Skip to main content
SpringerLink
Log in

Tuberositasosteotomie zur Behandlung des lateralen Patellamaltrackings oder Patella alta mit begleitender Instabilität

Tibial tubercle osteotomy for the treatment of lateral patellar maltracking or patella alta with accompanying instability

  • Leitthema
  • Published:
Knie Journal Aims and scope

Zusammenfassung

Die Tuberositasosteotomie (TTO) gilt als etablierte Technik in der operativen Behandlung patellofemoraler Instabilitäten. Gängige Indikationen sind die Patella alta und eine Lateralisation der Tuberositas tibiae, die durch ihre Assoziation mit einem Patellamaltracking als wichtige Risikofaktoren für rezidivierende Patellaluxationen gelten. Neben der klinischen Untersuchung hat die radiologische Diagnostik einen wichtigen Stellenwert bei der Indikationsstellung. Durch die Messung radiologischer Parameter können die Einflüsse beider Risikofaktoren eingeschätzt werden, wobei die postulierten Grenzwerte zur Indikationsstellung variieren. In Kombination mit einer Ersatzplastik des medialen patellofemoralen Ligaments (MPFL) können mittelfristig gute klinische Ergebnisse mit niedriger Reluxationsrate erreicht werden. Dennoch sollte die TTO als invasiver Eingriff verstanden und vor dem Hintergrund möglicher Komplikationen sorgfältig indiziert werden.

Abstract

Tibial tubercle osteotomy (TTO) is well established for the surgical treatment of patellofemoral instabilities. It is most commonly indicated for patella alta or a lateralized tibial tubercle. Both of these pathologies are associated with lateral patellar maltracking and therefore present important risk factors for recurring patellar dislocation. Preoperative diagnostics comprise a thorough clinical examination, as well as the radiological assessment of all underlying anatomic conditions. The individual influences of patella alta or tibial tubercle lateralization can be estimated by the measurement of specific radiological parameters. However, there are no clearly defined cut-off values for the indication of a medializing or distalizing osteotomy. In combination with medial patellofemoral ligament (MPFL) reconstruction, TTO can lead to a good-to-excellent outcome with a low redislocation rate in the midterm follow-up. Nevertheless, it remains an invasive procedure with a considerable complication profile and should therefore be indicated with caution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314

    Article  Google Scholar 

  2. Bartsch A, Lubberts B, Mumme M, Egloff C, Pagenstert G (2018) Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review. Arch Orthop Trauma Surg 138:1563–1573

    Article  Google Scholar 

  3. Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712

    Article  Google Scholar 

  4. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68:317–325

    CAS  PubMed  Google Scholar 

  5. Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ (2017) Risk factors and time to recurrent ipsilateral and contralateral patellar dislocations. Am J Sports Med 45:2105–2110

    Article  Google Scholar 

  6. Dickschas J, Harrer J, Bayer T, Schwitulla J, Strecker W (2016) Correlation of the tibial tuberosity-trochlear groove distance with the Q‑angle. Knee Surg Sports Traumatol Arthrosc 24:915–920

    Article  Google Scholar 

  7. Frings J, Balcarek P, Tscholl PM, Liebensteiner M, Dirisamer F, Koenen P (2020) Conservative versus surgical treatment for primary patellar dislocation—a systematic review to guide risk stratification. Dtsch Arztebl Int 117:279–286

    PubMed  PubMed Central  Google Scholar 

  8. Frings J, Dust T, Krause M, Ohlmeier M, Frosch KH, Adam G et al (2020) Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique. Sci Rep 10:16770

    Article  CAS  Google Scholar 

  9. Frings J, Krause M, Wohlmuth P, Akoto R, Frosch KH (2018) Influence of patient-related factors on clinical outcome of tibial tubercle transfer combined with medial patellofemoral ligament reconstruction. Knee 25:1157–1164

    Article  Google Scholar 

  10. Frings J, Seitlinger G (2020) Biomechanik und Untersuchung des patellofemoralen Gelenks. Arthroskopie 33:404–411

    Article  Google Scholar 

  11. Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497

    Article  Google Scholar 

  12. Gorbaty JD, Varkey DT, Hong IS, Trofa DP, Odum SM, Piasecki DP et al (2021) Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06784-5

    Article  PubMed  Google Scholar 

  13. Hevesi M, Heidenreich MJ, Camp CL, Hewett TE, Stuart MJ, Dahm DL et al (2019) The recurrent instability of the patella score: a statistically based model for prediction of long-term recurrence risk after first-time dislocation. Arthroscopy 35:537–543

