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Tibial Tubercle Osteotomies: a Review of a Treatment for Recurrent Patellar Instability

  • Advances in Patellofemoral Surgery (L Redler, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this review is to provide an overview of current surgical treatment options for tibial tubercle osteotomies as a treatment for recurrent patellofemoral instability. As such we sought to provide the reader with the most current answers to why treatment practices have changed and how this has affected the outcome of surgical treatment for patellar instability.

Recent Findings

As our understanding of patellofemoral biomechanics have grown, appropriate surgical and non-surgical treatment options have followed suit to address these findings.

Summary

A clear understanding of the pathomechanics causing the patient’s patellar instability is germane to choosing the most appropriate surgical intervention to address this instability. Likewise, understanding the goal of the intervention chosen—e.g., unloading, realignment—is paramount. These surgical techniques may be technically challenging and surgical specialists with experience in these techniques are recommended for optimal outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Elias JJ, Soehnlen NT, Guseila LM, Cosgarea AJ. Dynamic tracking influenced by anatomy in patellar instability. Knee. 2016;23(3):450–5. https://doi.org/10.1016/j.knee.2016.01.021. A novel computational model using CT imaging to assess patellar instability through a new measure described by the authors as the lateral tibial tubercle-posterior cruciate ligament distance.

    Article  PubMed  Google Scholar 

  2. Liu JN, Mintz DN, Nguyen JT, Brady JM, Strickland SM, Shubin Stein BE. Magnetic resonance imaging validation of tibial tubercle transfer distance in the Fulkerson osteotomy: a clinical and cadaveric study. Arthroscopy. 2018;34(1):189–97. https://doi.org/10.1016/j.arthro.2017.07.020.

    Article  PubMed  Google Scholar 

  3. Reider B, Marshall JL, Koslin B, Ring B, Girgis FG. The anterior aspect of the knee joint. J Bone Joint Surg Am. 1981;63(3):351–6.

    Article  PubMed  CAS  Google Scholar 

  4. Wiberg G. Roentgenographic and anatomic studies on the patellofemoral joint with special reference to chondromalaciae patellae. Acta Orthop Scand. 1941;12:319–410.

    Article  Google Scholar 

  5. Balcarek P, Jung K, Ammon J, Walde TA, Frosch S, Schuttrumpf JP, et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med. 2010;38(11):2320–7. https://doi.org/10.1177/0363546510373887.

    Article  PubMed  Google Scholar 

  6. van Huyssteen AL, Hendrix MR, Barnett AJ, Wakeley CJ, Eldridge JD. Cartilage-bone mismatch in the dysplastic trochlea: an MRI study. J Bone Joint Surg Br. 2006;88(5):688–91. https://doi.org/10.1302/0301-620X.88B5.16866.

    Article  PubMed  Google Scholar 

  7. Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology. 2000;216(3):858–64. https://doi.org/10.1148/radiology.216.3.r00se38858.

    Article  PubMed  CAS  Google Scholar 

  8. Maquet PA. Biomechanical treatment of femoro-patellar arthrosis: advancement of the patellar tendon. Revue du rhumatisme et des maladies osteo-articulaires. 1963;30:779–83.

    PubMed  CAS  Google Scholar 

  9. Maquet P. Advancement of the tibial tuberosity. Clin Orthop Relat Res. 1976;115:225–30.

    Google Scholar 

  10. Ferguson AB Jr, Brown TD, Fu FH, Rutkowski R. Relief of patellofemoral contact stress by anterior displacement of the tibial tubercle. J Bone Joint Surg Am. 1979;61(2):159–66.

    Article  PubMed  Google Scholar 

  11. Jenny JY, Sader Z, Henry A, Jenny G, Jaeger JH. Elevation of the tibial tubercle for patellofemoral pain syndrome. An 8- to 15-year follow-up. Knee Surg Sports Traumatol Arthrosc. 1996;4(2):92–6.

    Article  PubMed  CAS  Google Scholar 

  12. Trillat A, Dejour H, Couette A. Diagnosis and treatment of recurrent dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot. 1964;50:813–24.

    PubMed  CAS  Google Scholar 

  13. Cox JS. Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment. Am J Sports Med. 1982;10(5):303–10. https://doi.org/10.1177/036354658201000509.

    Article  PubMed  CAS  Google Scholar 

  14. Fulkerson JP, Becker GJ, Meaney JA, Miranda M, Folcik MA. Anteromedial tibial tubercle transfer without bone-graft. Am J Sport Med. 1990;18(5):490–7. https://doi.org/10.1177/036354659001800508.

    Article  CAS  Google Scholar 

  15. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med. 1997;25(4):533–7. https://doi.org/10.1177/036354659702500417.

    Article  PubMed  CAS  Google Scholar 

  16. Bellemans J, Cauwenberghs F, Witvrouw E, Brys P, Victor J. Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sport Med. 1997;25(3):375–81. https://doi.org/10.1177/036354659702500318.

    Article  CAS  Google Scholar 

  17. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. 2002;30(3):447–56. https://doi.org/10.1177/03635465020300032501.

