scholarly journals Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality

2010 ◽  
Vol 34 (2) ◽  
pp. 305-309 ◽  
Author(s):  
Jacques H. Caton ◽  
David Dejour
Keyword(s):  
Patellar Height ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy

scholarly journals Treatment of the Objective Patellofemoral Instability

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Federico Alfano ◽  
Walter Spreafico
Keyword(s):  
Surgical Procedures ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Preoperative Planning ◽  
Patellofemoral Instability ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Axial View ◽  
Associated Abnormalities

Objectives: The aim of this study is to show the different surgical procedures for treating the objective patellar instability, including the different tibial tubercle osteotomies and the sulcus deepening trochleoplasty. Methods: This study analyzed the Caton-Deschamps index used for assessment of patellar height, the distance from the tibial tubercle to the troclear groove (TT-TG) on CT Scan in the axial view, and the different trochlear and patellar morphotypes. This study included 19 knees (19 patients) treated in an objective and documented patellofemoral instability. Results: We have had good results with both the transfer of the tibial tuberosity as the trochleoplasty. A reconstruction of the medial patellofemoral ligament was performed in both procedures. Recurrence of instability is very rare after these procedures and this is more likely to result from missed associated abnormalities. Conslusion: Accurate preoperative planning of the patellar height and determining the location of the tibial tubercle and the trochlear and patellar morphotypes for satisfactory results are required. However, as with any surgical procedure, both tibial tubercle osteotomy and the sulcus deepening trochleoplasty are susceptible of complications.

Radiographic and Clinical Outcomes After Tibial Tubercle Osteotomy for the Treatment of Patella Alta: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110123
Author(s):  
Derrick M. Knapik ◽  
Kyle N. Kunze ◽  
Eric Azua ◽  
Amar Vadhera ◽  
Adam B. Yanke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Patellar Instability ◽  
Meta Analysis ◽  
Patellar Height ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
The Mean

Background: Patella alta is a known risk factor for patellar instability and, in the setting of recurrent patellar instability with significant patella alta, correction of patellar height with a tibial tubercle osteotomy (TTO) may help decrease the failure of soft tissue–based stabilization. Purpose: To perform a systematic review and meta-analysis of radiographic and clinical outcomes after TTO for patella alta. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in June 2020 for studies reporting outcomes of TTO for patella alta. Data pertaining to study characteristics and design, radiographic and clinical outcome values, and incidence of complications and reoperations were extracted. DerSimonian-Laird continuous and binary random-effects models were constructed to (1) perform subgroup-based analysis of mean changes in radiographic indices after TTO and (2) quantify the pooled incidence of complications and reoperations. Results: Eight studies including 340 patients (420 knees) with a mean age of 24.7 ± 8.4 years were included. The mean follow-up was 53.1 months (range, 3-120 months), with 1 study reporting a mean follow-up of less than 2 years. The pooled mean anterior transfer was 5.6 mm; the mean medial transfer was 8.7 ± 1.3 mm; and the pooled mean distalization of the tibial tubercle was 12.2 ± 4.5 mm. Continuous random-effects meta-analysis determined that significant reductions in the mean Insall-Salvati ratio (1.40 vs 0.98, P < .001), Caton-Deschamps index (1.26 vs 0.97, P < .001), and tibial tubercle to trochlear groove ratio (18.27 vs 10.69, P < .001) were observed after TTO. The overall incidence of complications was 7.6% (95% CI, 4.8%-10.5%), while the overall incidence of reoperations was 14.3% (95% CI 6.2%-22.4%). Conclusion: TTO for patellar instability in the setting of patella alta results in a significant decrease in patellar height with varying degrees of medialization depending on the utilized technique. A mean postoperative complication rate of 7.6% was reported with a reoperation incidence of 14.3%, related primarily to hardware removal.

Combined Tibial Tubercle Osteotomy With Medial Opening Wedge High Tibial Osteotomy Minimizes Changes in Patellar Height

2013 ◽  
Vol 41 (12) ◽  
pp. 2849-2857 ◽  
Author(s):  
P. David Longino ◽  
Trevor B. Birmingham ◽  
William J. Schultz ◽  
Rebecca F. Moyer ◽  
J. Robert Giffin
Keyword(s):  
High Tibial Osteotomy ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Tibial Osteotomy ◽  
Tibial Tubercle Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals Complex Patellofemoral Reconstruction for Recurrent Instability

2022 ◽  
Vol 2 (1) ◽  
pp. 263502542110353
Author(s):  
Edward R. Floyd ◽  
Nicholas I. Kennedy ◽  
Adam J. Tagliero ◽  
Gregory B. Carlson ◽  
Robert F. LaPrade
Keyword(s):  
Soft Tissue ◽  
Trochlear Dysplasia ◽  
Quadriceps Tendon ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Suture Anchors ◽  
Tibial Tubercle Osteotomy ◽  
Drill Holes

