scholarly journals Tibial Tubercle Proximalization: A Novel Technique to Lengthen the Extensor Mechanism in Skeletally Mature Patients With Lateral Habitual Patellar Dislocations

2019 ◽  
Vol 7 (3) ◽  
pp. 232596711983164
Author(s):  
Guan-yang Song ◽  
Hua Feng ◽  
Hui Zhang ◽  
Jin Zhang ◽  
Zhi-jun Zhang
Keyword(s):  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Novel Technique

scholarly journals SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Alexandra H. Aitchison ◽  
Kenneth M. Lin ◽  
Daniel W. Green
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Force Vector ◽  
Tibiofemoral Rotation ◽  
The Mean

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]

Extensor Mechanism Reconstruction: A Novel Technique for Bone Patella Allograft Post Partial Patellectomy Failure

2011 ◽  
Vol 24 (02) ◽  
pp. 129-136 ◽  
Author(s):  
Michael Drexler ◽  
Nehemia Blumberg ◽  
Amir Haim ◽  
Ron Arbel ◽  
Guy Morag
Keyword(s):  
Extensor Mechanism ◽  
Novel Technique ◽  
Partial Patellectomy

scholarly journals Revision Quadriceps Tendon Repair With Bone-Achilles Allograft Augmentation

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110326
Author(s):  
Navya Dandu ◽  
Nicholas A. Trasolini ◽  
Steven F. DeFroda ◽  
Tai Holland ◽  
Adam B. Yanke
Keyword(s):  
Weight Bearing ◽  
Tendon Repair ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Bone Block ◽  
Tissue Quality ◽  
Recipient Site ◽  
Patient Reported ◽  
Bone Plug

Background: Surgical repair of chronic quadriceps tendon ruptures can be daunting, especially after failure of a prior repair. In this setting, tissue quality is usually poor, necessitating graft augmentation. In this video, we describe our technique for Achilles tendon allograft augmentation for revision quadriceps tendon repair. Indications: Failed quadriceps tendon repair defined as ongoing extensor mechanism deficit including patella baja, functional deficit, or palpable quadriceps defect with confirmed retear on advanced imaging. Technique Description: Patient is placed in the supine position, and a midline incision is extended to the tibial tubercle. Full thickness medial and lateral flaps are raised, nonviable scar tissue is excised, and suprapatellar adhesions are released to ensure full mobilization of the viable remnant quadriceps. A plane is then developed deep to the patellar tendon paratenon from proximal to distal. A reamer is used to prepare a socket just medial to the tibial tubercle. The calcaneal bone block of the Achilles allograft is fashioned to match the recipient site on the tibia with a sagittal saw. The graft is shuttled deep to the paratenon, and the bone plug is fixed to the tibia with an interference screw. Suture from the patellar anchors is then used to place 2 running Krackow stitches spanning the remnant quadriceps tendon proximally. The remnant tissue is subsequently reduced and tied with an anchor pull-through technique. The soft tissue component of the Achilles graft is laid over the repair and oversewn with free nonabsorbable suture. Patient is placed in a brace locked in extension for 6 weeks and allowed to be weight bearing as tolerated. Results: Long-term patient-reported outcomes of Achilles allograft reconstruction for revision extensor mechanism repairs are limited. Two studies of 17 reconstructions each reported this to be a reliable and durable option at a mean follow-up of 65 and 52 months, respectively. Discussion/Conclusion: Revision surgery for extensor mechanism deficits can be a challenging procedure. Our preference is to perform augmentation with Achilles allograft with bone plug fixation on the tibial side. This allows for augmentation of the entire extensor mechanism, as well as bone-to-bone healing on the tibial side.

Extensor Mechanism Injury in the Pediatric Population—A Clinical Review

2018 ◽  
Vol 31 (06) ◽  
pp. 490-497 ◽  
Author(s):  
William Sessions ◽  
Matthew Herring ◽  
Walter Truong
Keyword(s):  
Pediatric Population ◽  
Tensile Force ◽  
Quadriceps Tendon ◽  
Operative Management ◽  
Extensor Mechanism ◽  
Patellar Ligament ◽  
Tibial Tubercle ◽  
Mechanism Of Injury ◽  
Lower Extremity Function ◽  
Pediatric Knee

AbstractThe extensor mechanism of the knee—consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament—is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis. It is the intent of this article to discuss the current literature regarding the mechanism of injury, diagnostic workup, classification, indications for surgical versus non-surgical management, and techniques for operative management for both tibial tubercle and patella (transverse and sleeve) fractures.

