Tibial tubercle osteotomy (Fulkerson procedure) on women athlete with anterior knee pain: a case series

Anterior knee pain (AKP) is one of the most frequent complaints in knee conditions of adolescent and young adult patients. Tibial tuberosity osteotomy (Fulkerson procedure) is a well-described treatment option for a broad range of patellofemoral joint disorders. This study aimed to evaluate the clinical outcomes of tibial tubercle osteotomy and prognostic factors correlated with the outcomes in adolescents’ athletes affected by anterior knee pain. Three patients treated with tibial tubercle osteotomy for anterior knee pain were prospectively evaluated using the Anterior Knee Pain Scale (AKPS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the part of the International Knee Documentation Committee (IKDC) score to find different potential risk factors as an objective evaluation. The three cases are showing improvement in overall scores, both in six months (WOMAC 72.4; KUJALA 64.6%; IKDC 52.1%) and after one year (WOMAC 82.6; KUJALA 83.3%; IKDC 70.3%) following the surgical procedure. Patient 1 and patient 2 obeyed the physiotherapy schedules and checked their condition regularly. Their scores indicate an immense improvement than patient 3, who did not comply with the physiotherapy nor the check-up. However, the comparison analysis shows a significant increase of the scores for all three assessment methods (WOMAC, KUJALA and IKDC), that implies a good result of clinical outcome may still be achieved even without a close follow up. Even though the Fulkerson procedure was the treatment option for a broad range of AKP, a different comprehensive range result of the scores was found.

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The modified tibial tubercle osteotomy for anterior knee pain due to chondromalacia patellae in adults

Bone and Joint Research ◽

10.1302/2046-3758.18.2000083 ◽

2012 ◽

Vol 1 (8) ◽

pp. 167-173 ◽

Cited By ~ 11

Author(s):

C. M. Jack ◽

S. S. Rajaratnam ◽

H. O. Khan ◽

O. Keast-Butler ◽

P. A. Butler-Manuel ◽

...

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Tibial Tubercle ◽

Tibial Tubercle Osteotomy ◽

Chondromalacia Patellae ◽

Anterior Knee

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Tibial Tubercle Osteotomy for Anterior Knee Pain

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116s00160 ◽

2016 ◽

Vol 4 (7_suppl4) ◽

pp. 2325967116S0016

Author(s):

Davide Bonasia ◽

Federica Rosso ◽

Umberto Cottino ◽

Giorgio Governale ◽

Valeria Cherubini ◽

...

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Tibial Tubercle ◽

Tibial Tubercle Osteotomy ◽

Anterior Knee

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Tibial Tubercle Osteotomy With Distalization Is a Safe and Effective Procedure for Patients With Patella Alta and Patellar Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120975101 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097510

Author(s):

Chilan B.G. Leite ◽

Társis P. Santos ◽

Pedro N. Giglio ◽

José R. Pécora ◽

Gilberto L. Camanho ◽

...

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Patellar Instability ◽

Activity Level ◽

Patella Alta ◽

Tibial Tubercle ◽

Tibial Tubercle Osteotomy ◽

Kujala Score ◽

The Mean ◽

Anterior Knee

Background: Tibial tubercle osteotomy with concomitant distalization for the treatment of patellar instability remains controversial, as it may cause anterior knee pain and chondral degeneration. Purpose: To evaluate radiographic, clinical, and functional outcomes in patients who had patellar instability with patella alta and underwent tibial tubercle osteotomy with distalization (TTO-d) as well as medial patellofemoral ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were 25 patients (31 cases) (mean age at surgery, 28.7 years; range, 14-33 years) with patellar instability and patella alta who underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index (CDI), tibial tubercle–trochlear groove (TT-TG) distance, and amount of distalization were assessed. Clinical and functional variables included J-sign, anterior knee pain, apprehension test, Tegner activity level, and Kujala score. Results: The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm (range, 7-24 mm); the mean CDI changed from 1.37 (1.25-1.7) preoperatively to 1.02 (0.9-1.12) postoperatively ( P = .001); and the mean amount of tibial tubercle distalization was 8.80 mm (range, 4-16 mm). Lateral release (22 cases; 71.0%), medialization of tibial tubercle (17 cases; 54.8%), and autologous chondrocyte implantation (4 cases; 12.9%) were other associated procedures. The J-sign improved in 30 cases (96.8%; P = .001), and there was a complete resolution of anterior knee pain in 22 cases (71.0%; P = .001). An exploratory analysis showed that patellar cartilage defect severity was correlated with persistent pain ( P = .005). The apprehension test became negative in all cases ( P = .001). The median Kujala score increased from 52 to 77 ( P = .001), and the median Tegner activity level improved from 3 to 4 ( P = .001). No cases of osteotomy nonunion were reported. One case (3.2%) of patellar instability recurrence and 3 cases (6.5%) with painful hardware were observed. Conclusion: TTO-d resulted in good radiographic, clinical, and functional outcomes providing proper patellar stability to patients with patella alta. TTO-d appears to be a safe and efficient procedure with low complication rates, providing an additional tool for the personalized treatment of patellar instability.

