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Arthroskopie

, Volume 23, Issue 3, pp 208–214 | Cite as

Einfluss des Tuberositastransfers auf das patellofemorale Gelenk

  • S. Ostermeier
  • C. Becher
Leitthema

Zusammenfassung

Zur operativen Therapie einer patellaren Instabilität oder degenerativer patellofemoraler Veränderungen werden im klinischen Alltag häufig knöcherne Eingriffe mit Transfers der Tuberositas tibiae eingesetzt. Dieser Eingriff hat Auswirkungen auf die retropatellare Druckbelastung und auf die Kinematik der Patella. Je nachdem in welche Richtung dieser Transfer stattfindet, werden Bereiche der retropatellaren Knorpeloberfläche entlastet und andere belastet. Die populärste Kombination der Transferrichtungen aus Medialisierung und Ventralisierung führt zu einer Entlastung der lateralen Patellafacette und zu einer Stabilisierung der Patellakinematik gegen laterale Auslenkungen und Luxationen.

Schlüsselwörter

Malalignment Patellare Instabilität Biomechanik Knorpel Kinematik 

Influence of tubercle transfer on the patellofemoral joint

Abstract

Transfer of the tibial tubercle is commonly used for treatment of an instable patella or degenerative changes of the patellofemoral joint. This treatment has significant effects on patellar kinematics as well as on retropatellar pressure. Retropatellar contact pressure is decreased or increased depending on the direction of the transfer. Representing one of the most popular combinations of transfer directions, ventromedialization of the tibial tubercle leads to decreased contact pressure of the lateral patellar facet and to stabilization of the patella against lateral dislocation.

