International Orthopaedics

, Volume 38, Issue 1, pp 61–66 | Cite as

Prevalence of osteoarthritis and clinical results after the Elmslie-Trillat procedure: a retrospective long-term follow-up

  • Sebastian FarrEmail author
  • Dominique Huyer
  • Patrick Sadoghi
  • Martin Kaipel
  • Franz Grill
  • Rudolf Ganger
Original Paper



Tibial tuberosity medialisation may be followed by osteoarthritis in the long term due to increased patellofemoral contact pressure and altered knee joint kinematics. We aimed to (1) systematically assess the grades of tibiofemoral and patellofemoral osteoarthritis ten to 30 years after the Elmslie-Trillat procedure and (2) to evaluate long-term knee function and activities of daily living.


A total of 26 patients (30 knees) were re-evaluated at a minimum follow-up of 12.3 years (mean 20.9 ± 4.1 years). Osteoarthritis was graded according to Kellgren and Lawrence (K/L) and Sperner. All patients were clinically evaluated using the Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Radiographic data were compared to an age-, sex- and body mass index-matched control group of healthy patients.


Radiographic evaluation revealed seven cases (23.3 %) with advanced osteoarthritis (K/L and Sperner grades 3 and 4). However, the observed differences from the matched cohort were not statistically significant (P = 0.189). A positive correlation was found between the age at index procedure and tibiofemoral osteoarthritis at follow-up (P = 0.013). Patient satisfaction was relatively high, showing a mean KSS of 89.9 (knee score) and 94.8 (function score), and a mean KOOS of 78.7. However, we noted four cases of frequent patellar re-dislocations and three total knee arthroplasties.


The Elmslie-Trillat procedure was associated with several cases of advanced tibiofemoral and patellofemoral osteoarthritis in the long term, especially if the procedure was performed late. Clinical results were still good to excellent in the majority of patients despite some observed cases of re-dislocations and decreased ability to perform sports.


Elmslie-Trillat procedure Tibial tuberosity medialisation Patellar dislocation Osteoarthritis Joint kinematics 



We thank Mrs. Helka Barna, M.D. and Mrs. Alexandra Fochtmann, M.D. for their assistance in data collection.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Earhart C, Patel DB, White EA, Gottsegen CJ, Forrester DM, Matcuk GR Jr (2013) Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options. Emerg Radiol 20:11–23PubMedCrossRefGoogle Scholar
  2. 2.
    Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121PubMedCrossRefGoogle Scholar
  3. 3.
    Vollnberg B, Koehlitz T, Jung T, Scheffler S, Hoburg A, Khandker D et al (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22:2347–2356PubMedCrossRefGoogle Scholar
  4. 4.
    Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F (2012) Modern management of patellar instability. Int Orthop 36:2447–2456PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Strobl W, Grill F (1998) Patellar luxation. Orthopade 27:197–205PubMedCrossRefGoogle Scholar
  6. 6.
    Ji G, Wang F, Zhang Y, Chen B, Ma L, Dong J (2012) Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents. Int Orthop 36:1819–1825PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Pećina M, Ivković A, Hudetz D, Smoljanović T, Janković S (2010) Sagittal osteotomy of the patella after Morscher. Int Orthop 34:297–303PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Trillat A, Dejour H, Couette A (1964) Diagnosis and treatment of recurrent dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot 50:813–824PubMedGoogle Scholar
  9. 9.
    Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34:305–309PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Barber FA, McGarry JE (2008) Elmslie-Trillat procedure for the treatment of recurrent patellar instability. Arthroscopy 24:77–81PubMedCrossRefGoogle Scholar
  11. 11.
    Carney JR, Mologne TS, Muldoon M, Cox JS (2005) Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up. Am J Sports Med 33:1220–1223PubMedCrossRefGoogle Scholar
  12. 12.
    Endres S, Wilke A (2011) A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability. BMC Musculoskelet Disord 12:48PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Karataglis D, Green MA, Learmonth DJ (2006) Functional outcome following modified Elmslie-Trillat procedure. Knee 13:464–468PubMedCrossRefGoogle Scholar
  14. 14.
    Krüger T, Birke A, Decker T, Röder T, Hein W (1999) Results of the Elmslie-Trillat procedure in cases of patella(sub)luxation related to chondral pathology. Unfallchirurg 102:700–707PubMedCrossRefGoogle Scholar
  15. 15.
    Sillanpää PJ, Mattila VM, Visuri T, Mäenpää H, Pihlajamäki H (2011) Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis. Knee Surg Sports Traumatol Arthrosc 19:230–235PubMedCrossRefGoogle Scholar
  16. 16.
    Smith TO, Song F, Donell ST, Hing CB (2011) Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:988–998PubMedCrossRefGoogle Scholar
  17. 17.
    Kuroda R, Kambic H, Valdevit A, Andrish JT (2001) Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study. Am J Sports Med 29:403–409PubMedGoogle Scholar
  18. 18.
    Mani S, Kirkpatrick MS, Saranathan A, Smith LG, Cosgarea AJ, Elias JJ (2011) Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 39:1024–1031PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Saranathan A, Kirkpatrick MS, Mani S, Smith LG, Cosgarea AJ, Tan JS, Elias JJ (2012) The effect of tibial tuberosity realignment procedures on the patellofemoral pressure distribution. Knee Surg Sports Traumatol Arthrosc 20:2054–2061PubMedCrossRefGoogle Scholar
  20. 20.
    Asif S, Choon DS (2005) Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong) 13:280–284Google Scholar
  21. 21.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  22. 22.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedCrossRefGoogle Scholar
  23. 23.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRefGoogle Scholar
  24. 24.
    Sperner G, Wanitschek P, Benedetto KP, Glötzer W (1990) Late results in patellar fracture. Aktuelle Traumatol 20:24–28PubMedGoogle Scholar
  25. 25.
    Goslings JC, Gouma DJ (2008) What is a surgical complication? World J Surg 32:952PubMedCrossRefGoogle Scholar
  26. 26.
    Hoenig JM, Heisey DM (2001) The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat 55:19–24CrossRefGoogle Scholar
  27. 27.
    Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861–864PubMedCrossRefGoogle Scholar
  28. 28.
    Nomura E, Inoue M, Kobayashi S (2007) Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 35:1851–1858PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sebastian Farr
    • 1
    Email author
  • Dominique Huyer
    • 2
  • Patrick Sadoghi
    • 3
  • Martin Kaipel
    • 4
  • Franz Grill
    • 1
  • Rudolf Ganger
    • 1
  1. 1.Department of Pediatric Orthopedics, Deformity Correction and Adult Foot and Ankle SurgeryOrthopedic Hospital SpeisingViennaAustria
  2. 2.Medical University of ViennaViennaAustria
  3. 3.Department of Orthopedic SurgeryUniversity Hospital GrazGrazAustria
  4. 4.Orthopedic DepartmentBarmherzige Brüder HospitalEisenstadtAustria

Personalised recommendations