    Article  Google Scholar 

  14. Hiemstra LA, Kerslake S, Lafave MR, Tucker A (2021) Patella alta is reduced following MPFL reconstruction but has no effect on quality-of-life outcomes in patients with patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 29:546–552

    Article  Google Scholar 

  15. Hiemstra LA, O’Brien CL, Lafave MR, Kerslake S (2021) Common physical examination tests for patellofemoral instability demonstrate weak inter-rater reliability. Arthrosc Sports Med Rehabil 3:e673–e677

    Article  Google Scholar 

  16. Johnson AA, Wolfe EL, Mintz DN, Demehri S, Shubin Stein BE, Cosgarea AJ (2018) Complications after tibial tuberosity osteotomy: association with screw size and concomitant distalization. Orthop J Sports Med 6:2325967118803614

    PubMed  PubMed Central  Google Scholar 

  17. Kita K, Tanaka Y, Toritsuka Y, Amano H, Uchida R, Takao R et al (2015) Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 43:2988–2996

    Article  Google Scholar 

  18. Leite CBG, Santos TP, Giglio PN, Pecora JR, Camanho GL, Gobbi RG (2021) Tibial tubercle osteotomy with distalization is a safe and effective procedure for patients with patella alta and patellar instability. Orthop J Sports Med 9:2325967120975101

    Article  Google Scholar 

  19. Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC (2014) Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 22:2545–2550

    Article  Google Scholar 

  20. Mortensen AJ, Ludwig TC, Adams BM, Adeyemi TF, Aoki SK (2021) The Blackburne-Peel index for determining patellar height is affected by tibial slope. Arthrosc Sports Med Rehabil 3:e359–e365

    Article  Google Scholar 

  21. Naveed MA, Ackroyd CE, Porteous AJ (2013) Long-term (ten- to 15-year) outcome of arthroscopically assisted Elmslie-Trillat tibial tubercle osteotomy. Bone Joint J 95-B:478–485

    Article  CAS  Google Scholar 

  22. Neri T, Parker DA, Beach A, Gensac C, Boyer B, Farizon F et al (2019) Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 27:805–813

    Article  Google Scholar 

  23. Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803

    Article  Google Scholar 

  24. Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125

    Article  Google Scholar 

  25. Tan SHS, Ngiam EHK, Lim JY, Lim AKS, Hui JH (2021) Surgical management of patella alta in patellofemoral instability: a systematic review and meta-analysis. Orthop J Sports Med 9:2325967121999642

    PubMed  PubMed Central  Google Scholar 

  26. Tanaka MJ, Elias JJ, Williams AA, Carrino JA, Cosgarea AJ (2015) Correlation between changes in tibial tuberosity-trochlear groove distance and patellar position during active knee extension on dynamic kinematic computed tomographic imaging. Arthroscopy 31:1748–1755

    Article  Google Scholar 

  27. Tischer T, Geier A, Lenz R, Woernle C, Bader R (2017) Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study. Knee Surg Sports Traumatol Arthrosc 25:3123–3133

    Article  Google Scholar 

  28. Trillat A, Dejour H, Couette A (1964) Diagnosis and treatment of recurrent dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot 50:813–824

    CAS  PubMed  Google Scholar 

  29. Tscholl PM, Wanivenhaus F, Centmaier-Molnar V, Camenzind RS, Fucentese SF (2020) Clinical and radiological results after one hundred fifteen MPFL reconstructions with or without tibial tubercle transfer in patients with recurrent patellar dislocation—a mean follow-up of 5.4 years. Int Orthop 44:301–308

    Article  CAS  Google Scholar 

  30. Yue RA, Arendt EA, Tompkins MA (2017) Patellar height measurements on radiograph and magnetic resonance imaging in patellar instability and control patients. J Knee Surg 30(9):943–950. https://doi.org/10.1055/s-0037-1599249

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsmedizin Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    Jannik Frings,  Matthias Krause &  Karl-Heinz Frosch

  2. Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland

    Karl-Heinz Frosch

Authors
  1. Jannik Frings
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karl-Heinz Frosch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jannik Frings.

Ethics declarations

Interessenkonflikt

J. Frings, M. Krause und K.-H. Frosch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Jörg Dickschas, Bamberg

Matthias Feucht, Stuttgart

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frings, J., Krause, M. & Frosch, KH. Tuberositasosteotomie zur Behandlung des lateralen Patellamaltrackings oder Patella alta mit begleitender Instabilität. Knie J. 4, 94–99 (2022). https://doi.org/10.1007/s43205-022-00143-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43205-022-00143-1

Schlüsselwörter

Keywords

Search

Navigation