Tibial Tubercle Osteotomy With Distalization Is a Safe and Effective Procedure for Patients With Patella Alta and Patellar Instability
Carregando...
Citações na Scopus
27
Tipo de produção
article
Data de publicação
2021
Título da Revista
ISSN da Revista
Título do Volume
Editora
SAGE PUBLICATIONS INC
Citação
ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, v.9, n.1, article ID 2325967120975101, 7p, 2021
Resumo
Background: Tibial tubercle osteotomy with concomitant distalization for the treatment of patellar instability remains controversial, as it may cause anterior knee pain and chondral degeneration. Purpose: To evaluate radiographic, clinical, and functional outcomes in patients who had patellar instability with patella alta and underwent tibial tubercle osteotomy with distalization (TTO-d) as well as medial patellofemoral ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were 25 patients (31 cases) (mean age at surgery, 28.7 years; range, 14-33 years) with patellar instability and patella alta who underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, and amount of distalization were assessed. Clinical and functional variables included J-sign, anterior knee pain, apprehension test, Tegner activity level, and Kujala score. Results: The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm (range, 7-24 mm); the mean CDI changed from 1.37 (1.25-1.7) preoperatively to 1.02 (0.9-1.12) postoperatively (P = .001); and the mean amount of tibial tubercle distalization was 8.80 mm (range, 4-16 mm). Lateral release (22 cases; 71.0%), medialization of tibial tubercle (17 cases; 54.8%), and autologous chondrocyte implantation (4 cases; 12.9%) were other associated procedures. The J-sign improved in 30 cases (96.8%; P = .001), and there was a complete resolution of anterior knee pain in 22 cases (71.0%; P = .001). An exploratory analysis showed that patellar cartilage defect severity was correlated with persistent pain (P = .005). The apprehension test became negative in all cases (P = .001). The median Kujala score increased from 52 to 77 (P = .001), and the median Tegner activity level improved from 3 to 4 (P = .001). No cases of osteotomy nonunion were reported. One case (3.2%) of patellar instability recurrence and 3 cases (6.5%) with painful hardware were observed. Conclusion: TTO-d resulted in good radiographic, clinical, and functional outcomes providing proper patellar stability to patients with patella alta. TTO-d appears to be a safe and efficient procedure with low complication rates, providing an additional tool for the personalized treatment of patellar instability.
Palavras-chave
patellofemoral joint, knee surgery, osteotomy, joint instability
Referências
- Al-Sayyad MJ, 2002, CLIN ORTHOP RELAT R, P152
- Ambra LF, 2019, AM J SPORT MED, V47, P2444, DOI 10.1177/0363546519859320
- Ambra LF, 2018, ORTHOP J SPORTS MED, V6, DOI 10.1177/2325967118798621
- Arendt EA, 2002, CLIN SPORT MED, V21, P499, DOI 10.1016/S0278-5919(02)00031-5
- Brittberg M, 2003, J BONE JOINT SURG AM, V85A, P58, DOI 10.2106/00004623-200300002-00008
- CATON J, 1982, REV CHIR ORTHOP, V68, P317
- Caton JH, 2010, INT ORTHOP, V34, P305, DOI 10.1007/s00264-009-0929-4
- Cerciello S, 2018, J ORTHOP TRAUMATOL, V19, DOI 10.1186/s10195-018-0508-9
- Christiansen SE, 2008, ARTHROSCOPY, V24, P82, DOI 10.1016/j.arthro.2007.08.005
- DeJour D, 2010, INT ORTHOP, V34, P311, DOI 10.1007/s00264-009-0933-8
- Enea Davide, 2018, Joints, V6, P80, DOI 10.1055/s-0038-1661340
- Feller JA, 2014, KNEE SURG SPORT TR A, V22, P2470, DOI 10.1007/s00167-014-3132-0
- Franciozi CE, 2019, ARTHROSCOPY, V35, P566, DOI 10.1016/j.arthro.2018.10.109
- Herbort M, 2014, KNEE, V21, P1169, DOI 10.1016/j.knee.2014.07.026
- Hevesi M, 2019, ARTHROSCOPY, V35, P537, DOI 10.1016/j.arthro.2018.09.017
- Johnson AA, 2018, ORTHOP J SPORTS MED, V6, DOI 10.1177/2325967118803614
- Lippacher S, 2012, AM J SPORT MED, V40, P837, DOI 10.1177/0363546511433028
- Magnussen Robert A, 2017, Am J Orthop (Belle Mead NJ), V46, P229
- Magnussen RA, 2014, KNEE SURG SPORT TR A, V22, P2545, DOI 10.1007/s00167-013-2445-8
- Mountney J, 2005, J BONE JOINT SURG BR, V87B, P36
- Payne J, 2015, ARTHROSCOPY, V31, P1819, DOI 10.1016/j.arthro.2015.03.028
- Prakash J, 2018, CLIN ORTHOP SURG, V10, P420, DOI 10.4055/cios.2018.10.4.420
- Purohit N, 2019, SKELETAL RADIOL, V48, P859, DOI 10.1007/s00256-018-3123-1
- Ridley TJ, 2017, ARTHROSC TEC, V6, pE1211, DOI 10.1016/j.eats.2017.04.013
- Sappey-Marinier E, 2019, AM J SPORT MED, V47, P1323, DOI 10.1177/0363546519838405
- Schottle P, 2009, ARCH ORTHOP TRAUM SU, V129, P305, DOI 10.1007/s00402-008-0712-9
- Schottle PB, 2007, AM J SPORT MED, V35, P801, DOI 10.1177/0363546506296415
- Weber AE, 2016, J BONE JOINT SURG AM, V98, P417, DOI 10.2106/JBJS.O.00354
- Yang JS, 2017, ARTHROSCOPY, V33, P2038, DOI 10.1016/j.arthro.2017.06.043
- Zilber S, 2019, ORTHOP TRAUMATOL-SUR, V105, P129, DOI 10.1016/j.otsr.2018.09.020