Abstract
Purpose
The aim of this study is to examine the short-term effects of patellar tendon advancement on the proximal tibial slope in the skeletally immature patient.
Methods
A retrospective, non-randomized, comparative cohort design was used. Koshino indices and tibial slopes were assessed pre-operatively and post-operatively and compared with age- and sex-matched controls.
Results
Nine children with 17 patellar tendon advancements were analyzed for changes in Koshino indices. Of these 17 tibiae, radiographs on changes in tibial slope were available for 16 tibiae which were also compared with controls. Children aged <11 years had a greater initial posterior tibial slope (69.8° ± 3.5°) than age-matched controls (80.3° ± 2.7°). A decrease in posterior slope was seen in these younger patients (average change 10.3° ± 4.8°) at an average of 1.6 years of follow-up. Of the nine apophyses in children aged <11 years of age, seven had undergone premature closure.
Conclusion
Patellar tendon advancement appears to have an unreported effect on the proximal tibial growth in the young patient (<11 years old). These patients appear to be susceptible to apophyseal closure, resulting in subsequent loss of posterior tibial slope. Surgeons should be aware of this effect and monitor younger patients with radiographs if performing this procedure.
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References
Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K et al (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12(3):165–168
de Boer JJ, Blankevoort L, Kingma I, Vorster W (2009) In vitro study of inter-individual variation in posterior slope in the knee joint. Clin Biomech (Bristol, Avon) 24(6):488–492
Chiu K, Zhang S, Zhang G (2000) Posterior slope of tibial plateau in Chinese. J Arthroplast 15(2):224–227
Gugenheim JJ, Rosenthal RK, Simon SR (1979) Knee flexion deformities and genu recurvatum in cerebral palsy: roentgenographic findings. Dev Med Child Neurol 21(5):563–570
Beskin JL, Burke SW, Johnston CE, Roberts JM (1986) Clinical basis for a mechanical etiology in adolescent Blount’s disease. Orthopedics 9(3):365–370
Cook SD, Lavernia CJ, Burke SW, Skinner HB, Haddad RJ Jr (1983) A biomechanical analysis of the etiology of tibia vara. J Pediatr Orthop 3(4):449–454
Gage JR (2004) The treatment of gait problems in cerebral palsy. MacKeith Press (distributed by Cambridge University Press), London
Stout JL, Gage JR, Schwartz MH, Novacheck TF (2008) Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Jt Surg 90(11):2470–2484
Novacheck TF, Stout JL, Gage JR, Schwartz MH (2009) Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. Surgical technique. J Bone Jt Surg Am 91[Suppl 2]:271–286
Das SP, Pradhan S, Ganesh S, Sahu PK, Mohanty RN, Das SK (2012) Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy. Indian J Orthop 46(2):221–228
Sutherland D, Davids J (1993) Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res 288:139–147
Koshino T, Sugimoto K (1989) New measurement of patellar height in the knees of children using the epiphyseal line midpoint. J Pediatr Orthop 9(2):216–218
Joseph B, Reddy K, Varghese RA, Shah H, Doddabasappa SN (2010) Management of severe crouch gait in children and adolescents with cerebral palsy. J Pediatr Orthop 30(8):832–839
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Patthanacharoenphon, C., Maples, D.L., Saad, C. et al. The effects of patellar tendon advancement on the immature proximal tibia. J Child Orthop 7, 139–146 (2013). https://doi.org/10.1007/s11832-012-0480-5
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DOI: https://doi.org/10.1007/s11832-012-0480-5