Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta

Otsuki, Shuhei; Nakajima, Mikio; Oda, Shunsuke; Hoshiyama, Yoshiaki; Fujiwara, Keiichi; Jotoku, Tsuyoshi; Neo, Masashi

doi:10.1007/s00776-013-0364-7

Cited by 14 publications

(41 citation statements)

References 26 publications

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“…The benefits of distalization have been well documented in previous clinical studies [2,22,23]. Poor patellofemoral anatomy, such as lateral tilt of patella can be improved substantially after surgery [22,23]; patient-reported outcomes such as the Lysholm and Kujala scores also could be substantially improved [2,22,23].…”

Section: Discussionmentioning

confidence: 90%

“…Poor patellofemoral anatomy, such as lateral tilt of patella can be improved substantially after surgery [22,23]; patient-reported outcomes such as the Lysholm and Kujala scores also could be substantially improved [2,22,23]. Distalization + tenodesis also showed ideal clinical outcomes at long-term followup, in objective and subjective assessments [20].…”

Section: Discussionmentioning

confidence: 99%

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Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. Questions/purposes We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? Methods Subject-specific finite-element models were created for 10 individuals with patella alta (mean InsallSalvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. Results Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0. Conclusions Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. Clinical Relevance This study suggests that distalization may result in less stress than distalization + tenodesis,

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…‡ One of these risk factors is patella alta. 6 , 7 , 14 – 18 , 21 – 23 Patella alta, defined as a Caton-Deschamps index >1.2, has been noted to be present in 24% of patients with patellofemoral instability but only 3% of normal controls. 13 Patella alta has also been shown to be a strong predictor of recurrent patellofemoral instability.…”

mentioning

confidence: 99%

“… 13 Multiple surgeries have been described for patella alta; however, there is a lack of consensus regarding the accepted techniques for the management of patellofemoral instability in the presence of patella alta. 6 , 7 , 14 – 18 , 21 – 23 , 33 A previous systematic review concluded that tibial tubercle distalization is an effective technique to correct patellar height and prevent recurrent patellar dislocations. 13 However, the systematic review included only studies in which tibial tubercle distalization was performed to manage patella alta and recurrent patellofemoral instability, despite there being many other studies that also published the outcomes for patella alta and patellofemoral instability after other proximal or distal procedures.…”

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confidence: 99%

Surgical Management of Patella Alta in Patellofemoral Instability: A Systematic Review and Meta-analysis

Tan

Ngiam

Lim

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Proximal, distal, and combined proximal and distal procedures have been performed for patellofemoral instability in the presence of patella alta. No consensus exists regarding the accepted surgical management for this condition. Purpose: To pool the outcomes of surgical management for patellofemoral instability in the presence of patella alta and to determine whether the outcomes differ for different surgical techniques. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies that reported surgical outcomes for patellofemoral instability in the presence of patella alta were included. The random-effects model was used to analyze pooled estimates of preoperative and postoperative differences for outcomes that were reported in ≥3 studies. If heterogeneity existed among the studies, further analysis was performed using random-effects meta-regression analysis, which allowed for the identification of moderators. Results: A total of 11 studies with 546 knees were included. The pooled relative risk (RR) of having no patellofemoral dislocation and no patellofemoral apprehension or subjective instability postoperatively was 51.80 (95% CI, 20.75-129.31) and 48.70 (95% CI, 17.22-137.71), respectively. The pooled weighted mean improvement (WMI) for the Kujala and Lysholm scores postoperatively was 31.98 (95% CI, 28.66-35.30) and 35.93 (95% CI, 30.12-41.74), respectively. The pooled WMI for patellar tilt angles postoperatively was 10.94 (95% CI, 7.87-14.01). These outcomes were homogeneous across all studies. The pooled WMI for Insall-Salvati ratio, Caton-Deschamps index, and tibial tubercle–trochlear groove distance postoperatively was 0.31 (95% CI, 0.17-0.45), 0.24 (95% CI, 0.12-0.36), and 6.77 (95% CI, 1.96-11.58), respectively. These outcomes were heterogeneous across the studies, with the presence of distal procedures being a significant moderator. The presence of distal procedures had a significantly higher unweighted RR of 38.07 (95% CI, 2.37-613.09) for major complications compared with proximal procedures alone, although the incidence of minor complications was comparable (unweighted RR, 1.25; 95% CI, 0.35-4.48). Conclusion: Surgical management for patellofemoral instability in the presence of patella alta consistently led to improvement in clinical and functional outcomes, regardless of the type of procedure performed. Distal procedures were better able to correct the patellar height and tibial tubercle–trochlear groove distance, although these procedures also posed a higher RR of subsequent surgery compared with proximal procedures alone.

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“…5 6 7 8 9 A three-dimensional transfer of the tibial tuberosity (distalization, medialization, and anteriorization) has also been proposed. 10 …”

Section: Introductionmentioning

confidence: 99%

Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta

Enea

Cane²,

Fravisini³

et al. 2018

Joints

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Purpose The aim of the study was to test the distalization and medialization of the tibial tuberosity (DMTT) for the treatment of patellar instability associated with patella alta, focusing on residual instability and pain. Methods Twenty-four consecutive patients (26 knees) suffering from patellofemoral instability and patella alta were treated by DMTT. Two groups were identified, which differed for documented history of frank patella dislocation. The groups were named objective patellar instability (OPI) (history of dislocation) and potential patella instability (PPI) (no dislocation). Outcome was measured with visual analogue scale (VAS), Kujala score, and Tegner score. Comparison between groups was performed using Student's t -test, Wilcoxon rank score, and Fisher's exact test (significance at p < 0.05). Results At 50 ± 18 and 41 ± 18 months of follow-up, respectively, both PPI and OPI groups obtained a significant pain reduction and functional improvement. The PPI group showed a significant decrease of the subjective instability. No procedure-related complications were reported. Conclusion This study suggests that DMTT is a viable option for PPI patients with patella alta. The outcome was comparable between PPI and OPI cases; however, decrease in subjective instability was significantly greater in PPI patients. Level of Evidence Level III, retrospective comparative study.

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Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta

Cited by 14 publications

References 26 publications

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Surgical Management of Patella Alta in Patellofemoral Instability: A Systematic Review and Meta-analysis

Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta

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