Skip to main content
Log in

Tibial tubercle osteotomy for patello-femoral joint disorders

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage.

Level of evidence III.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Al-Sayyad MJ, Cameron JC (2002) Functional outcome after tibial tubercle transfer for the painful patella alta. Clin Orthop Relat Res 396:152–162

    Article  PubMed  Google Scholar 

  2. Arendt E (2005) Anatomy and malalignment of the patellofemoral joint: its relation to patellofemoral arthrosis. Clin Orthop Relat Res 436:71–75

    Article  PubMed  Google Scholar 

  3. Barbari S, Raugstad TS, Lichtenberg N et al (1990) The Hauser operation for patella dislocation: 3–32 year results in 63 knees. Acta Orthop Scand 61(1):32–35

    Article  CAS  PubMed  Google Scholar 

  4. Bellemans J, Cauwenberghs F, Brys P et al (1998) Fracture of the proximal tibia after fulkerson anteromedial tibia tubercle transfer a report of four cases. Am J Sports Med 26:300–302

    CAS  PubMed  Google Scholar 

  5. Bessette GC, Hunter RE (1988) The Maquet procedure: a retrospective review. Clin Orthop Relat Res 232:159–167

    PubMed  Google Scholar 

  6. Caldwell PE, Bohlen BA, Owen JR et al (2004) Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy. Clin Orthop Relat Res 424:173–179

    Article  PubMed  Google Scholar 

  7. Carofino BC, Fulkerson JP (2008) Anteromedialization of the tibial tubercle for patellofemoral arthritis in patients >50 years. J Knee Surg 21(2):101–105

    PubMed  Google Scholar 

  8. Chinzei N, Ishida K, Kuroda R (2014) Tibial tubercle osteotomy with screw fixation for total knee replacement. Orthopaedics 37(4):367–373

    Article  Google Scholar 

  9. Cosgarea AJ, Schatzke MD, Seth AK et al (1999) Biomechanical analysis of flat and oblique tibial tubercle osteotomy for recurrent patellar instability. Am J Sports Med 27:507–512

    CAS  PubMed  Google Scholar 

  10. Cosgarea AJ, Freedman JA, McFarland EG (2001) Nonunion of the tibial tubercle shingle following Fulkerson osteotomy. Am J Sports Med 14:51–54

    CAS  Google Scholar 

  11. Davis K, Caldwell PE, Wayne J et al (2000) Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. Clin Orthop Relat Res 380:241–249

    Article  PubMed  Google Scholar 

  12. Dejour H, Walch G, Nove-Josserand L et al (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  PubMed  Google Scholar 

  13. Eager MR, Bader DA, Kelly JDT et al (2004) Delayed fracture of the tibia following anteromedialisation osteotomy of the tibial tubercle: a report of 5 cases. Am J Sports Med 32:1041–1048

    Article  PubMed  Google Scholar 

  14. Elias JJ, Cech JA, Weinstein DM et al (2004) Reducing the lateral force acting on the patella does not consistently decrease patellofemoral pressures. Am J Sports Med 32:1202–1208

    Article  PubMed  Google Scholar 

  15. Escamilla RF, Zheng N, Macleod TD et al (2009) Patellofemoral joint force and stress during the wall squat and one-leg squat. Med Sci Sports Exerc 41(4):879–888

    Article  PubMed  Google Scholar 

  16. Farr J (2007) Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res 463:187–194

    PubMed  Google Scholar 

  17. Feller JA (2012) Distal realignment tibial tuberosity transfer. Sports Med Arthrosc Rev 20(3):152–161

    Article  Google Scholar 

  18. Feller JA, Amis AA, Andrish JT et al (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23(5):542–553

    Article  PubMed  Google Scholar 

  19. Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 177:176–181

    PubMed  Google Scholar 

  20. Fulkerson JP, Becker GJ, Meaney JA et al (1990) Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med 18(5):490–497

    Article  CAS  PubMed  Google Scholar 

  21. Fulkerson JP (1999) Fracture of the proximal tibia after Fulkerson anteromedial tibial tubercle transfer: a report of four cases. Am J Sports Med 27:265