Keywords

Malalignment Patellar instability Biomechanics Cartilage Kinematics 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Ali SA, Helmer R, Terk MR (2009) Patella alta: lack of correlation between patellotrochlear cartilage congruence and commonly used patellar height ratios. AJR Am J Roentgenol 193(5):1361–1366CrossRefPubMedGoogle Scholar
  2. 2.
    Barber FA, McGarry JE (2008) Elmslie-Trillat procedure for the treatment of recurrent patellar instability. Arthroscopy 24(1):77–81CrossRefPubMedGoogle Scholar
  3. 3.
    Barnett AJ, Prentice M, Mandalia V et al (2009) Patellar height measurement in trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 17(12):1412–1415CrossRefPubMedGoogle Scholar
  4. 4.
    Beck PR, Thomas AL, Farr J et al (2005) Trochlear contact pressures after anteromedialization of the tibial tubercle. Am J Sports Med 33(11):1710–1715CrossRefPubMedGoogle Scholar
  5. 5.
    Biedert RM (2008) Osteotomies. Orthopäde 37(9):872–883CrossRefPubMedGoogle Scholar
  6. 6.
    Biedert RM, Gruhl C (1997) Axial computed tomography of the patellofemoral joint with and without quadriceps contraction. Arch Orthop Trauma Surg 116(1–2):77–82Google Scholar
  7. 7.
    Bull AM, Amis A (2005) Biomechanik. In: Kohn D (Hrsg) Knie. Thieme, Stuttgart, S 48Google Scholar
  8. 8.
    Caton J, Deschamps G, Chambat P et al (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325PubMedGoogle Scholar
  9. 9.
    Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop [Epub ahead of print]Google Scholar
  10. 10.
    Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238PubMedGoogle Scholar
  11. 11.
    Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg [Am] 90(12):2751–2762Google Scholar
  12. 12.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26CrossRefPubMedGoogle Scholar
  13. 13.
    Elias JJ, Cech JA, Weinstein DM, Cosgrea AJ (2004) Reducing the lateral force acting on the patella does not consistently decrease patellofemoral pressures. Am J Sports Med 32(5):1202–1208CrossRefPubMedGoogle Scholar
  14. 14.
    Feller JA, Amis AA, Andrish JT et al (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23(5):542–553CrossRefPubMedGoogle Scholar
  15. 15.
    Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop (177):176–181Google Scholar
  16. 16.
    Fulkerson JP (2002) Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 30(3):447–456PubMedGoogle Scholar
  17. 17.
    Fulkerson JP (2004) Patellar subluxation. In: Fulkerson JP (ed) Disorders of the patellofemoral joint. Lippincott Williams & Wilkins, Philadelphia, p 185Google Scholar
  18. 18.
    Fulkerson JP, Becker GJ, Meaney JA et al (1990) Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med 18(5):490–496CrossRefPubMedGoogle Scholar
  19. 19.
    Hockings M, Cameron JC (2004) Patella baja following chronic quadriceps tendon rupture. Knee 11(2):95–97CrossRefPubMedGoogle Scholar
  20. 20.
    Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104PubMedGoogle Scholar
  21. 21.
    Kohn D, Steimer O, Seil R (2004) Anterior medial correction the tibial tuberosity. Orthopäde 33(2):218–223CrossRefPubMedGoogle Scholar
  22. 22.
    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(4):403–409PubMedGoogle Scholar
  23. 23.
    Luyckx T, Didden K, Vandenneucker H et al (2009) Is there a biomechanical explanation for anterior knee pain in patients with patella alta? Influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg [Br] 91(3):344–350Google Scholar
  24. 24.
    Mann RW, Roberts CA, Thomas MD, Davy DT (1991) Pressure erosion of the femoral trochlea, patella baja, and altered patellar surfaces. Am J Phys Anthropol 85(3):321–327CrossRefPubMedGoogle Scholar
  25. 25.
    Maquet P (1976) Advancement of the tibial tuberosity. Clin Orthop Relat Res (115):225–230Google Scholar
  26. 26.
    Müller W, Wirz D (2000) Anatomie, Biomechanik und Dynamik des Patellofemoragelenks. In: Wirth CJ, Rudert M (Hrsg) Das patellofemorale Schmerzsyndrom. Steinkopff, Darmstadt, S 3Google Scholar
  27. 27.
    Nakamura N, Ellis M, Seedhom BB (1985) Advancement of the tibial tuberosity. A biomechanical study. J Bone Joint Surg [Br] 67(2):255–260Google Scholar
  28. 28.
    Ostermeier S, Hurschler C, Stukenborg-Colsman C, Wirth CJ (2006) In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy 22(3):308–319CrossRefPubMedGoogle Scholar
  29. 29.
    Paar O, Riederer A (1988) Comparative measurement of retropatellar pressure and contact surface before and after distal repositioning of the tibial tuberosity in patella alta. An experimental study. Unfallchirurg 91(5):229–233PubMedGoogle Scholar
  30. 30.
    Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP (1997) Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 25(4):533–537CrossRefPubMedGoogle Scholar
  31. 31.
    Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med 21(3):521–546CrossRefPubMedGoogle Scholar
  32. 32.
    Radin EL (1986) The Maquet procedure – anterior displacement of the tibial tubercle. Indications, contraindications, and precautions. Clin Orthop Relat Res (213):241–248Google Scholar
  33. 33.
    Ramappa AJ, Apreleva M, Harrold FR et al (2006) The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Med 34(5):749–756CrossRefPubMedGoogle Scholar
  34. 34.
    Rantanen J, Paananen M (1996) Modified Hauser operation for patellar instability. Immediate mobilization of 35 knees, a 5–8 year follow-up study. Acta Orthop Scand 67(5):455–458CrossRefPubMedGoogle Scholar
  35. 35.
    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):1953–1959CrossRefPubMedGoogle Scholar
  36. 36.
    Schoettle PB, Zanetti M, Seifert B et al (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13(1):26–31CrossRefPubMedGoogle Scholar
  37. 37.
    Seil R, Muller B, Georg T et al (2000) Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc 8(4):231–236CrossRefPubMedGoogle Scholar
  38. 38.
    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):344–351Google Scholar
  39. 39.
    Stiebel M (2010) Osirix quick tips measuring the TT-TG distance. London, Meeting IPSGGoogle Scholar
  40. 40.
    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
  41. 41.
    Van Huyssteen AL, Hendrix MR, Barnett AJ et al (2006) Cartilage-bone mismatch in the dysplastic trochlea. An MRI study. J Bone Joint Surg [Br] 88(5):688–691Google Scholar
  42. 42.
    Wagenaar FC, Koeter S, Anderson PG, Wymenga AB (2007) Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation. Knee 14(1):51–54CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Orthopädische KlinikMedizinische Hochschule Hannover (MHH)HannoverDeutschland

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