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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 10, pp 2350–2356 | Cite as

Variations in kinematics and function following patellar stabilization including tibial tuberosity realignment

  • John J. EliasEmail author
  • John A. Carrino
  • Archana Saranathan
  • Loredana M. Guseila
  • Miho J. Tanaka
  • Andrew J. Cosgarea
Knee

Abstract

Purpose

The current study was performed to characterize the influence of patellar stabilization procedures on patellofemoral and tibiofemoral dynamic motion.

Methods

Six knees were evaluated pre-operatively and 1 year or longer following stabilization via tibial tuberosity realignment, with simultaneous medial patellofemoral ligament reconstruction performed for five knees. Knees were imaged during extension against gravity using a dynamic CT scanner. Models representing each knee at several positions of extension were reconstructed from the images. Local coordinate systems were created within one femur, patella and tibia for each knee, with shape matching of the bones used to transfer the coordinate axes to the other models. The patellar lateral shift and tilt and tibial external rotation were quantified based on the reference axes and interpolated to flexion angles from 5° to 40°. Pre-operative and post-operative data were compared with the paired t tests.

Results

Surgical realignment significantly decreased the average patellar lateral shift and tilt at low flexion angles. At 5°, surgical realignment decreased the average lateral shift from 15.5 (6.3) to 8.5 (4.7) mm and decreased the average lateral tilt from 20.8 (9.4)° to 13.8 (6.4)°. The changes were statistically significant (p < 0.05) at 5° and 10° of flexion, as well as 20° for lateral shift. The average tibial external rotation also increased significantly at 30° and 40° following surgery.

Conclusion

Patellar stabilization including a component of tuberosity realignment reduces patellar lateral shift and tilt at low flexion angles, but the long-term influence of increased tibial external rotation on tibiofemoral function is currently unknown.

Level of evidence

Prospective comparative study, Level II.

Keywords

Patellofemoral instability Tibial tuberosity realignment MPFL reconstruction Patellar tracking Tibial rotation 

Notes

Acknowledgments

Funding was provided by a research grant from Toshiba Medical Systems. Assistance in obtaining and exporting scanning data provided by the staff of the Musculoskeletal Radiology Division of Johns Hopkins Medicine and Antonio Machado, and Gaurav Thawait in particular is greatly appreciated.

