Anteromedial tibial tubercle transfer without bone graft

Abstract

We followed 30 patients for more than 2 years after anteromedial tibial tubercle transfer for persistent patellofemoral pain associated with patellar articular degeneration. Twelve of these patients were followed more than 5 years. We report 93% good and excellent results subjectively and 89% good and excellent results objectively. The quality of improvement was sustained in all 12 of the patients who were evaluated again after more than 5 years from surgery. When examined separately, 75% of those patients with advanced patellar arthrosis achieved a good result; none of these patients achieved an excellent result. Postoperative continuous passive motion has markedly reduced the incidence of stiffness. Serious complications such as compartment syndrome, infection, and skin slough were avoided completely in 51 consecutive cases. Patellofemoral contact pressure studies in five cadaver knees have shown that anteromedial tibial tubercle transfer can provide substantial reduction of patellofemoral contact stress while helping to balance medial and lateral facet pressures. This surgical procedure is mechanically and clinically successful for alleviating intractable pain related to patellar malalignment and articular degeneration. This procedure enables the majority of appropriately selected patients with malalignment and patellar articular degeneration to resume increased levels of activity with substantially diminished pain.

Diagnosis and Treatment of Lateral Patellar Compression Syndrome

“…20,21 Anteromedialization of the tibial tubercle is a surgical option for improving patellofemoral alignment. 22 In cases in which there is excessive lateralization of the tibial tubercle, lateral retinacular release alone is not enough to adequately reduce pressure on the lateral facet of the patella, and a tibial tubercle osteotomy is performed. Medializing the tibial tubercle by 10 mm significantly decreases the maximum lateral pressure by 15% to 20% for intact cartilage without overloading the medial cartilage.…”

Analysis of Two Different Techniques for Treatment of Patellar Dislocation Due to Fibrous Quadriceps Muscle in Children

“…Clinical examination: For a dislocation we would expect to find the following clinical signs: 1) knee defor- mation; 2) atrophy of the thigh compared to the opposite healthy thigh; 3) on knee flexion, a prominent lateral knee; the patellar medial glide test < 5 mm at 30 degrees of knee flexion [9]; and 4) the patient being unable to run. We also tested the following factors: Q-angle [10], genu valgum, and the ligament laxity.…”

Modern management of patellar instability

“…The anteromedialisation of the tibial tubercle elevates the distal pole of the patella, which in turn reduces contact on the distal patella during early knee flexion, thus potentially alleviating anterior knee pain symptoms and preventing arthritic progression. Fulkerson and associates reported 93 % good and excellent results subjectively and 89 % good and excellent results objectively [97]. A review of their results demonstrated an overall 74 % of their 42 patients as having good or excellent results at an average of 8.2 years postoperatively [98].…”