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Verschiebeosteotomie der Tuberositas tibiae bei patellofemoraler Instabilität

Sliding osteotomy of the tibial tuberosity in patellofemoral instability

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Zusammenfassung

Operationsziel

Stabilisierung der Patella über eine Versetzung der Tuberositas tibiae und damit Normalisierung der Patellaposition.

Indikationen

Patellofemorale Instabilität mit erhöhtem Tibial-tuberosity-trochlear-groove(TT-TG)-Abstand (≥ 20 mm) und vergrößertem Patellahöhenindex [nach Caton-Deschamps (≥ 1,3)].

Kontraindikationen

Offene Wachstumsfuge und Apophysenfuge der proximalen Tibia. Normaler TT-TG-Abstand und normale Patellaposition. Höhergradige Knorpelschäden der femoropatellaren Gelenkabschnitte (ICRS Grad 3 und 4).

Operationstechnik

Untersuchung des Kniegelenks in Narkose und Evaluation von Stabilität und mediolateraler Translation der Patella. Diagnostische Kniearthroskopie mit Therapie von chondralen oder osteochondralen Läsionen. Anschließend längsverlaufender Hautschnitt lateral der Tuberositas tibiae und Darstellen der Tuberositas sowie des Patellasehnenansatzes. Osteotomie der Tuberositas tibiae in der Frontalebene, sodass ein mindestens 6 cm langes Fragment entsteht. Anschließend Verschieben der Tuberositas in die gewünschte Position nach medial und gegebenenfalls distal entsprechend der präoperativen Analyse und Planung. Dann vorsichtiges Durchbohren der posterioren Kortikalis der Tibia und Zugschraubenosteosynthese.

Weiterbehandlung

Teilbelastung 20 kg in Mecronschiene für 6 Wochen. Bewegungslimitierung Extension/Flexion 0/0/90 Grad aus Mecronschiene heraus ohne forcierte aktive Streckung. Isometrische Anspannungsübungen für die Oberschenkelmuskulatur in Kniestreckung.

Ergebnisse

Bei sorgfältiger Vorbereitung und Durchführung, bei ausgeprägter Trochleadysplasie in Kombination mit einer Plastik des medialen patellofemoralen Ligaments, zeigt die Verschiebeosteotomie der Tuberositas tibiae eine hohe Erfolgsrate.

Abstract

Objective

The development of a stable patellofemoral joint by distal realignment with normal positioning of the patella.

Indications

Patellofemoral instability with increased tibial tubercle to trochlear groove (TT–TG) distance ≥ 20 mm and higher Caton–Deschamps patellar height index ≥ 1.3.

Contraindications

Open epiphyseal and apophyseal plates of the proximal tibia, normal TT–TG distance with normal patellar height, and high-grade chondral lesions of the patellofemoral joint (ICRS grades 3 and 4).

Surgical technique

Examination of the knee joint under anesthesia and evaluation of stability and mediolateral translation of the patella. Diagnostic knee arthroscopy and treatment of chondral or osteochondral lesions. Lateral approach to the tibial tuberosity with soft tissue mobilization and exposure of the patellar tendon. Osteotomy is performed in the frontal plane, creating a fragment at least 6 cm long. The tuberosity is slid into the desired position, medially and distally, if necessary, according to preoperative analysis and planning, followed by careful drilling of the posterior tibial cortex and lag screw osteosynthesis.

Postoperative management

Partial weight-bearing of 20 kg in a MECRON knee brace for 6 weeks. Mobilization 0/0/90° from the MECRON knee brace without active knee extension. Isometric training of the thigh muscles with the knee fully extended.

Results

With meticulous planning and implementation, and in cases of severe trochlear dysplasia combined with medial patellofemoral ligament reconstruction, the technique of sliding osteotomy of the tibial tuberosity has a high success rate.

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Authors and Affiliations

  1. Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland

    C. Konrads, S. Reppenhagen, M. Hoberg, M. Rudert & T. Barthel

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  1. C. Konrads
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  2. S. Reppenhagen
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  3. M. Hoberg
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  4. M. Rudert
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  5. T. Barthel
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Correspondence to C. Konrads.

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Interessenkonflikt

C. Konrads, S. Reppenhagen, M. Hoberg, M. Rudert und T. Barthel geben an, dass kein Interessenkonflikt besteht.

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Redaktion

M. Rudert, Würzburg

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R. Himmelhan, Mannheim

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Konrads, C., Reppenhagen, S., Hoberg, M. et al. Verschiebeosteotomie der Tuberositas tibiae bei patellofemoraler Instabilität. Oper Orthop Traumatol 27, 464–473 (2015). https://doi.org/10.1007/s00064-015-0421-9

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  • DOI: https://doi.org/10.1007/s00064-015-0421-9

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