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Treatment of acquired patella baja by proximalization tibial tubercle osteotomy significantly improved knee joint function but overall patient-reported outcome measures remain diminished after two to four years of follow-up

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Acquired patella baja is often characterized by painful limitation of knee joint range of motion and anterior knee pain (AKP). Only few studies have evaluated the effectiveness of surgical treatment in terms of patient-reported outcome measures (PROM’s) and sports activity. Thus, the goal of this study was to assess PROM’s and sports activity after proximalization tibial tubercle osteotomy (P-TTO) in patients with symptomatic patella baja.

Methods

Between 2016 and 2018, a case series of 11 patients (male/female 4/7; age 48 ± 12 years) were treated by P-TTO and were retrospectively evaluated after a mean of 33.7 months (range 24–51 months). The Tegner activity score and the Kujala anterior knee pain scale were used in addition to a visual analogue scale (VAS; 0–10) regarding self-reported knee joint function and intensity of AKP. Radiographic assessment included the measure of patellar height using the Caton–Deschamps (CD) and Blackburne–Peel (BP) index.

Results

Postoperatively both the CD and the BP index increased to normality (p < 0.0001; p = 0.0012). Knee joint flexion improved from 100 ± 32° preoperatively to 123 ± 14° postoperatively (p = 0.0235). AKP decreased from 6.5 ± 2.1 points preoperatively to 3.7 ± 2.1 points postoperatively (p = 0.0061). This was accompanied by a significant increase in self-reported knee joint function from 1.8 ± 1.2 points preoperatively to 6.8 ± 2.3 points postoperatively (p = 0.0001) and an increase of the Tegner activity score from 1.8 ± 1.6 points preoperatively to 3.9 ± 1.5 points postoperatively (p = 0.0074). Although the Kujala score improved significantly by an average of 31.55 points (p = 0.001) overall score results remained reduced at 65.6 ± 17.9 points at final follow-up.

Conclusion

P-TTO yielded significant improvements in terms of AKP, subjective knee joint function and sports activity. However, the overall Kujala score results remained reduced, indicating that surgical correction of patellar height is not sufficient to relieve all patients’ complaints. In addition, the incidence of postoperative complications was high.

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Acknowledgements

S.S. and N.M. contributed equally to this work (shared first authorship).

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Arcus Sportklinik, Pforzheim, Germany

    Sebastian Schmidt, Natalie Mengis, Jules N. Rippke, Danko D. Milinkovic & Peter Balcarek

  2. BG Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany

    Felix Zimmermann

  3. Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany

    Peter Balcarek

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Contributions

S.S.: Data aquisition, data analysis, data interpretation, writing the paper, final approval. N.M: Data aquisition, data analysis, data interpretation, writing the paper, final approval. J.N.R.: Data interpretation, final approval. F.Z.: Data interpretation, final approval. D.D.M.: Data interpretation, writing the paper, final approval. P.B.: Study design, data analysis, data interpretation, statistical analysis, writing the paper, final approval.

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Correspondence to Peter Balcarek.

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Obtained from the local Ethics committee (F-2019-070).

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Schmidt, S., Mengis, N., Rippke, J.N. et al. Treatment of acquired patella baja by proximalization tibial tubercle osteotomy significantly improved knee joint function but overall patient-reported outcome measures remain diminished after two to four years of follow-up. Arch Orthop Trauma Surg 142, 2481–2487 (2022). https://doi.org/10.1007/s00402-021-03863-7

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