Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta

2013 ◽  
Vol 18 (3) ◽  
pp. 437-442 ◽  
Author(s):  
Shuhei Otsuki ◽  
Mikio Nakajima ◽  
Shuhei Oda ◽  
Yoshiaki Hoshiyama ◽  
Kenta Fujiwara ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Three Dimensional ◽  
Tibial Tuberosity ◽  
Patella Alta

Influence of age on clinical outcomes of three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta

2016 ◽  
Vol 25 (8) ◽  
pp. 2392-2396 ◽  
Author(s):  
Shuhei Otsuki ◽  
Mikio Nakajima ◽  
Kenta Fujiwara ◽  
Yoshinori Okamoto ◽  
Go Iida ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Instability ◽  
Three Dimensional ◽  
Tibial Tuberosity ◽  
Patella Alta

scholarly journals Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 080-084 ◽  
Author(s):  
Davide Enea ◽  
Pier Paolo Canè ◽  
Marco Fravisini ◽  
Antonio Gigante ◽  
Luca Dei Giudici
Keyword(s):  
Patellar Instability ◽  
Patellofemoral Instability ◽  
Tibial Tuberosity ◽  
Patella Alta ◽  
Functional Improvement ◽  
Patella Dislocation ◽  
Level Of Evidence ◽  
Exact Test ◽  
History Of ◽  
Retrospective Comparative Study

Purpose The aim of the study was to test the distalization and medialization of the tibial tuberosity (DMTT) for the treatment of patellar instability associated with patella alta, focusing on residual instability and pain. Methods Twenty-four consecutive patients (26 knees) suffering from patellofemoral instability and patella alta were treated by DMTT. Two groups were identified, which differed for documented history of frank patella dislocation. The groups were named objective patellar instability (OPI) (history of dislocation) and potential patella instability (PPI) (no dislocation). Outcome was measured with visual analogue scale (VAS), Kujala score, and Tegner score. Comparison between groups was performed using Student's t-test, Wilcoxon rank score, and Fisher's exact test (significance at p < 0.05). Results At 50 ± 18 and 41 ± 18 months of follow-up, respectively, both PPI and OPI groups obtained a significant pain reduction and functional improvement. The PPI group showed a significant decrease of the subjective instability. No procedure-related complications were reported. Conclusion This study suggests that DMTT is a viable option for PPI patients with patella alta. The outcome was comparable between PPI and OPI cases; however, decrease in subjective instability was significantly greater in PPI patients. Level of Evidence Level III, retrospective comparative study.

scholarly journals The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhe Li ◽  
Guanzhi Liu ◽  
Run Tian ◽  
Ning Kong ◽  
Yue Li ◽  
...  
Keyword(s):  
Individual Differences ◽  
Chinese Population ◽  
Pearson Correlation ◽  
Three Dimensional ◽  
Correlation Coefficients ◽  
Tibial Tuberosity ◽  
Trochlear Groove ◽  
Lasso Regression ◽  
Cross Sectional ◽  
Anterior Posterior

Abstract Background Our objective was to obtain normal patellofemoral measurements to analyse sex and individual differences. In addition, the absolute values and indices of tibial tuberosity-trochlear groove (TT-TG) distances are still controversial in clinical application. A better method to enable precise prediction is still needed. Methods Seventy-eight knees of 78 participants without knee pathologies were included in this cross-sectional study. A CT scan was conducted for all participants and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analysed 19 parameters including the TT-TG distance and dimensions and shapes of the patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances. Results The dimensional parameters, TT-TG distance, and femoral aspect ratio of the men were significantly larger than those of women (all p values < 0.05). However, after controlling for the bias from age, height, and weight, there were no significant differences in TT-TG distances and anterior-posterior dimensions between the sexes (all p values > 0.05). The Pearson correlation coefficients between the anterior femoral offset and other indexes were consistently below 0.3, indicating no relationship or a weak relationship. Similar results were observed for the sulcus angle and the Wiberg index. Using LASSO regression, we obtained four parameters to predict the TT-TG distance (R2 = 0.5612, p < 0.01) to achieve the optimal accuracy and convenience. Conclusions Normative data of patellofemoral morphology were provided for the Chinese population. The anterior-posterior dimensions of the women were thicker than those of men for the same medial-lateral dimensions. More attention should be paid to not only sex differences but also individual differences, especially the anterior condyle and trochlea. In addition, this study provided a new method to predict TT-TG distances accurately.

scholarly journals Patellofemoral reconstruction for patellar instability with patella alta in middle-aged patients: Clinical outcomes

2018 ◽  
Vol 104 (2) ◽  
pp. 217-221 ◽  
Author(s):  
S. Otsuki ◽  
Y. Okamoto ◽  
T. Murakami ◽  
K. Nakagawa ◽  
N. Okuno ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Instability ◽  
Patella Alta ◽  
Middle Aged ◽  
Aged Patients

Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability

2021 ◽  
pp. 036354652110377
Author(s):  
Jong-Min Kim ◽  
Jae-Ang Sim ◽  
HongYeol Yang ◽  
Young-Mo Kim ◽  
Joon-Ho Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Functional Failure ◽  
Radiological Parameters ◽  
Recurrent Patellar Instability

Background: No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Purpose: To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). Results: All of the clinical outcome parameters significantly improved in both groups at the final follow-up ( P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups ( P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. Conclusion: MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.

How Does Isolated Medial Patellofemoral Ligament Reconstruction Influence Patellar Height?

