Riallineamento mediale e/o distale della tuberosità tibiale anteriore. Attuali indicazioni, note di tecnica e risultati a distanza
Medial and/or distal realignment of anterior tibial tubercle. Current indications, technical notes and long-term results
Fifty-two patients and sixty-six knees with patellar symptoms and high-riding patella were operated in our department between June 1996 and June 2006, by a Elmslie-Trillat procedure with lateral release and tibial tubercle transfer medially and distally. Thirty-nine patients and forty-nine knees were available for this review and have been divided into two groups: those (21 knees) who felt the patella slipping and those (24 knees) who simply had pain with or without patellar, troclear or extensor apparatus dysplasias. Insall or Hughston proximal realignment had been associated in eight patients with patellar instability. The results were evaluated using the score of Fulkerson and Kujala and were slightly better in the first group. Excellent, very good and good results were respectively in 86% and 81% of instability category and 68% and 76% in the pain group; no poor results in the Fulkerson scale and 5% in Kujala score in the former and 11% and 15% in the latter. Medial and lowering translation of the tibial tuberosity with normalization of the patellar index must be taken in account to obtain a satisfactory result in patients with patella alta and patellofemoral syndrome, with instability or only with pain. This procedure is not indicated in case of excessive lateral tibial torsion, lateral and postero-lateral laxity and genu varum. In the latter deformity, if minor, we can do only distal without medial tubercle transplantation.
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