The Effect of Anterior Displacement of the Tibial Tuberosity in Idiopathic Chondromalacia Patellae:A Prospective Randomized Study

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.…”

“…Probably for this reason and by avoiding graft harvest, the operative time, blood loss, and duration of hospitalization were lower using the tantalum implant than when using local graft. The fact that the complexity of the procedure correlates with the length of hospital stay is manifest when comparing the mean hospital stay of 4.1 days reported by Hejgaard et al [20] after TTA with local bone graft combined with shaving of the patella with the 3.1 days of our Group 1 undergoing TTA with local bone graft and 2 days with a tantalum implant. Harvesting autologous iliac graft may even increase the numbers for perioperative parameters to means of as much as 2 hours 20 minutes surgery duration (range, 1.5-4 hours), 820 mL blood loss (range, 520-1350 mL), and 27 days hospitalization (range, 14-73 days), as reported by Mendes et al [31].…”

“…TTA greater than 1.5 cm reportedly reduces the contact area [5,30,31,43,50] and congruity of the patellofemoral joint [37] with a paradoxic increase of joint stresses on the medial facet and proximal portion of the patella [2,14,49]. Such advancement also produces substantial changes in knee mechanics (2-cm posterior translation and 20% increase on tibiofemoral contact forces [52]), causes a higher rate of complications [8,19,31] and cosmetically worse appearance [8], and does not yield better results than 1 cm TTA [20]. Conversely, an advancement less than 1 cm reportedly fails to substantially increase the patellar tendon lever arm [40].…”

“…We no longer use screws in this application. Sudmann and Salkowitsch [55] believed the rate of complications could be lessened by improving the surgical technique and avoiding immobilization and the delayed rehabilitation recommended by some authors [10,19,20,29]. Bessette and Hunter [3] reported a complication rate of 67% associated with the use of screws compared with a 27% incidence in patients in whom no screw was used.…”

“…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.…”