References

  1. 1.
    Beck P, Brown NA, Greis PE, Burks RT (2007) Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. Am J Sports Med 35:1557–1563PubMedCrossRefGoogle Scholar
  2. 2.
    Besl PJ, McKay HD (1992) A method for registration of 3-D shapes. IEEE Trans Pattern Anal Mach Intell 14:239–256CrossRefGoogle Scholar
  3. 3.
    Brossmann J, Muhle C, Büll CC, Zieplies J, Melchert UH, Brinkmann G, Schröder C, Heller M (1995) Cine MR imaging before and after realignment surgery for patellar maltracking—comparison with axial radiographs. Skeletal Radiol 24:191–196PubMedCrossRefGoogle Scholar
  4. 4.
    Camp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ (2010) Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med 38:2248–2254PubMedCrossRefGoogle Scholar
  5. 5.
    Cofield RH, Bryan RS (1977) Acute dislocation of the patella: results of conservative treatment. J Trauma 17:526–531PubMedCrossRefGoogle Scholar
  6. 6.
    Colvin AC, West RV (2008) Patellar instability. J Bone Jt Surg Am 90:2751–2762CrossRefGoogle Scholar
  7. 7.
    Deie M, Ochi M, Adachi N, Shibuya H, Nakamae A (2011) Medial patellofemoral ligament reconstruction fixed with a cylindrical bone plug and a grafted semitendinosus tendon at the original femoral site for recurrent patellar dislocation. Am J Sports Med 39:140–145PubMedCrossRefGoogle Scholar
  8. 8.
    Dietrich TJ, Betz M, Pfirrmann CW, Koch PP, Fucentese SF (2014) End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc 22:214–218PubMedCrossRefGoogle Scholar
  9. 9.
    Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34:1478–1485PubMedCrossRefGoogle Scholar
  10. 10.
    Elias JJ, Saranathan A (2013) Discrete element analysis for characterizing the patellofemoral pressure distribution: model evaluation. J Biomech Eng 135:81011PubMedCrossRefGoogle Scholar
  11. 11.
    Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 177:176–181PubMedGoogle Scholar
  12. 12.
    Fulkerson JP, Shea KP (1990) Disorders of patellofemoral alignment. J Bone Jt Surg Am 72:1424–1429Google Scholar
  13. 13.
    Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144PubMedCrossRefGoogle Scholar
  14. 14.
    Kalia V, Obray RW, Filice R, Fayad LM, Murphy K, Carrino JA (2009) Functional joint imaging using 256-MDCT: technical feasibility. AJR Am J Roentgenol 192:W295–W299PubMedCrossRefGoogle Scholar
  15. 15.
    Kita K, Horibe S, Toritsuka Y, Nakamura N, Tanaka Y, Yonetani Y, Mae T, Nakata K, Yoshikawa H, Shino K (2012) Effects of medial patellofemoral ligament reconstruction on patellar tracking. Knee Surg Sports Traumatol Arthrosc 20:829–837PubMedCrossRefGoogle Scholar
  16. 16.
    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163PubMedCrossRefGoogle 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.
    Maenpaa H, Lehto MU (1997) Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 25:213–227PubMedCrossRefGoogle Scholar
  19. 19.
    Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC (2013) Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-013-2445-8 Google Scholar
  20. 20.
    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 39:1024–1031PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    McWalter EJ, Hunter DJ, Wilson DR (2010) The effect of load magnitude on three-dimensional patellar kinematics in vivo. J Biomech 43:1890–1897PubMedCrossRefGoogle Scholar
  22. 22.
    Monllau JC, Pelfort X, Gelber P, Tey M (2011) Combined tibial tubercle realignment and MPFL Reconstruction. In: Sanchis-Alfonso V (ed) Anterior knee pain and patellar instability, 2nd edn. Springer, London, pp 451–454CrossRefGoogle Scholar
  23. 23.
    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 Jt Surg Br 84:861–864CrossRefGoogle Scholar
  24. 24.
    Naveed MA, Ackroyd CE, Porteous AJ (2013) Long-term (10–15-year) outcome of arthroscopically assisted Elmslie-Trillat tibial tubercle osteotomy. Bone Jt J 95-B:478–485CrossRefGoogle Scholar
  25. 25.
    Nelitz M, Theile M, Dornacher D, Wölfle J, Reichel H, Lippacher S (2012) Analysis of failed surgery for patellar instability in children with open growth plates. Knee Surg Sports Traumatol Arthrosc 20:822–828PubMedCrossRefGoogle Scholar
  26. 26.
    Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ (2007) In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 15:276–285PubMedCrossRefGoogle Scholar
  27. 27.
    Ostermeier S, Stukenborg-Colsman C, Hurschler 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 22:308–319PubMedCrossRefGoogle Scholar
  28. 28.
    Otsuki S, Nakajima M, Oda S, Hoshiyama Y, Fujiwara K, Jotoku T, Neo M (2013) Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta. J Orthop Sci 18:437–442PubMedCrossRefGoogle Scholar
  29. 29.
    Parikh SN, Nathan ST, Wall EJ, Eismann EA (2013) Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 41:1030–1038PubMedCrossRefGoogle Scholar
  30. 30.
    Philippot R, Boyer B, Testa R, Farizon F, Moyen B (2012) Study of patellar kinematics after reconstruction of the medial patellofemoral ligament. Clin Biomech 27:22–26CrossRefGoogle Scholar
  31. 31.
    Pritsch T, Haim A, Arbel R, Snir N, Shasha N, Dekel S (2007) Tailored tibial tubercle transfer for patellofemoral malalignment: analysis of clinical outcomes. Knee Surg Sports Traumatol Arthrosc 15:994–1002PubMedCrossRefGoogle Scholar
  32. 32.
    Ramappa AJ, Apreleva M, Harrold FR, Fitzgibbons PG, Wilson DR, Gill TJ (2006) The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Med 34:749–756PubMedCrossRefGoogle Scholar
  33. 33.
    Sandmeier RH, Burks RT, Bachus KN, Billings A (2000) The effect of reconstruction of the medial patellofemoral ligament on patellar tracking. Am J Sports Med 28:345–349PubMedGoogle Scholar
  34. 34.
    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
  35. 35.
    Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J 2nd, Bach BR Jr, Cole BJ (2013) Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med. doi: 10.1177/0363546513507423 Google Scholar
  36. 36.
    Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34:1254–1261PubMedCrossRefGoogle Scholar
  37. 37.
    Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  38. 38.
    Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • John J. Elias
    • 1
    • 3
    Email author
  • John A. Carrino
    • 2
  • Archana Saranathan
    • 3
  • Loredana M. Guseila
    • 3
  • Miho J. Tanaka
    • 2
  • Andrew J. Cosgarea
    • 2
  1. 1.Department of Orthopaedic SurgeryAkron General Medical CenterAkronUSA
  2. 2.Department of Orthopaedic SurgeryJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of ResearchAkron General Medical CenterAkronUSA

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