    CAS  PubMed  Google Scholar 

  22. Gallo RA, Feeley BT (2009) Cartilage defects of the femoral trochlea. Knee Surg Sports Traumatol Arthrosc 17:1316–1325

    Article  PubMed  Google Scholar 

  23. Gobbi A, Kon E, Berruto M et al (2009) Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med 37(6):1083–1092

    Article  PubMed  Google Scholar 

  24. Godde S, Rupp S, Dienst M et al (2001) Fracture of the proximal tibia six months after Fulkerson osteotomy: a report of two cases. J Bone Joint Surg (Br) 83(6):832–833

    Article  CAS  Google Scholar 

  25. Greslamer RP, Weinstein CH (2001) Applied biomechanics of the patella. Clin Orthop Relat Res 389:9–14

    Article  Google Scholar 

  26. Hauser EDW (1938) Total tendon transplant for slipping patella: a new operation for recurrent dislocation of the patella. Surg Gynecol Obstet 66:199–214

    Google Scholar 

  27. Heatley FW, Allen PR, Patrick JH (1986) Tibial tubercle advancement for anterior knee pain: a temporary or permanent solution. Clin Orthop Relat Res 208:215–224

    PubMed  Google Scholar 

  28. Hingelbaum S, Best R, Huth J et al (2014) The TT-TG index: a new knee size adjusted a measure method to determine the TT-TG distance. Knee Surg Sports Traumatol Arthrosc 22(10):2388–2395

    Article  PubMed  Google Scholar 

  29. Jenny JY, Sader Z, Henry A et al (1996) Elevation of the tibial tubercle for patellofemoral pain syndrome: an 8 to 15 year follow-up. Knee Surg Sports Traumatol Arthrosc 4(2):92–96

    Article  CAS  PubMed  Google Scholar 

  30. Juliusson R, Markhede G (1984) A modified hauser procedure for recurrent dislocation of the patella: a long-term follow-up study with special reference to osteoarthritis. Arch Orthop Trauma Surg 103(1):42–46

    Article  CAS  PubMed  Google Scholar 

  31. Kadambande SS, Auyeung J, Ghandour A et al (2004) A review of wound healing following Maquet osteotomy. Knee 11(6):463–467

    Article  CAS  PubMed  Google Scholar 

  32. Kanamiya T, Naito M, Hara M et al (2006) Tibial tubercle transfer on a medial periosteal pedicle—a report of a new technique. Knee 13(6):469–473

    Article  PubMed  Google Scholar 

  33. Karamehmetoglu M, Ozturkmen Y, Azboy I et al (2007) Fulkersons osteotomy for the treatment of chronic patellofemoral malalignment. Acta Orthop Traumatol Turc 41(1):21–30

    PubMed  Google Scholar 

  34. Kuroda R, Kambic H, Valdevit A et al (2001) Articular cartilage contact pressures after tibial tuberosity transfer: a cadaveric study. Am J Sports Med 29:403–409

    CAS  PubMed  Google Scholar 

  35. Luhmann SJ, Fuhrhop S, O’Donnell JC et al (2011) Tibial fractures after tibial tubercle osteotomies for patellar instability: a comparison of three osteotomy configurations. J Child Orthop 5(1):19–26

    Article  PubMed Central  PubMed  Google Scholar 

  36. Lund F, Nilsson BE (1980) Anterior displacement of the tibial tuberosity in chondromalacia patellae. Acta Orthop Scan 51(4):679–688

    Article  CAS  Google Scholar 

  37. Mandelbaum B, Browne JE, Fu F et al (2007) Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea. Am J Sports Med 35(6):915–921

    Article  PubMed  Google Scholar 

  38. Marcacci M, Zaffagnini S, Iacono F et al (1995) Results in the treatment of recurrent dislocation of the patella after 30 years’ follow-up. Knee Surg Sports Traumatol Arthrosc 3:163–166

    Article  CAS  PubMed  Google Scholar 

  39. Maquet P (1976) Advancement of the tibial tuberosity. Clin Orthop Relat Res 15:225–230

    Google Scholar 

  40. Monson J, Arendt EA (2012) Rehabilitative protocols for select patellofemoral procedures and nonoperative management schemes. Sports Med Arthrosc Rev 20(3):136–144

