“…There is no existing literature on the use of PTT in combination with MPFLR and lateral lengthening (LL) to treat habitual PFI in patients with DS as they represent a particular group of patients, although a recent study that used a combination of 4 procedures: MPFLR, tibial tubercle medialization, PTT for extensor lengthening, and lateral retinacular release (LRR) instead of LL, to treat habitual patellar dislocations caused by severe quadriceps contracture 15 showed good outcomes. Furthermore, specifically for PFI in patients with DS, existing literature only reports corrective surgeries being performed in skeletally immature children 2,9,16,17 instead of the adulthood (19-40 years) or senescence (>40 years) stages of DS 18 .…”