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

Clinical Anatomy ◽

10.1002/(sici)1098-2353(2000)13:3<199::aid-ca7>3.0.co;2-o ◽

2000 ◽

Vol 13 (3) ◽

pp. 199-203 ◽

Cited By ~ 11

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

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Congenital internal rotation deformity of the distal femur presenting as patellofemoral instability and pain

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000260 ◽

2019 ◽

Vol 4 (2) ◽

pp. 93-97 ◽

Cited By ~ 2

Author(s):

Xinyuan Zhang ◽

John Attenello ◽

Marc R Safran ◽

David W Lowenberg

Keyword(s):

Internal Rotation ◽

Knee Pain ◽

Anterior Knee Pain ◽

Distal Femur ◽

Case Series ◽

Patellofemoral Instability ◽

Level Of Evidence ◽

Femoral Antetorsion ◽

Derotational Osteotomy ◽

Anterior Knee

ObjectivesFemoral antetorsion, defined as the angle of rotation of the femoral head and neck axis in relation to the transcondylar axis of the distal femur, is a cause for patellofemoral instability and anterior knee pain. Most clinical reports do not distinguish between antetorsion of the femur distal to the isthmus and anteversion of the proximal femur, which is another cause of femoral internal rotational deformity.MethodsThis retrospective observational case series evaluated four cases in three female patients who underwent evaluation of surgical intervention for chronic anterior knee pain since childhood. Physical examination and radiographic images supported the diagnosis of internal rotation deformity at the distal femora in all four cases. Distal femoral derotational osteotomy of 45°, 60° and 30° were performed, respectively. Kujala scoring system for patellofemoral pathology was used to assess the change in knee symptoms before and after the osteotomies.ResultsThis study demonstrated successful treatment of the resultant knee symptoms from femoral antetorsion with distal femur derotational osteotomy in all three patients.ConclusionsPatellofemoral syndrome is multifactorial, and the true anatomic reason for each patient’s individual pathology must be determined before surgery proceeds.Level of evidenceLevel V.

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Successful Treatment of Painful Synchondrosis of Bipartite Patella after Direct Trauma by Operative Fixation: A Series of Six Cases

The Open Orthopaedics Journal ◽

10.2174/1874325001711010390 ◽

2017 ◽

Vol 11 (1) ◽

pp. 390-396 ◽

Cited By ~ 1

Author(s):

Sarkhell Radha ◽

Michael Shenouda ◽

Sujith Konan ◽

Jonathon Lavelle ◽

Samuel Church

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Case Series ◽

Symptomatic Treatment ◽

Operative Management ◽

The Body ◽

Direct Trauma ◽

Bipartite Patella ◽

Operative Fixation ◽

Anterior Knee

Introduction: The patella is the largest sesamoid bone in the body and may have one (77%) or multiple (23%) ossification centres. Patellar and patellofemoral joint abnormalities are a common cause of anterior knee pain but symptomatic bipartite patella is an uncommon problem. Case Series: We report a series of six cases of painful synchondrosis in bipartite patellae, all in keen athletes following a direct blow to the anterior aspect of the knee. A complete rupture of the synchondrosis with evidence of retropatellar chondral separation was seen on MRI scan in all cases. Successful surgical fixation was undertaken with complete resolution of symptoms in all patients at an average of three months post-operatively. Conclusion: Painful synchondrosis of a bipartite patella in young and active individuals following direct trauma is a relatively rare cause of anterior knee pain, but may be associated with significant morbidity. In cases refractory to non-operative management, successful symptomatic treatment can be achieved by operative fixation.

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