Tibial tubercle advancement osteotomy with bone allograft for patellofemoral arthritis: a retrospective cohort study of 50 knees

Abstract

Tibial tubercle advancement osteotomy can be an effective treatment for anterior knee pain and for patients with arthroscopic evidence of patellar chondral damage. It can provide excellent/good long-term functional results in the majority of patients, with very high satisfaction levels and sustained improvement in pain symptoms. The use of femoral head bone allograft is both effective in obtaining bony union and by definition avoids the donor-site morbidity. Knees with patellar malalignment may also undergo individualised medialisation of the tibial tubercle such that the patella lies in the centre of the femoral trochlea, and may benefit from lateral trochleaplasty surgery in the presence of trochlear dysplasia. However, the major operative complication rate is high at 12%, and fracture of the tibial tubercle is associated with a poorer outcome. One can expect 10% of operated knees to have had some clinical deterioration in the patellofemoral joint by a mean follow-up of 93 months.

Older age and varus alignment lead to early failure in treating patellofemoral osteoarthritis with Fulkerson osteotomy

“…In their study, the overall clinical outcomes were rated as excellent/good in 77%, fair in 35%, and poor in 8% of the knees. 12 The modified Fulkerson procedure seems to be an appropriate treatment for overloading around the patella. Because the patella engages in the trochlear groove at approximately 30°–90° of knee flexion, anteriorization of the tibial tubercle may decrease the patellofemoral contact pressure in this functional range.…”

“…After the arthroscopy procedure, we did a standard modified Fulkerson osteotomy; 12,30–32 a longitudinal incision was made from the lower pole of the patella, extending to the base of the tibial tuberosity. The patellar tendon was isolated by sharp dissection along its medial and lateral borders.…”

“…5,8–11 Another common treatment is osteotomy of the tibial tuberosity; it was first conceived in the 19th century to improve patellar tracking, but it has also been used to treat chondromalacia patellae. 12–15 There are many different methods of performing tibial tubercle osteotomies, including the Hauser, Roux-Goldthwaite, Trillat, and Bandi procedures. 16–20 The modified Fulkerson procedure is one of the most promising methods for TTO, some studies have reported improvement in 92% of patients’ symptoms.…”

Postoperative Imaging of the Knee Extensor Mechanism

“…13) occur in 1 to 2% of patients, most commonly when the transferred fragment is especially thin or short. 40,66 Fractures can also occur in the underlying tibia due to stress riser creation at the distal edge of the osteotomy (►Fig. 14).…”

Total knee arthroplasty in the younger patient: challenges and solutions

“…PFA is an attractive option for younger patients with isolated patellofemoral disease when considering that the results of extensor mechanism realignment procedures are not uniformly successful -with as many as 35% reported to have persistent pain after surgery. 27 While Meding et al reported more predictable outcomes in younger patients undergoing TKA than undergoing PFA using an earlier component design, improvements in second generation designs have received favorable early reports. 28,29 Longer follow-up will be needed to define the outcomes of this procedure among younger patients who may wish to remain active.…”