2020 ◽  
Vol 48 (4) ◽  
pp. 895-900 ◽  
Author(s):  
Francesco Luceri ◽  
Julien Roger ◽  
Pietro Simone Randelli ◽  
Sébastien Lustig ◽  
Elvire Servien
Keyword(s):  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Case Series ◽  
Patellofemoral Instability ◽  
Patellar Height ◽  
Patella Alta ◽  
Level Of Evidence ◽  
Normal Limits ◽  
Patient Reported ◽  
History Of

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is the gold standard treatment for recurrent patellar dislocation. Patella alta has been reported in about half of patients with recurrent patellofemoral instability. Hypothesis: MPFL reconstruction (MPFLr) has a beneficial role in the correction of patellar height in patients with mild patella alta (Caton-Deschamps index [CDI] between 1.20 and 1.40). Study Design: Case series; Level of evidence, 4. Methods: Skeletally mature patients, with no history of previous or concomitant knee surgical procedures, who underwent isolated MPFLr using hamstring autograft for recurrent patellar instability between 2005 and 2018, were included in this study. The authors calculated CDI, modified Insall-Salvati index (MISI), and Blackburne-Peel index (BPI) ratios. Measurements done by 2 independent observers were calculated and used to compare pre- and postoperative patellar height (patella alta: CDI >1.20). Results: A total of 89 patients (95 knees) were included in the study, with a mean age of 25.0 years (range, 15.0-45.0 years). There were 70% women and 30% men. We found patella alta in 35.8% of cases preoperatively. Among them, 79.4% had reduced patellar height indices, within normal limits, postoperatively (mean follow-up, 18.4 ± 12.0 months). All the ratios showed a significant reduction in patellar height after surgery (CDI: 0.19 [range, –0.05, 0.60]; MISI: 0.22 [–0.14, 0.76]; BPI: 0.18 [–0.08, 0.59]; P < .00001). The CDI of 79.4% of the study knees was reduced to within normal limits postoperatively. The CDI was maintained within normal limits postoperatively in 93.4% of the knees with normal patellar height and reduced to normal in 50% of the knees with severe patella alta before surgery . No patient reported patella infera before surgery, whereas this condition was found in 8.2% of study patients postoperatively. A moderate correlation was reported between preoperative radiographic indices and their reduction after surgery (CDI: P < .001, ρ = 0.39; MISI: P < .001, ρ = 0.39; BPI: P < .001, ρ = 0.48). Conclusion: The higher the preoperative patellar height, the more important is the lowering effect of MPFLr using the hamstring for patellar instability. Bony procedures should not be indicated in patients with patellar instability and a CDI between 1.20 and 1.40.

Classification of dysplasia of the femoral trochlea in patients with patellar instability depends on the evaluation plane

2019 ◽  
Vol 4 (6) ◽  
pp. 290-295
Author(s):  
Yuzo Yamada ◽  
Yukiyoshi Toritsuka ◽  
Shuji Horibe ◽  
Norimasa Nakamura ◽  
Kazuomi Sugamoto ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Articular Surface ◽  
Trochlear Dysplasia ◽  
Three Dimensional ◽  
Reference Plane ◽  
Transepicondylar Axis ◽  
Predisposing Factor ◽  
Femoral Trochlea ◽  
Dejour Classification ◽  
Axial View

ObjectiveTrochlear dysplasia is a major predisposing factor of patellar instability (PI). Dysplasia types are generally evaluated using the Dejour classification, but it is unclear whether this classification covers the entire spectrum. The objective of this study was to confirm whether the trochlear types on an axial view categorised according to the classification represent the entire trochlear shape.MethodsNinety knees from 81 patients with PI and 15 knees from 10 healthy volunteers (HVs) were evaluated. Three-dimensional knee models were created by MRIs. The femoral trochlear planes (FTPs) were defined as virtual cross sections including the transepicondylar axis, closer to the perpendicular plane of the articular surface. FTP 0 was defined as the reference plane including the proximal edge of the femoral trochlea and FTP θ as the plane making optional angle θ to FTP 0. Trochlear dysplasia types according to the classification were evaluated at every 10 degrees of FTPs up to 60 degrees (FTP 10, 20, 30, 40, 50 and 60). A trochlea with a sulcus angle <145° was defined as normal. Changes in the trochlear type according to FTPs, and agreement with clinical classification were evaluated.ResultsEighty-six knees (96%) in patients with PI and 12 (80%) in HVs showed changing trochlear types in different FTPs. Patterns of change varied among patients with PI and HVs. This suggests morphological variation of dysplastic trochleae. Agreement of trochlear type on each FTP with the clinically used Dejour classification was 42% on FTP 10, 49% on FTP 20, 33% on FTP 30, 22% on FTP 40, 22% on FTP 50% and 22% on FTP 60 in patients with PI, and 20% at FTP 10, 80% at FTP 20 and 100% on FTP 30 through FTP 60 in HVs. This suggests that the trochlear types in the clinically used plane do not always match the ones on the planes describing the contact surface to the patella.ConclusionThe trochlear types on an axial view provided by the Dejour classification do not represent the entire trochlear geometry. Multiple axial planes should be clinically used to more precisely describe the entire trochlear shape.

scholarly journals Reply to comment on: Patellar instability in Indian population: relevance of tibial tuberosity and trochlear groove distance

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 25
Author(s):  
Sourabh Kulkarni ◽  
Amith P. Shetty ◽  
Karan K. Alva ◽  
Saurabh Talekar ◽  
Vijay D. Shetty
Keyword(s):  
Patellar Instability ◽  
Indian Population ◽  
Tibial Tuberosity ◽  
Trochlear Groove
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