scholarly journals Complete Traumatic Trifocal Failure of the Extensor Mechanism of the Knee: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Alexander J. Johnson ◽  
Katharine D. Harper ◽  
Christopher Haydel
Keyword(s):  
Knee Injuries ◽  
Knee Extensor ◽  
High Energy ◽  
Tendon Injury ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Limited Data ◽  
Adequate Treatment ◽  
Tibial Tubercle Avulsion Fracture ◽  
Knee Extensor Mechanism

The unique case of a rare 3-level extensor mechanism failure in a 28-year-old male, involving a tibial tubercle avulsion fracture, a patellar tendon avulsion off the tibial tubercle fragment, and a severely comminuted patella fracture, and the surgical technique required to repair such an injury is presented. Focus is spent on the unique repair of a tendon injury when both proximal and distal bony attachments are damaged. Trifocal knee extensor mechanism is a rare clinical entity with minimal literature available—to date, this injury has only been reported in a retrospective review of combat-related injuries in military personnel. It is important to maintain an understanding of knee extensor mechanism anatomy and perform thorough investigation of high-energy knee injuries to ensure adequate treatment of all injuries. The outcome presented in this case shows that positive results after complex extensor mechanism injuries may be achieved, but limited data exists to elucidate optimum treatment. It is essential for surgeons to have firm grasp of techniques used to treat each segment of the extensor mechanism so that they may be combined when a patient presents with complex, multifocal injury.

scholarly journals Tibial Tubercle Fracture in a 14-Year-Old Athlete with Bilateral Lower Pole Bipartite Patella and Osgood-Schlatter Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Fabio Pascarella ◽  
Antonio Ziranu ◽  
Giulio Maccauro
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Young Male ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Type I ◽  
Lower Pole ◽  
Male Athlete ◽  
Bipartite Patella

We present a case of tibial tubercle fracture in a young male athlete with both bilateral bipartite patella at the lower pole (Saupe type I) and Osgood-Schlatter disease. Open reduction and internal fixation were performed to restore the extensor mechanism of the knee.

Predicting Risk of Recurrent Patellofemoral Instability With Measurements of Extensor Mechanism Containment

2021 ◽  
Vol 49 (3) ◽  
pp. 706-712
Author(s):  
Daniel Weltsch ◽  
Calvin T. Chan ◽  
R. Justin Mistovich ◽  
John W. Urwin ◽  
Christopher R. Gajewski ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Patellar Dislocation ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Regression Analyses ◽  
Recurrent Patellar Dislocation ◽  
Recurrent Instability ◽  
First Time ◽  
Mri Measurements

Background: Identifying risk factors for recurrent patellar dislocation after a primary dislocation may help guide initial treatment. Magnetic resonance imaging (MRI) measurements relating the alignment of the extensor mechanism to trochlear morphology have been shown to distinguish patients with dislocations from controls, but their usefulness in predicting the risk of a second dislocation is not known. Purpose: To identify the association of novel MRI measures of patellar containment with recurrent instability in pediatric patients presenting with a first-time patellar dislocation. Study Design: Cohort study (Prognosis); Level of evidence, 3. Methods: The study was conducted at a tertiary care children’s hospital (2005-2014) on patients (age, 8-19 years) with a first-time patellar dislocation. MRI measurements were made by 2 independent raters. Interobserver reliability was assessed for all measurements via an intraclass correlation coefficient (ICC). Only measurements with an ICC >0.8 were included. Univariable and multivariable logistic regression analyses were used to evaluate variables associated with recurrence. Results: A total of 165 patients with a median age of 14 years and a slight (57.6%) female predominance was identified. The median follow-up length of the whole cohort was 12.2 months (interquartile range, 1.6-37.1 months). Subsequent instability was documented in 98 patients (59.4%). MRI measurements with excellent correlation (ICC > 0.8) were the tibial tubercle to trochlear groove distance (TT-TG), the tangential axial width of the patella, the tangential axial trochlear width, the axial width of the patellar tendon beyond the lateral trochlear ridge (LTR), and the tibial tubercle to LTR distance. In univariate analysis, all mentioned MRI measurements had significant association with recurrent instability. However, after both backward and forward stepwise regression analyses, the tibial tubercle to LTR distance was the only independent predictor of recurrent instability ( P = .003 in both). Patients with a tibial tubercle to LTR distance value greater than –1 mm had a significantly higher rate of recurrent patellar dislocation (72%). Conclusion: Of numerous axial view MRI parameters, only the tibial tubercle to LTR distance demonstrated a statistically significant association with recurrent patellar instability upon multivariable logistic regression analysis during short-term follow-up of a pediatric population presenting with initial lateral patellar dislocation. Interobserver correlation of the tibial tubercle to LTR distance was good (ICC > 0.8) and similar to that of TT-TG.

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