The Classic: Total Tendon Transplant for Slipping Patella

Hauser, Emil D. W.

doi:10.1097/01.blo.0000238831.50186.87

Cited by 65 publications

(30 citation statements)

References 1 publication

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“…The patella centres in the trochlear groove and the tibial tubercle medialises at 90˚ of knee flexion. We believe this prevents high patellofemoral pressure with subsequent arthritic changes as is seen after the Hauser procedure, 15 is unlikely. It is unclear whether preoperative arthritic change is a contraindication to surgery.…”

Section: Discussionmentioning

confidence: 94%

A modified tibial tubercle osteotomy for patellar maltracking

Koëter

Diks²,

Anderson

et al. 2007

The Journal of Bone and Joint Surgery. British volume

152

140

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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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Section: Discussionmentioning

confidence: 94%

A modified tibial tubercle osteotomy for patellar maltracking

Koëter

Diks²,

Anderson

et al. 2007

The Journal of Bone and Joint Surgery. British volume

152

140

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“…In 1938 Hauser [114] a technique for medialising the tibia tubercle to decrease the Q angle. The concurrent posterior tranlsation resulted in an increase in patellofemoral contact forces and the procedure had unfavorable outcomes.…”

Section: Distal Realignment Proceduresmentioning

confidence: 99%

The Operative Management of Patella Malalignment

Iliadis¹,

Jaiswal²,

Khan³

et al. 2012

TOORTHJ

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Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment.Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness.A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.

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“…Patients often present with symptoms that relate to instability or maltracking, because the patellofemoral joint is rather incongruent and the patella is a small bone that moves a large amount during knee flexion-extension and is acted upon by powerful muscles that converge from different directions. The frequency and complexity of clinical problems has led to a wide range of surgical procedures 1 that address joint geometry, 2,3 skeletal alignment, [4][5][6][7] or the soft tissues. 8,9 Little data are available providing objective information about the effects of these factors on patellar tracking or relationships to symptoms.…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral kinematics during knee flexion-extension: An in vitro study

2006

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The purpose of this work was to obtain kinematics data for the normal human patellofemoral joint in vitro. Eight fresh-frozen cadaver knees were used. The heads of the quadriceps were separated, and the knees mounted in a kinematics rig. The femoral axis was aligned with an electromagnetic transmitter. The six heads of the quadriceps, including vasti medialis and lateralis obliquus, were loaded via cables according to their physiological cross-sectional areas and orientations. Magnetic trackers were mounted on the patella and tibia. The knee was flexedextended against the extending muscle action, and patellar tracking was measured in six degrees of freedom. As the knee flexed, the patella flexed by 0.7 times the tibiofemoral flexion angle. It also translated medially 4 mm to engage the trochlear groove at 208 knee flexion, then translated to 7 mm lateral by 908 knee flexion. The patella tilted progressively to 78 lateral by 908 knee flexion, and patellar medial-lateral rotation was usually less than 38. This is believed to be the first set of patellar tracking data obtained in both flexion and extension motion while the patella was acted on by a full set of quadriceps muscle tensions acting in physiological directions. These data may be used in future studies of the effects of pathologies on patellar tracking. ß

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The Classic: Total Tendon Transplant for Slipping Patella

Cited by 65 publications

References 1 publication

A modified tibial tubercle osteotomy for patellar maltracking

A modified tibial tubercle osteotomy for patellar maltracking

The Operative Management of Patella Malalignment

Patellofemoral kinematics during knee flexion-extension: An in vitro study

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