Tibial Tubercle Osteotomy: Indication and Techniques

Abstract

Osteotomy of the tibial tubercle is a versatile procedure that can be utilized for several common pathologies about the patellofemoral joint. Most commonly, tuberosity transfer is employed for the treatment of patellar instability or symptomatic overload of the patella. The osteotomy can be combined with soft tissue realignment procedures or cartilage reconstructive techniques. A precise understanding of the surgical anatomy and the biomechanics of the patellofemoral articulation is essential for producing a successful outcome during surgery. Tailoring the direction of transfer to the pathoanatomy of each patient is critical for producing a durable and lasting result following a tibial tubercle osteotomy. When evaluating a patient for a possible transfer, a thorough history and physical evaluation must be undertaken, along with imaging to the patellofemoral joint. Several useful advanced imaging techniques can also be used to guide the surgeon toward the most appropriated osteotomy for the patient. The purpose of this article is to review the indications for performing a tibial tubercle osteotomy, and highlighting the various techniques for transfer.

Keywords

tibial tubercle osteotomy - patellar instability - patellofemoral arthritis - patellofemoral pain

• References

• 1 Sherman SL, Erickson BJ, Cvetanovich GL , et al. Tibial tubercle osteotomy: indications, techniques, and outcomes. Am J Sports Med 2013; 42 (8) 2006-2017
• 2 Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 2007; 14 (3) 177-182
• 3 Blønd L, Hansen L. Patellofemoral pain syndrome in athletes: a 5.7-year retrospective follow-up study of 250 athletes. Acta Orthop Belg 1998; 64 (4) 393-400
• 4 Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 1994; 14 (4) 513-515
• 5 Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 2013; 41 (3) 575-581
• 6 Hall MJ, Mandalia VI. Tibial tubercle osteotomy for patello-femoral joint disorders. Knee Surg Sports Traumatol Arthrosc 2014; ; October 19 (Epub ahead of print)
• 7 Draper CE, Besier TF, Gold GE , et al. Is cartilage thickness different in young subjects with and without patellofemoral pain?. Osteoarthritis Cartilage 2006; 14 (9) 931-937
• 8 Fox AJ, Wanivenhaus F, Rodeo SA. The basic science of the patella: structure, composition, and function. J Knee Surg 2012; 25 (2) 127-141
• 9 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (1) 19-26
• 10 Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM. Surgical biomechanics of the patellofemoral joint. Arthroscopy 2007; 23 (5) 542-553
• 11 Philippot R, Boyer B, Testa R, Farizon F, Moyen B. The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 2012; 20 (2) 331-336
• 12 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (3) 215-220
• 13 Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res 1983; (176) 217-224
• 14 Greene CC, Edwards TB, Wade MR, Carson EW. Reliability of the quadriceps angle measurement. Am J Knee Surg 2001; 14 (2) 97-103
• 15 Farr J, Schepsis A, Cole B, Fulkerson J, Lewis P. Anteromedialization: review and technique. J Knee Surg 2007; 20 (2) 120-128
• 16 Beaconsfield T, Pintore E, Maffulli N, Petri GJ. Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 1994; (308) 18-28
• 17 Aarvold A, Pope A, Sakthivel VK, Ayer RV. MRI performed on dedicated knee coils is inaccurate for the measurement of tibial tubercle trochlear groove distance. Skeletal Radiol 2014; 43 (3) 345-349
• 18 Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S. The position of the tibia tubercle in 0°-90° flexion: comparing patients with patella dislocation to healthy volunteers. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2396-2400
• 19 Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane. A clinical analysis. Am J Sports Med 1994; 22 (1) 61-66
• 20 Roux C. The classic. Recurrent dislocation of the patella: operative treatment. Clin Orthop Relat Res 1979; (144) 4-8
• 21 Hauser E. Total tendon transplantation for slipping patella. Surg Gynecol Obstet 1938; 66: 199-214
• 22 Chrisman OD, Snook GA, Wilson TC. A long-term prospective study of the Hauser and Roux-Goldthwait procedures for recurrent patellar dislocation. Clin Orthop Relat Res 1979; (144) 27-30
• 23 Radin EL. The Maquet procedure—anterior displacement of the tibial tubercle. Indications, contraindications, and precautions. Clin Orthop Relat Res 1986; (213) 241-248
• 24 Trillat A, Dejour H, Couette A. Diagnosis and treatment of recurrent dislocations of the patella. Rev Chir Orthop Repar Appar Mot 1964; 50: 813-824
• 25 Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 1997; 25 (4) 533-537
• 26 Maquet P. Advancement of the tibial tuberosity. Clin Orthop Relat Res 1976; (115) 225-230