Elevation of the tibial tubercle for patellofemoral pain syndrome

Abstract

One hundred patients were operated on by the Maquet procedure for chondromalacia patellae. All of them were first re-examined after a mean follow-up of 4 years, and 65 of them re-examined after a mean follow-up of 11 years (range, 8-15 years). The pain score improved significantly after the operation and remained unchanged with longer follow-up. The success rate was only 62% at both follow-ups. Outerbridge grade IV chondral lesions at the time of surgery were associated with a significant improvement of the pain score at the 4-year follow-up and a success rate of 69%. The Maquet procedure should only be proposed for chronic retropatellar pain with grade IV chondral lesions, after conservative treatment has proven unsuccessful, as the expected failure rate is about 30%.

Tantalum is a good bone graft substitute in tibial tubercle advancement

“…Our experience, like that of other authors [10,20,30,31,43,50], has confirmed that appropriate indication and accurate surgical technique facilitate good clinical results in the treatment of degenerative patellofemoral chondral lesions (Table 5). However, direct comparison of our results with published results is limited by the heterogeneity of cohorts [3,10,15,19,55], the exact procedures used, and the outcome instruments used [8,10,20,26,50]. Consistent with the findings of others [3,26], we found age, gender, body mass index, duration of symptoms, preoperative patellofemoral narrowing, or location of chondral lesion did not influence the clinical outcome scores.…”

“…However, direct comparison of our results with published results is limited by the heterogeneity of cohorts [3,10,15,19,55], the exact procedures used, and the outcome instruments used [8,10,20,26,50]. Consistent with the findings of others [3,26], we found age, gender, body mass index, duration of symptoms, preoperative patellofemoral narrowing, or location of chondral lesion did not influence the clinical outcome scores. However, we found outcomes correlated with preoperative clinical status and grade of chondral lesion (Table 3).…”

“…The incidence in our series was 10.5% using the tantalum implant and 15.6% using local bone graft, comparable to the 20% reported by Lund and Nilsson [29]. Problems with wound healing and cosmetic appearance also are related to the magnitude of advancement, reported as being less for TTA of 1.5 cm, or less as performed in our study [10,26,29]. Progression of osteoarthrosis has been only briefly assessed in other studies.…”

“…However, the literature contains differing opinions regarding the magnitude of optimal advancement [2,14,37,40,50] and predictability and reliability of clinical results [5,8,21,29,40,43,50]. Some of the studies are limited by cohort size [3,5,19], cohort heterogeneity [5,9,10,15,17,19,55], short followup [3,10,20,29,55], or inadequate scoring systems [10,17,20,26,50]. Nonetheless, the consensus suggests that with proper indications and accurate technique, TTA still plays a role Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Imaging of postoperative knee extensor mechanism

“…A bone block is then placed in the osteotomy site to displace this loosened bone wedge anteriorly (Fig. 6) [13]. The EllmslieTrillat procedure consists of a complete osteotomy of the tibial tuberosity at its base and medial screw fixation (Fig.…”