Patients who undergo tibial tubercle anteromedialization with medial patellofemoral ligament reconstruction demonstrate similar rates of return to sport compared to isolated MPFL reconstruction

Li, Zachary I.; Garra, Sharif; Eskenazi, Jordan; Montgomery, Samuel R.; Triana, Jairo; Hughes, Andrew J.; Alaia, Michael J.; Strauss, Eric J.; Jazrawi, Laith M.; Campbell, Kirk A.

doi:10.1002/ksa.12051

Cited by 2 publications

(2 citation statements)

References 37 publications

(51 reference statements)

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“…The TT torsion could potentially aid the development of a novel surgical procedure using a modified TT osteotomy. To date, medialization or anteromedialization of the TT has been performed in cases of patellofemoral instability with an increased TT-TG distance [19]. A combination of medialization and closing wedge TT osteotomy should be considered in patients with increased TT-TG distance and TT torsion to correct both conditions.…”

Section: Discussionmentioning

confidence: 99%

Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters

Jud,

Hartmann,

Vlachopoulos

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe multifactorial nature of patellofemoral instability requires a comprehensive assessment of the affected patients. While an association between tibial tuberosity (TT) torsion and patellofemoral instability is known, its specific effect has not yet been investigated. This study investigated the effect of TT torsion on patellofemoral instability.MethodsThis retrospective cohort study compared patients who underwent surgical intervention for patellofemoral instability and asymptomatic controls. TT torsion was measured in addition to other commonly assessed risk factors for patellofemoral instability using standardised computed tomography (CT) data of the lower extremities. The diagnostic performances of the assessed parameters were evaluated using receiver operating characteristic curve analysis and odds ratios (ORs) were calculated.ResultsThe patellofemoral instability group consisted of 79 knees, compared to 72 knees in the asymptomatic control group. Both groups differed significantly in all assessed parameters (p < 0.001), except for tibial torsion (n.s.). Among all parameters, TT torsion presented the best diagnostic performance for predicting patellar instability with an area under the curve of 0.95 (95% confidence interval [CI], 0.91–0.98; p < 0.001). A cut‐off value of 17.7° yielded a 0.87 sensitivity and 0.89 specificity to predict patellar instability (OR, 55.2; 95% CI, 20.5–148.6; p < 0.001).ConclusionAmong the evaluated risk factors, TT torsion had the highest predictive value for patellofemoral instability. Patients with TT torsions ≥ 17.7° showed a 55‐fold increased probability of patellofemoral instability. Therefore, TT torsion should be included in the assessment of patients with patellofemoral instability.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters

Jud,

Hartmann,

Vlachopoulos

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Then, these two points were projected onto the line connecting the posterior condyles of the femur, and the distance (GB′) between the two points represented the TT-TG distance [7]. The Caton-Deschamps index (CDI) is commonly used to evaluate patellar height [11,17,27]. It can be measured on the lateral view with 30°o f the knee (Figure 2b).…”

Section: Gradementioning

confidence: 99%

Recurrent patellar dislocation patients with high‐grade J‐sign have multiple structural bone abnormalities in the lower limbs

Wang,

Zhang,

Cao

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo explore the relationship between preoperative J‐sign grading and structural bone abnormalities in patients with recurrent patellar dislocation (RPD).MethodsA retrospective study was conducted on RPD patients over 5 years. Patients were categorised based on J‐sign grade into low (J‐ and J1+), moderate (J2+) and high groups (J3+). Trochlear dysplasia (TD) and osseous structures (femoral anteversion angle [FAA], knee torsion, tibial tuberosity‐trochlear groove [TT‐TG] distance, Caton–Deschamps index) were assessed and grouped according to risk factor thresholds. The χ2 test was used to compare composition ratio differences of structural bone abnormalities among the groups.ResultsA total of 256 patients were included, with 206 (80.5%) females. The distribution of J‐sign grade was as follows: 89 knees (34.8%) of low grade, 86 moderate (33.6%) and 81 high (31.6%). Among the five structural bone abnormalities, TD was the most common with a prevalence of 78.5%, followed by increased TT‐TG at 47.4%. Excessive tibiofemoral rotation had the lowest occurrence at 28.9%. There were 173 (67.6%) patients who had two or more abnormalities, while 45 (17.6%) had four to five bony abnormalities. Among patients with any bony abnormality, the proportion of high‐grade J‐sign surpassed 40%. Patients with moderate and high‐grade J‐sign had more increased FAA and more pronounced patella alta (all p < 0.001). The proportion of excessive knee torsion and TD increased with increasing each J‐sign grade, with the more notable tendency in knee torsion (high vs. moderate vs. low‐grade: 61% vs. 22% vs 7%, p < 0.001). Furthermore, the higher J‐sign grade was also associated with more combined bony abnormalities (p < 0.001). In the high‐grade J‐sign group, 90.2% of the knees had two or more bony risk factors and 40.7% had four or more, which were significantly higher than the moderate and low‐grade J‐sign groups (40.7% vs. 11.6% vs. 2.2%, p < 0.001).ConclusionIn patients with a high‐grade J‐sign, over 90% of the lower limbs had two or more structural bone risk factors, and more than 40% had four or more. These proportions were significantly higher compared to knees with low‐grade and moderate J‐sign. In clinical practice, when treating high‐grade patellar mal‐tracking, it is important to focus on and correct these strongly correlated abnormal bone structures.Level of EvidenceLevel III.

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Patients who undergo tibial tubercle anteromedialization with medial patellofemoral ligament reconstruction demonstrate similar rates of return to sport compared to isolated MPFL reconstruction

Cited by 2 publications

References 37 publications

Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters

Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters

Recurrent patellar dislocation patients with high‐grade J‐sign have multiple structural bone abnormalities in the lower limbs

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