Correlation of Patellar Articular Lesions with Results from Anteromedial Tibial Tubercle Transfer

Abstract

This retrospective study determined that the outcome from anteromedialization of the tibial tubercle correlates well with the location of patellar articular lesions. Detailed descriptions of patellar articular cartilage lesions were obtained from the operative reports of 36 patients who had anteromedialization performed between February 1984 and March 1994. The patterns fell into four distinct groups. Ten patients with type I (distal) patellar lesions and 13 patients with type II (lateral facet) patellar lesions had 87% good to excellent subjective results, and 100% of these patients said they would have the procedure done again. Nine patients with type III (medial facet) lesions had 55% good to excellent results, and 5 patients with type IV (proximal or diffuse) lesions had only 20% good to excellent results. Patients with type I or II lesions were significantly more likely to have good or excellent results than those with type III or IV lesions. Central trochlear lesions were associated with medial patellar lesions and all patients with central trochlear lesions had poor results. There was no significant correlation between the Outerbridge grading of the patellar lesion and the overall results. Workers' compensation issues diminished the likelihood of a satisfactory outcome by 19%; however, this was not statistically significant. This is the first study to correlate the patellar articular cartilage lesion with outcome after tibial tubercle transfer.

Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population

“…In such cases the surgical approach should address both conditions, because transfer of the tibial tuberosity alone cannot solve the cartilage problem and could thus fail to provide pain relief [45]. On the other hand, it is disputed whether cartilage defects should be repaired without addressing the biomechanical imbalance [23].…”

“…Unless corrected, this process can undermine and even reverse the clinical outcome of the surgical realignment and eventually impair patellofemoral joint function [45].…”

Tantalum is a good bone graft substitute in tibial tubercle advancement

“…The treating surgeon (MF-F) graded the cartilage changes according to the Outerbridge criteria [39]: Grade 1, softening and swelling of cartilage; Grade 2, fragmentation and fissuring in an area half an inch or less in diameter; Grade 3, the same as Grade 2 but in an area more than half an inch in diameter; and Grade 4, erosion of cartilage down to bone. The location of chondral alterations was mapped following the classification proposed by Pidoriano et al [41].…”

Retinacular band excision improves outcome in treatment of plica syndrome

“…The patients were followed up for pain, range of motion, quadriceps atrophy, and patellar stability and were also evaluated using preoperative and latest follow-up Lysholm scores. Lysholm scores between 95 and 100 were considered as excellent results, between 90 and 94 as very good, between 80 and 89 as good, between 70 and 79 as fair, and below 70 as poor, using the system recommended by Pidoriano et al [22]. The scores were analysed statistically using the Mann-Whitney test.…”