Background: Patellofemoral instability is due to a combination of bony and soft tissue factors. While recurrent patellar dislocations are rare, evaluation and treatment of these conditions require addressing patellar height and lateralization of the tibial tubercle (TT), restraint to lateral patellar subluxation, and trochlear dysplasia. Other factors to consider are coronal limb-length alignment outside of the physiologic 5 to 8° of valgus, which may significantly alter the Q angle and contribute to lateral instability. Other ligaments around the patella contribute to soft-tissue restraint, including the medial and lateral patellotibial ligaments, patellomeniscal ligaments, and the medial quadriceps tendon femoral ligament. Patellar tilt is assessed with and without quadriceps contraction to further evaluate the patella’s relationship to the trochlear groove. The Caton-Deschamps Index, as well as patellar trochlear index (PTI), are used to measure patellar height for patella alta or baja. Technique Description: The technique is to surgically manage a patient in neutral mechanical alignment on standing limb radiographs, with moderate-to-severe DeJour type B trochlear dysplasia and a trochlear sulcus angle of around 145°, patella alta with a Caton-Deschamps Index of 1.6 and PTI of 0.22, a TT to trochlear groove (TT-TG) distance of 8 mm, and a deficient medial patellofemoral ligament (MPFL). The MPFL reconstruction is done first, with harvesting of the ipsilateral quadriceps tendon and maintenance of its distal attachment on the superior patellar pole. The quadriceps tendon graft is folded medially upon its distal attachment and fixed in this position with suture anchors. Tibial tubercle osteotomy is accomplished by spacing drill holes 2 mm apart, medially and laterally, on the TT and connecting the drill holes with an osteotome and reciprocating saw. A distalized location to secure the TT is selected and superficial bone is excised. A medial parapatellar arthrotomy is performed, and bur attachments are used to drill into the subchondral bone beneath the femoral articular surface to create a V-shaped flap of trochlear cartilage. An arthroscope is inserted under the trochlear flap during this process to visualize the appropriate depth. The trochlear flap is then secured with screws passed over guide pins to secure the flap to the desired location. Cannulated screws and washers are then used to secure the TT to its distalized and/or medialized position, with fluoroscopic verification of screw depth and location. The arthrotomy is then closed with the knee at 45°. The quadriceps graft is passed through a subretinacular channel and secured with suture anchors, adjacent to the adductor tubercle, to complete the MPFL reconstruction. Before closure, appropriate tracking and translation of the patella is verified. Results: Sulcus-deepening trochleoplasty, with or without MPFL reconstruction, has been reported to obtain satisfactory outcomes at 2 years, with close to 85% return to sport and 100% return to work, with improvements in International Knee Documentation Committee (IKDC) scores from 50.8 to 79.1 in some studies. MPFL reconstruction with tibial tubercle osteotomy (TTO) has yielded a 94.5% patient satisfaction rate in the literature. Discussion/Conclusion: In patients with recurrent patellar instability and DeJour types B-D trochlear dysplasia, MPFL reconstruction with TTO and sulcus-deepening trochleoplasty provides excellent subjective outcomes and restores patellar tracking with elimination of recurrent subluxation.

Distalising tibial tubercle osteotomy decreases patellar tendon force — A treatment rationale for recalcitrant patellar tendinopathy

The Knee ◽  
2020 ◽  
Vol 27 (3) ◽  
pp. 871-877 ◽  
Author(s):  
Michael J. Dan ◽  
Joseph Cadman ◽  
James McMahon ◽  
William C.H. Parr ◽  
David Broe ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Tendon Force

Tibial tubercle position and patellar height as indicators of malalignment in women with anterior knee pain

2000 ◽  
Vol 13 (3) ◽  
pp. 199-203 ◽  
Author(s):  
S. Metin �ubuk ◽  
Muzaffer Sindel ◽  
Kamil Karaali ◽  
A. G�khan Arslan ◽  
Feyyaz Akyildiz ◽  
...  
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Anterior Knee

Biomechanical investigation of tibial tubercle osteotomy fixed with various screw configurations

Injury ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 263-271 ◽  
Author(s):  
Chih-Wei Chang ◽  
Yen-Nien Chen ◽  
Chun-Ting Li ◽  
Chi-Rung Chung ◽  
Chung‐Chih Tseng ◽  
...  
Keyword(s):  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Biomechanical Investigation

Tibial Tubercle Osteotomy With Screw Fixation for Total Knee Arthroplasty

Orthopedics ◽  
2014 ◽  
Vol 37 (4) ◽  
pp. e367-e373 ◽  
Author(s):  
Nobuaki Chinzei ◽  
Kazunari Ishida ◽  
Ryosuke Kuroda ◽  
Tomoyuki Matsumoto ◽  
Seiji Kubo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Screw Fixation ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Total Knee
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