    Article  PubMed  Google Scholar 

  18. Woodall WR, Welsh J. A biomechanical basis for rehabilitation programs involving the patellofemoral joint. J Orthop Sports Phys Ther. 1990;11(11):535–42.

    Article  PubMed  CAS  Google Scholar 

  19. Fithian DC, Powers CM, Khan N. Rehabilitation of the knee after medial patellofemoral ligament reconstruction. Clin Sports Med. 2010;29(2):283–90, ix. https://doi.org/10.1016/j.csm.2009.12.008.

    Article  PubMed  Google Scholar 

  20. Bicos J, Fulkerson JP, Amis A. Current concepts review: the medial patellofemoral ligament. Am J Sports Med. 2007;35(3):484–92. https://doi.org/10.1177/0363546507299237.

    Article  PubMed  Google Scholar 

  21. Makhsous M, Lin F, Koh JL, Nuber GW, Zhang LQ. In vivo and noninvasive load sharing among the vasti in patellar malalignment. Med Sci Sports Exerc. 2004;36(10):1768–75.

    Article  PubMed  Google Scholar 

  22. Radin EL, Pan HQ. Long-term follow-up study on the Maquet procedure with special reference to the causes of failure. Clin Orthop Relat Res. 1993;290:253–8.

    Google Scholar 

  23. Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA. The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy. 2015;31(9):1819–25. https://doi.org/10.1016/j.arthro.2015.03.028.

    Article  PubMed  Google Scholar 

  24. Tompkins M, Arendt EA. Complications in patellofemoral surgery. Sports Med Arthrosc Rev. 2012;20(3):187–93. https://doi.org/10.1097/JSA.0b013e31825c74cf.

    Article  PubMed  Google Scholar 

  25. van Houten AH, Heesterbeek PJ, van Heerwaarden RJ, van Tienen TG, Wymenga AB. Medial open wedge high tibial osteotomy: can delayed or nonunion be predicted? Clin Orthop Relat Res. 2014;472(4):1217–23. https://doi.org/10.1007/s11999-013-3383-y.

    Article  PubMed  Google Scholar 

  26. Stetson WB, Friedman MJ, Fulkerson JP, Cheng M, Buuck D. Fracture of the proximal tibia with immediate weightbearing after a Fulkerson osteotomy. Am J Sports Med. 1997;25(4):570–4. https://doi.org/10.1177/036354659702500422.

    Article  PubMed  CAS  Google Scholar 

  27. Harrison RK, Magnussen RA, Flanigan DC. Avoiding complications in patellofemoral surgery. Sports Med Arthrosc Rev. 2013;21(2):121–8. https://doi.org/10.1097/JSA.0b013e31828e88a2.

    Article  PubMed  Google Scholar 

  28. Eager MR, Bader DA, Kelly JD, Moyer RA. Delayed fracture of the tibia following anteromedialization osteotomy of the tibial tubercle: a report of 5 cases. Am J Sports Med. 2004;32(4):1041–8. https://doi.org/10.1177/0363546503258702.

    Article  PubMed  Google Scholar 

  29. Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H. Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg Br. 2002;84(6):861–4.

    Article  PubMed  CAS  Google Scholar 

  30. Carney JR, Mologne TS, Muldoon M, Cox JS. Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up. Am J Sports Med. 2005;33(8):1220–3. https://doi.org/10.1177/0363546504272686.

    Article  PubMed  Google Scholar 

  31. Buuck DA, Fulkerson JP. Anteromedialization of the tibial tubercle: a 4-to 12-year follow-up. Oper Techn Sport Med. 2000;8(2):131–7. https://doi.org/10.1053/otsm.2000.6581.

    Article  Google Scholar 

  32. Ramappa AJ, Apreleva M, Harrold FR, Fitzgibbons PG, Wilson DR, Gill TJ. The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Med. 2006;34(5):749–56. https://doi.org/10.1177/0363546505283460.

    Article  PubMed  Google Scholar 

  33. Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop. 1994;14(4):513–5.

    Article  PubMed  CAS  Google Scholar 

  34. Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med. 2013;41(3):575–81. https://doi.org/10.1177/0363546512472873.

    Article  PubMed  Google Scholar 

  35. • Grawe B, Stein BS. Tibial tubercle osteotomy: indication and techniques. J Knee Surg. 2015;28(4):279–84. https://doi.org/10.1055/s-0035-1544973. Excellent review of applied surgical anatomy and biomechanics of the patellofemoral joint. Step-by-step discussion of the author’s preferred technique for tibial tubercle osteotomies.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA

    Nathan L. Grimm, Alexander L. Lazarides & Annunziato Amendola

Authors
  1. Nathan L. Grimm
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  2. Alexander L. Lazarides
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  3. Annunziato Amendola
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Correspondence to Nathan L. Grimm.

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All authors declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Advances in Patellofemoral Surgery

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Grimm, N.L., Lazarides, A.L. & Amendola, A. Tibial Tubercle Osteotomies: a Review of a Treatment for Recurrent Patellar Instability. Curr Rev Musculoskelet Med 11, 266–271 (2018). https://doi.org/10.1007/s12178-018-9482-3

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  • DOI: https://doi.org/10.1007/s12178-018-9482-3

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