Treatment of a combined deformity following tibial tubercle ventromedialization with single proximal tibial closing wedge osteotomy

Abstract

Incidence of patellar dislocation is highest in adolescents; almost 10 times higher than in adults. [1] It is known that 69% of first time patellar dislocations are seen between 10-19 years. [2] There are dynamic factors (weak hip abductors and vastus medialis, tight lateral retinaculum and iliotibial band) and static factors (increased Q-angle, valgus malalignment, patella alta, trochlear dysplasia, lateralization of tibial tuberosity) ÖZİskelet gelişimi tamamlanmamış hastalarda patellar instabiliteye yaklaşırken olası fizis hasarı göz önünde bulundurulmalıdır. Bu yazıda, pediatrik tibial tüberkül ventromedializasyonunu takiben gelişen; genu rekurvatum, genu valgum ve patella baja'dan oluşan bir kombine diz deformitesi olgusu sunuldu. Hasta ilk başvurusunda 22 yaşında olan bir kadın idi. Kıkırdağın sağlıklı olduğu doğrulandıktan sonra deformite tek bir supratüberküler posteriyor ve medial temelli proksimal tibial kapalı kama osteotomisi ile düzeltildi. Yedinci yıl kontrolünde hastanın ağrısı yoktu, fonksiyonel açıdan memnundu ve radyografik değerlendirme düzgün dizilim gösterdi. Bu olgu patellar instabilite tedavisi sırasında fizis hasarı gelişirse karşılaşılacak zorlukları ve kombine genu rekurvatum, genu valgum ve patella baja deformitelerini tedavi eden tek bir iyi planlanmış supratüberküler proksimal tibial osteotominin etkililiğini, kullanımının yaygınlaşması için anatomik ve klinik çalışmalara gerek olsa da göstermektedir. ABSTRACTPatellar instability in skeletally immature patients must be approached with concern of potential damage to physes. In this article, we present a case of combined knee deformity consisting of genu recurvatum, genu valgum and patella baja which arose subsequent to a pediatric tibial tubercle ventromedialization. Patient was a female who was 22 years old upon first admission. After confirming cartilage to be in good health, the deformity was corrected with a single supratubercular posteriorly and medially based proximal tibial closing wedge osteotomy. At the seventh year follow-up, patient was pain free, functionally satisfied and radiographic evaluation showed correct alignment. This case illustrates the consequent difficulties faced if physeal damage occurs during treatment of patellar instability as well as effectiveness of a single well-planned supratubercular proximal tibial osteotomy treating combined genu recurvatum, genu valgum and patella baja deformities; although anatomic and clinical studies are required to generalize its use. Citation:Sezgin EA, Szerb I, TÓTH Z, Hangody L. Treatment of a combined deformity following tibial tubercle ventromedialization with single proximal tibial closing wedge osteotomy. Eklem Hastalik Cerrahisi 2019;30(3):316-321.