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Increased TT–TG distance caused by excessive tibiofemoral rotation predicts poor clinical outcomes after tibial tubercle osteotomy in recurrent patellar dislocation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare clinical outcome between recurrent patellar dislocation (RPD) with or without actual tibial tubercle lateralisation (TTL) after medial patellofemoral ligament reconstruction (MPFL-R) combined with tibial tubercle transfer.

Methods

From 2015 to 2018, a total of 172 knees with RPD and a tibial tubercle–trochlear groove (TT–TG) distance of > 20 mm were treated with MPFL-R combined with tibial tubercle transfer. Patients were divided into the lateralisation group (TT–PCL > 24 mm, n = 74) and the nonlateralisation group (TT–PCL ≤ 24 mm, n = 60) based on the presence or absence of actual TTL (TT–PCL > 24 mm). Clinical outcomes were assessed postoperatively at a minimum of 2 years. Second-look arthroscopic evaluations were available for 84 knees to assess cartilage damage.

Results

A total of 134 knees with a median follow-up time of 32 months were included. Tibiofemoral rotation (TFR) was significantly higher in the nonlateralisation group than in the lateralisation group (15.4° vs. 9.4°, P < 0.001). At the final follow-up, the nonlateralisation group had significantly lower Kujala (78.2 vs. 86.4, P = 0.001) and Lysholm (80.3 vs. 88.2, P = 0.003) scores than the lateralisation group. At the time of the second-look arthroscopic assessment, 38.9% of the patients in the nonlateralisation group showed cartilage worsening in the medial patellar facet that was significantly higher than that in the lateralisation group (38.9% vs. 12.5%, P = 0.015).

Conclusion

Patients with RPD and an increased TT–TG distance of > 20 mm but without actual tibial tubercle lateralisation benefit less from tibial tubercle transfer than patients with actual tibial tubercle lateralisation, which may be related to the significantly higher tibiofemoral rotation angle of the former.

Level of evidence

III.

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Availability of data and material

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Yes.

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Authors and Affiliations

  1. Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China

    Zhi-jun Zhang, Zheng Feng, Menglinqian Di, Yan-wei Cao, Tong Zheng & Hui Zhang

Authors
  1. Zhi-jun Zhang
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  2. Zheng Feng
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  3. Menglinqian Di
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  4. Yan-wei Cao
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  5. Tong Zheng
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  6. Hui Zhang
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Contributions

ZZ participated in study design, data collection and drafted the manuscript. MD and TZ carried out the radiological measurements. YC and ZF participated in the data collection and statistical analysis. HZ conceived of the study, and participated in its design and helped to draft the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Hui Zhang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was funded by Beijing Municipal Commission of Science and Technology (Z211100002921043), Beijing Jishuitan Hospital Nova Program (XKXX202211) and National Natural Science Foundation of China (82202777).

Ethics approval

All the procedures performed in this retrospective study were in accordance with the ethical standards of the Beijing Jishuitan hospital, and this study was performed after obtaining approval from our institutional review board (IRB, No. 20230309).

Consent to participate

All the patients provided informed consent before participating in this study.

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All the patients provided informed consent for publication.

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Zhang, Zj., Feng, Z., Di, M. et al. Increased TT–TG distance caused by excessive tibiofemoral rotation predicts poor clinical outcomes after tibial tubercle osteotomy in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 31, 5162–5170 (2023). https://doi.org/10.1007/s00167-023-07587-6

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  • DOI: https://doi.org/10.1007/s00167-023-07587-6

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