scholarly journals Clinical Improvement Is Achieved Following Tibial Tubercle Distomedialization for Patellar Maltracking and Patella Alta Without Instability

2021 ◽  
Vol 3 (3) ◽  
pp. e845-e853
Author(s):  
Tarik Bayoumi ◽  
Dennis C. van Duijvenbode ◽  
Joyce L. Benner ◽  
Kirsten D.S. Boerma-Argelo ◽  
Michel H.J. Stavenuiter ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Patellar Maltracking

Medial Patellofemoral Ligament Reconstruction With or Without Derotational Distal Femoral Osteotomy in Treating Recurrent Patellar Dislocation With Increased Femoral Anteversion: A Retrospective Comparative Study

2020 ◽  
Vol 49 (1) ◽  
pp. 200-206
Author(s):  
ZhiJun Zhang ◽  
Guanyang Song ◽  
Yue Li ◽  
Tong Zheng ◽  
QianKun Ni ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Femoral Anteversion ◽  
Tibial Tubercle ◽  
Control Group ◽  
High Grade ◽  
Recurrent Patellar Dislocation ◽  
Distal Femoral Osteotomy ◽  
Patellar Maltracking ◽  
Tibial Tubercle Transfer

Background: Controversy exists regarding the surgical treatment of recurrent patellar dislocation (RPD) with an increased femoral anteversion angle (FAA). Medial patellofemoral ligament reconstruction (MPFL-R) either alone or combined with derotational distal femoral osteotomy (DDFO) results in favorable clinical outcomes. Purpose: To compare the clinical outcomes of MPFL-R versus MPFL-R with DDFO in treating RPD with increased FAA (>30°). Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2014 and December 2017, 126 patients (135 knees) with RPD and increased FAA (>30°) were surgically treated using MPFL-R with or without DDFO and eligible for this retrospective study. These patients were allocated into 2 groups based on whether an additional DDFO was performed: the DDFO group (MPFL-R + DDFO with or without tibial tubercle transfer; n = 66) and the control group (MPFL-R with or without tibial tubercle transfer; n = 69). Pre- and postoperative patellar stability was measured using stress radiography. Patellar maltracking (J-sign) and patient-reported outcomes (Kujala, International Knee Documentation Committee, Lysholm, and Tegner scores) were evaluated and compared between the 2 groups. Subgroup analysis was performed by stratifying the results in terms of the severity of preoperative patellar maltracking (low-grade vs high-grade J-sign). Results: A total of 135 knees (126 patients) with a mean follow-up time of 3.7 ± 1.2 years were evaluated in the present study. The rates of postoperative MPFL residual graft laxity and residual J-sign were significantly lower in the DDFO group than in the control group (6% vs 19%, P = .028; 33% vs 54%, P = .018). The DDFO group had significantly higher Kujala (82.3 vs 76.7; P = .001) and Lysholm (83.7 vs 77.7; P = .034) scores than the control group had postoperatively. For patients with a preoperative high-grade J-sign, further subgroup analysis demonstrated that the DDFO group had a significantly lower rate of MPFL residual graft laxity than the control group had (18% vs 57%; P = .029). Conclusion: In this retrospective study, treatment of RPD with increased femoral anteversion using MPFL-R with DDFO yielded more favorable subjective and objective outcomes than did MPFL-R without DDFO, and this circumstance was more remarkable when the patients had a preoperative high-grade J-sign.

scholarly journals Identifying Patients With Patella Alta and/or Severe Trochlear Dysplasia Through the Presence of Patellar Apprehension in Higher Degrees of Flexion

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092548
Author(s):  
Matthew Colatruglio ◽  
David C. Flanigan ◽  
Sarah Harangody ◽  
Robert A. Duerr ◽  
Christopher C. Kaeding ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Type B ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Recurrent Patellar Instability

Background: Recurrent patellar instability is frequently treated surgically with reconstruction of the medial patellofemoral ligament (MPFL). Patients with significant patella alta, trochlear dysplasia, and/or an elevated tibial tubercle–trochlear groove (TT-TG) distance may benefit from a concurrent bony procedure such as tibial tubercle osteotomy or trochleoplasty. The indications to perform such procedures are traditionally based on imaging criteria but remain controversial. Patellar apprehension is common in patients with patellar instability but typically resolves in higher degrees of knee flexion. Hypothesis: The persistence of patellar apprehension at greater than 60° of knee flexion is associated with patella alta, an increased TT-TG distance, and trochlear dysplasia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 76 patients with recurrent patellar instability were prospectively identified in a sports medicine clinic. Patellar apprehension was evaluated in each patient. Apprehension was defined as the patient reporting that the patella felt unstable to lateral patellar translation. Apprehension was first assessed at full knee extension and repeatedly assessed as the knee was flexed in 10° intervals, as measured using a goniometer. The degree of flexion at which patellar apprehension disappeared was recorded. Plain radiographs and magnetic resonance imaging (MRI) scans were obtained for all patients. Patellar height was assessed with the Caton-Deschamps (CD) index, and trochlear morphology was assessed through measurements of the sulcus angle and depth on MRI and classified using the Dejour classification system. Imaging measurements of patients in whom apprehension resolved by 60° of knee flexion were compared with measurements for those with apprehension that persisted deeper into flexion. Results: Apprehension resolved by 60° of flexion in 56 patients and persisted into deeper flexion in 20 patients. The patients with a delayed resolution of apprehension demonstrated a higher CD index; elevated TT-TG distance; increased sulcus angle; decreased sulcus depth; and higher incidence of Dejour type B, C, or D dysplasia (all P < .05). Of the 20 patients with a delayed resolution of apprehension, 18 had either Dejour type B, C, or D dysplasia or a CD index of at least 1.30. A delayed resolution of apprehension was present in 11 of the 16 patients with Dejour type B, C, or D dysplasia. Conclusion: Overall, 90% of patients with significant patella alta and the majority of patients with high-grade trochlear dysplasia demonstrated patellar apprehension that persisted beyond 60° of knee flexion. Additionally, 90% of patients with persistent apprehension had significant patella alta and/or trochlear dysplasia. Further work is needed to evaluate the utility of these findings to inform surgical decision-making in this population.

