
AU - Muhammad Deryl Ivansyah
AU - Garry Gabe J Saragih
AU - Aryadi Kurniawan
PY - 2026
DA - 2026/10/06
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001019
UR - https://doi.org/10.1097/rc9.0000000000001019
AB - Introduction and importance:: Chronic patellar instability in skeletally immature patients presents a significant surgical challenge, and the modified Grammont procedure offers potential advantages over other soft-tissue techniques. We present the early clinical and functional outcomes of a skeletally immature patient treated with a modified Grammont procedure (a medial transfer of the patellar tendon) combined with arthroscopy-assisted medial patellofemoral ligament (MPFL) reconstruction using an ipsilateral quadriceps tendon autograft. Case presentation:: A 10-year-old girl presented with recurrent right patellar dislocations over the preceding 1.5 years, with persistent instability while walking that frequently resulted in falls, following failure of conservative treatment. She was diagnosed with chronic patellar instability and trochlear dysplasia (Dejour type A). The patient underwent MPFL reconstruction using an ipsilateral quadriceps tendon autograft combined with a modified Grammont procedure. Functional outcomes were evaluated post operatively using the Kujala Knee Score and the International Knee Documentation Committee (IKDC) 2000 knee score. Discussion:: In patients with open epiphyses, surgery near the growth plate risks premature physeal closure, and MPFL reconstruction is the treatment of choice. However, in patients with predisposing anatomic geometry, such as trochlear dysplasia or an increased tibial tubercle–trochlear groove (TT–TG) distance, reconstruction alone may be insufficient. We performed a modified Grammont procedure using a periosteal flap to achieve medialization of the patellar tendon. This soft-tissue technique avoids the growth disturbance associated with bony tibial tubercle osteotomy and showed favorable early functional outcomes. Conclusion:: The modified Grammont procedure combined with arthroscopy-assisted MPFL reconstruction using an ipsilateral quadriceps tendon autograft improved early clinical and functional outcomes in this skeletally immature patient, with restored patellar stability, a Kujala score of 92, and an IKDC 2000 score 88 at the third postoperative month. Long-term follow-up for at least 1–2 years is essential and is planned for this patient.
SN - 2210-2612
ER -