    Article  Google Scholar 

  41. Nakagawa K, Wada Y, Minamide M et al (2002) Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg (Br) 84(6):861–864

    Article  CAS  Google Scholar 

  42. Naranja RJ, Reilly PJ, Kuhlman JR et al (1996) Long-term evaluation of the Elmslie-Trillat-Maquet procedure for patellofemoral dysfunction. Am J Sports Med 24(6):779–784

    Article  PubMed  Google Scholar 

  43. Naveed MA, Ackroyd CE, Porteous AJ (2013) Long-term (ten to 15 year) outcome of the arthroscopically assisted Elmslie-Trillat tibial tubercle osteotomy. Bone Joint J 95-B(4):478–485

    Article  CAS  PubMed  Google Scholar 

  44. Pan HQ, Kish V, Boyd RD (1993) The Maquet procedure: effect of tibial shingle length on patellofemoral pressures. J Orthop Res 11(2):199–204

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  46. Phillips CL, Silver DA, Schranz PJ, Mandalia V (2010) The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 92(8):1045–1053

    Article  CAS  PubMed  Google Scholar 

  47. Pidoriana AJ, Weinstein RN, Buuck DA et al (1997) Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 25(4):533–537

    Article  Google Scholar 

  48. Post WR, Fulkerson JP (1992) Distal realignment of the patellofemoral joint indications, effects, results and recommendations. Orthop Clin North Am 23(4):631–643

    CAS  PubMed  Google Scholar 

  49. Priitsch T, Haim A, Snir N et al (2007) Tailored tibial tubercle transfer for patellofemoral malalignment: analysis of clinical outcomes. Knee Surg Sports Traumatol Arthrosc 15:994–1002

    Article  Google Scholar 

  50. Roux C (1979) The classic: recurrent dislocation of the patella: operative treatment. Clin Orthop Relat Res 144:4–8

    PubMed  Google Scholar 

  51. Rue JP, Colton A, Zare SM et al (2008) Trochlear contact pressures after straight anteriorization of the tibial tuberosity. Am J Sports Med 36(10):1953–1959

    Article  PubMed  Google Scholar 

  52. Schoettle PB, Zanetti M, Seifert B (2006) The tibial tuberosity–trochlear groove distance; a comparison study between CT and MRI scanning. Knee 13(1):26–31

    Article  PubMed  Google Scholar 

  53. Schmid F (1993) The Maquet procedure in the treatment of patellofemoral osteoarthrosis: long-term results. Clin Orthop Relat Res 294:254–258

    PubMed  Google Scholar 

  54. Shirazi-Adl A, Mesfar W (2007) Effect of tibial tubercle elevation on biomechanics of the entire knee joint under muscle loads. Clin Biomech (Bristol, Avon) 22(3):344–351

    Article  CAS  Google Scholar 

  55. Souza RB, Draper CE, Fredericson M et al (2010) Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther 40(5):277–285

    Article  PubMed  Google Scholar 

  56. Stetson WB, Friedman MJ, Fulkerson JP et al (1997) Fracture of the proximal tibia with immediate weight bearing after a Fulkerson osteotomy. Am J Sports Med 25:570–574

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  58. Wang CJ (2001) Management of patellofemoral arthrosis in middle-aged patients. Chang Gung Med J 24(11):672–679

    CAS  PubMed  Google Scholar 

  59. Wang CJ, Chen LM, Chen HS (1999) Patellofemoral disorders treated by distal realignment. J Orthop Surg ROC 16:61–68

    Google Scholar 

  60. Wang CJ, Wong T, Ko JY et al (2012) Triple positioning of tibial tubercle osteotomy for patellofemoral disorders. Knee 21(1):133–137

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthew J. Hall.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hall, M.J., Mandalia, V.I. Tibial tubercle osteotomy for patello-femoral joint disorders. Knee Surg Sports Traumatol Arthrosc 24, 855–861 (2016). https://doi.org/10.1007/s00167-014-3388-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3388-4

Keywords

Navigation