scholarly journals Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: An upright, weightbearing MRI study

2012 ◽  
Vol 31 (3) ◽  
pp. 448-457 ◽  
Author(s):  
Saikat Pal ◽  
Thor F. Besier ◽  
Gary S. Beaupre ◽  
Michael Fredericson ◽  
Scott L. Delp ◽  
...  
Keyword(s):  
Patellofemoral Pain ◽  
Patella Alta ◽  
Patellar Maltracking ◽  
Mri Study

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.

Patellar Tendon Tenodesis in Association With Tibial Tubercle Distalization for the Treatment of Episodic Patellar Dislocation With Patella Alta

2011 ◽  
Vol 40 (2) ◽  
pp. 346-351 ◽  
Author(s):  
Cyril Mayer ◽  
Robert A. Magnussen ◽  
Elvire Servien ◽  
Guillaume Demey ◽  
Matthias Jacobi ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Patellar Dislocation ◽  
Patella Alta ◽  
Tibial Tubercle

scholarly journals Distalization Of Tibial Tubercle For Patella Stabilization: Does Length Of Distalization Or Residual Patella Alta Effect Outcome?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0030
Author(s):  
Andrew Schmiesing ◽  
Marta Engelking ◽  
Julie Agel ◽  
Elizabeth A. Arendt
Keyword(s):  
Surgical Procedure ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
High Rate ◽  
Tibial Tubercle ◽  
Patella Dislocation ◽  
Patella Height ◽  
Increased Risk ◽  
Increase Fracture Risk ◽  
Lateral Patella

Objectives: Distalization of the tibial tubercle (DTT) is a surgical procedure to help stabilize the patella when patella alta is present. The purpose of this study is to: evaluate the accuracy of our operative intervention (i.e. how often is patella height normalization achieved). correlate post-operative (residual) patella alta with recurrent patellar instability correlate the mm of distal displacement with negative outcomes Methods: Data was collected retrospectively on consecutive patients who underwent DTT as part of their surgical procedure for recurrent lateral patella dislocation. All patients had concurrent medial patella ligament reconstruction (MPFLR), performed by a single surgeon between 2009-2015. Data collected included demographics, pre-and post-operative imaging measurements related to patella alta and trochlear dysplasia on MRI and plain radiographs, recurrent lateral patella dislocations, and complications including fracture and knee arthrofibrosis. Surgical planning including the assessment of the Caton-Deschamps index (CD) on sagittal radiographic imaging. The surgical goal was to have a final CD between 1.0 -1.2, or a maximum distance moved of 15 mm in cases of severe patella alta. When CD was within normal limits due to patellar anatomy, we used as a proxy the patellar-trochlear index (PTI), aiming for a PTI of 25% judged intra-operatively. Results: 89 patients underwent DTT over a 7-year period. There were 21 (24%) males/68 (76%) females. Mean (range): age 21 (13-45), BMI 25.8 (17-44.6). Pre-op imaging measurements were: IS ratio 1.5 (1.18-2.06), CD ratio 1.4 (1.05 -1.93), lateral patella tilt 24.7º (1º-53º), TT-TG 18.6 mm (8-28), sulcus angle 158º (123-180), PTI 29% (5-70). Post-operative mean CD was 1.09 (0.92 -1.67). The amount of distalization averaged 9.8 (range 4 to 15). 13 patients had residual patella alta (CD>1.2). One patient with residual patella alta re-dislocated (CD=1.25). The most extreme residual patella alta (1.67) had a pre-op CD of 1.97 and was distalized 15 mm. There was no patellar baja. 6 patients (6%) had frank recurrent patellar dislocation; postoperative patella height in this group averaged 1.11 (1.02 -1.25), indicating that re-dislocation was not due to residual patella alta. Tibia fracture (4%) was not related to mm of distalization; mean (10) /range 8-15 mm. Arthrofibrosis requiring manipulation was needed in 11 patients (13%) whose mean distalization was 11.8 mm (9-15 mm). This distance was significantly different (p=0.009) from those not requiring manipulation. Conclusion: Distalization of TT leads to a high rate of normalization of patellar height measurements, with 94% patella stabilization. Residual patella alta was not associated with an increased risk of recurrence (p=0.57). Distalizing the tibial tubercle up to 15 mm did not increase fracture risk, however there was an increase in arthrofibrosis requiring manipulation.

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