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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 2, 180-185.
doi: 10.1302/0301-620X.89B2.18358  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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A modified tibial tubercle osteotomy for patellar maltracking

RESULTS AT TWO YEARS

S. Koëter, MD, Orthopaedic Resident1; M. J. F. Diks, MD, Orthopaedic Surgeon2; P. G. Anderson, MA, Orthopaedic Researcher3; and A. B. Wymenga, MD, PhD, Orthopaedic Surgeon3

1 Department of Orthopaedic Surgery, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands.
2 Department of Orthopaedic Surgery, Ysselland Hospital, Prins Constantijnweg 2, 2906 ZC Capelle aan de Yssel, The Netherlands.
3 Department of Orthopaedic Surgery, St Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands.

Correspondence should be sent to Dr A. B. Wymenga; e-mail: a.wymenga{at}maartenskliniek.nl

An abnormal lateral position of the tibial tuberosity causes distal malalignment of the extensor mechanism of the knee and can lead to lateral tracking of the patella causing anterior knee pain or objective patellar instability, characterised by recurrent dislocation. Computer tomography is used for a precise pre-operative assessment of the tibial tubercle-trochlear groove distance. A distance of more than 15 mm is considered to be pathological and an indication for surgery in symptomatic patients.

In a prospective study we performed a subtle transfer of the tibial tuberosity according to the information gained from the pre-operative CT scan. This method was applied to two groups of patients, those with painful lateral tracking of the patella, and those with objective patellar instability. We evaluated the clinical results in 30 patients in each group. The outcome was documented at 3, 12 and 24 months using the Lysholm scale, the Kujala score, and a visual analogue pain score.

Post-operatively, all but one patient in the instability group who had a patellar dislocation requiring further surgery reported good improvement with no further subluxation or dislocation. All patients in both groups had a marked improvement in pain and functional score. Two patients sustained a tibial fracture six and seven weeks after surgery. One patient suffered a per-operative fracture of the tibial tubercle which later required further fixation.

If carefully performed, this type of transfer of the tibial tubercle appears to be a satisfactory technique for the treatment of patients with an increased tibial tubercle-trochlear groove distance and who present with symptoms related to lateral maltracking of the patella.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General