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The effects of patellar tendon advancement on the immature proximal tibia

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

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

  1. 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

    CAS  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. Chiu K, Zhang S, Zhang G (2000) Posterior slope of tibial plateau in Chinese. J Arthroplast 15(2):224–227

    Article  CAS  Google Scholar 

  4. 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

    Article  CAS  Google Scholar 

  5. 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

    CAS  Google Scholar 

  6. 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

    Article  CAS  Google Scholar 

  7. Gage JR (2004) The treatment of gait problems in cerebral palsy. MacKeith Press (distributed by Cambridge University Press), London

  8. 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

    Article  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. 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

    Google Scholar 

  11. Sutherland D, Davids J (1993) Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res 288:139–147

    Google Scholar 

  12. 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

    CAS  Google Scholar 

  13. 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

    Google Scholar 

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Conflict of interest

None.

Author information

Authors and Affiliations

  1. College of Human Medicine, Michigan State University, Grand Rapids, MI, USA

    Cameron Patthanacharoenphon & Christina Saad

  2. Helen DeVos Children’s Hospital, Grand Rapids, MI, USA

    Dayle L. Maples & Michael J. Forness

  3. American Family Children’s Hospital, University of Wisconsin, Madison, WI, USA

    Matthew A. Halanski

  4. Orthopaedics and Rehabilitation University of Wisconsin, UWMF Centennial Building, Rm 6170-12D, Madison, WI, 53705, USA

    Matthew A. Halanski

Authors
  1. Cameron Patthanacharoenphon
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  2. Dayle L. Maples
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  3. Christina Saad
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  4. Michael J. Forness
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  5. Matthew A. Halanski
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Corresponding author

Correspondence to Matthew A. Halanski.

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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

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