Both Medialization and Anteromedialization Tibial Tubercle Osteotomies are Effective Surgical Management for Skeletally Mature Patients with Patellofemoral Instability when Combined with Medial Patellofemoral Ligament Reconstruction

Abstract

The study aimed to compare the midterm outcomes of medialization and anteromedialization tibial tubercle osteotomies when used in the management of recurrent patellofemoral instability. The hypothesis is that both techniques would result in significant improvement for patellofemoral instability, but anteromedialization would result in a lower incidence of early osteoarthritis. In the cohort study, all skeletally mature patients aged 18 years old or younger who underwent tibial tubercle osteotomy for recurrent patellofemoral instability within a 10-year period in a single institution were included. All patients underwent either medialization or anteromedialization tibial tubercle osteotomy. The preoperative and postoperative outcomes of the tibial tubercle osteotomies were compared. All patients included in the study had a minimum of 5-year follow-up duration before the conclusion of the study. There was no statistically significant difference in the rates of preoperative and postoperative patellofemoral dislocation when either technique was employed (p = 0.999). Additionally, both the preoperative and postoperative Kujala scores were similar (p = 0.166 and p = 0.554, respectively). The knees did not have a statistically significant difference in their patellar tilt angles and tibial tubercle-trochlear groove distances preoperatively or postoperatively when either technique was used (p = 0.165 and 0.149, respectively). There was also no incidence of osteoarthritis identified in either of the groups (p = 0.999). Both anteriorization and anteromedialization tibial tubercle osteotomies were effective surgical management for patellofemoral instability when combined with medial patellofemoral ligament reconstruction. There were no significant differences in clinical, functional, and radiological outcomes when either medialization or anteromedialization tibial tubercle osteotomy was performed.

Keywords

tibial tubercle osteotomy - tibial tuberosity osteotomy - tibial tubercle medialisation - tibial tubercle anteromedialisation

Publikationsverlauf

Eingereicht: 16. Juli 2020

Angenommen: 19. Juni 2022

Artikel online veröffentlicht:
01. September 2022

• References

• 1 Khormaee S, Kramer DE, Yen YM, Heyworth BE. Evaluation and management of patellar instability in pediatric and adolescent athletes. Sports Health 2015; 7 (02) 115-123
• 2 Hasler CC, Studer D. Patella instability in children and adolescents. EFORT Open Rev 2017; 1 (05) 160-166
• 3 White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis 2009; 67 (01) 22-29
• 4 Popkin CA, Bayomy AF, Trupia EP, Chan CM, Redler LH. Patellar instability in the skeletally immature. Curr Rev Musculoskelet Med 2018; 11 (02) 172-181
• 5 Bellemans J, Cauwenberghs F, Witvrouw E, Brys P, Victor J. Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sports Med 1997; 25 (03) 375-381
• 6 Buuck DA, Fulkerson JP. Anteromedialization of the tibial tubercle: a 4-to 12-year follow-up. Oper Tech Sports Med 2000; 8 (02) 131-137
• 7 Cox JS. An evaluation of the Elmslie-Trillat procedure for management of patellar dislocations and subluxations: a preliminary report. Am J Sports Med 1976; 4 (02) 72-77
• 8 Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 1983; ; (177): 176-181
• 9 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
• 10 Ramappa AJ, Apreleva M, Harrold FR, Fitzgibbons PG, Wilson DR, Gill TJ. The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Med 2006; 34 (05) 749-756
• 11 Barber FA, McGarry JE. Elmslie-Trillat procedure for the treatment of recurrent patellar instability. Arthroscopy 2008; 24 (01) 77-81
• 12 Dannawi Z, Khanduja V, Palmer CR, El-Zebdeh M. Evaluation of the modified Elmslie-Trillat procedure for patellofemoral dysfunction. Orthopedics 2010; 33 (01) 13
• 13 Longo UG, Rizzello G, Ciuffreda M. et al. Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and other distal realignment procedures for the management of patellar dislocation: Systematic review and quantitative synthesis of the literature. Arthroscopy 2016; 32 (05) 929-943
• 14 Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA. The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy 2015; 31 (09) 1819-1825
• 15 Stetson WB, Friedman MJ, Fulkerson JP, Cheng M, Buuck D. Fracture of the proximal tibia with immediate weightbearing after a Fulkerson osteotomy. Am J Sports Med 1997; 25 (04) 570-574