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The Effect Of Tibial Tubercle Osteotomy And Trochleoplasty On Femorotibial Rotation In Patients With Patellar Instability

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The Effect Of Tibial Tubercle Osteotomy And Trochleoplasty On Femorotibial Rotation In Patients With Patellar Instability

Martin Hartmann, MD, SWITZERLAND Lukas Jud, MD, SWITZERLAND Florian B. Imhoff, MD, Priv.-Doz., SWITZERLAND Lazaros Vlachopoulos, MD, PhD, SWITZERLAND Jakob Ackermann, MD, SWITZERLAND Sandro Fucentese, Prof MD, SWITZERLAND

Balgrist Hospital, University of Zurich, Department of Orthopaedics, Zurich, Zurich, SWITZERLAND

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Anatomic Location

Knee Patellofemoral

Diagnosis / Condition

Instability

Treatment / Technique

Osteotomy

Diagnosis Method

MRI

Patellofemoral

Recurrent Subluxation and Dislocation Patellofemoral Ligament Rupture

Summary: Patients with patellar instability and trochlear dysplasia have increased femorotibial (FT) rotation. This study shows that Tibial tubercle osteotomy (TTO) can significantly reduce FT rotation, correlating with reduced tibial tubercle torsion. Thus, TTO may be indicated not only for increased TTTG but also for elevated FT rotation to improve outcomes

Background

Patellar instability is multifactorial. Different procedures exist to address the underlying causes. Recently, increased femorotibial (FT) rotation has been shown to contribute to patellar instability by further lateralizing the muscle force vector acting on the patellar. However, it is not yet known how to surgically address this parameter.
Hypothesis/Purpose: To assess whether tibial tubercle osteotomy (TTO) and/or trochleoplasty reduce femorotibial rotation in patients with trochlear dysplasia (TD) experiencing patellar instability.
Study Design: retrospective cohort study, level of evidence 3

Methods

One-hundred-forty-four kness who underwent patellar stabilizing surgery between January 2010 and December 2020 were retrospectively analysed. Caton-Deschamps index (CDI), tibial-tubercle-trochlear-groove distance (TTTG), tibial tubercle (TT) torsion, tibial tubercle-to-posterior cruciate ligament distance (TT-PCL), and pre- and postoperative FT rotation were assessed. Based on the performed patellar stabilizing procedures, knees were stratified in 4 groups: 1: Isolated medial patella-femoral ligament (MPFL) reconstruction (n=51), 2: MPFL reconstruction and TTO (n=24), 3: MPFL reconstruction and trochleoplasty (n=37), 4: MPFL reconstruction, trochleoplasty, and TTO (n=32).

Results

Preoperative FT rotation differed significantly between groups (-0.2 ± 6.1° vs 3.1 ± 6.7° vs. 5.0 ± 5.6° vs 9.6 ± 6.0°, p<0.001). Groups 2 and 4 (with TTO) showed a reduction of FT rotation postoperatively, yet group 2 without statistical significance (delta FT rotation: group 2: -1.3 ± 7°, p=0.370, group 4: -2.0 ± 3.5°, p= 0.003). Group 1 and 3 showed no reduction of FT rotation. Knees with concomitant TTO (group 2 + 4; n=56 patients) had a significantly reduced postoperative FT rotation by a mean of 1.7  5.3° compared to knees without TTO (0.3 ± 5°, group 1 + 3, n=88 patients) (p<0.021). Reduction of FT rotation significantly correlated to the reduction of the TT-Torsion but not medialization achieved by TTO (r=0.511, p<0.001 and r=0.185, p= 0.173, respectively).

Conclusion

Patients presenting with patellar instability and trochlear dysplasia show elevated FT rotation. While trochleoplasty addresses trochlear dysplasia, concomitant TTO seems to decrease FT rotation, which is directly associated with the reduction of the TT-torsion. Thus, TTO may be indicated not only in patients with increased TTTG, but also in those with increased femorotibial rotation, to enhance outcomes in patients with patellar instability.

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Utility of 3D biomodels in the surgical planning of femoral derotational osteotomies ePoster Presentation Caterina Chiappe , MD, SPAIN Alejandro Roselló-Añón, PhD, SPAIN Vicente Sanchis-Alfonso, MD, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN Julio Domenech-Fernández, PhD, SPAIN
Headless Screw Fixation Lowers Re-Operation Rate Following Tibial Tubercle Osteotomy ePoster Presentation Ran Atzmon, MD, ISRAEL Aimee Steen, MS2, UNITED STATES Kinsley J Pierre, BS (Student), UNITED STATES Monica S. Vel, BS, UNITED STATES Nicole Segovia Pham, MPH, UNITED STATES Kenneth Lin, MD, UNITED STATES Seth L. Sherman, MD, UNITED STATES
Is it correct to perform lateral release in combination with MPFL reconstruction in patients with acute patellar dislocation? A finite element analysis study ePoster Presentation Giuseppe Salvatore, MD, PhD, ITALY Alessandra Berton, MD, ITALY Alexander Orsi, PhD, AUSTRALIA Jonathan Egan, BS, MEng, UNITED STATES Amin Mohamadi, MD, MPH, UNITED STATES Joseph P. DeAngelis, MD, UNITED STATES Arun Ramappa, MD, UNITED STATES Umile Giuseppe Longo, MD, MSc, PhD, Prof., ITALY Ara Nazarian, PhD, UNITED STATES
Translation and Validation of The Spanish Version of The Banff Patellofemoral Instability Instrument 2.0 (BPII) ePoster Presentation Juan Pablo Martinez-Cano, MD, MSc, PhD, COLOMBIA Alejandro Gallego, MD, COLOMBIA Johan Von Heideken, MD, PhD, SWEDEN
From Clinic To Smartphone: A Randomized Controlled Trial Of A Novel Digital Therapeutic For Patellofemoral Pain Integrating Exercise And Cognitive-Behavioral Therapy ePoster Presentation Jae-Young Park, MD, KOREA, REPUBLIC OF Sanghee Lee, MD, KOREA, REPUBLIC OF Chan Yoon, MD, MS, KOREA, REPUBLIC OF Jin-Goo Kim, MD, PhD, KOREA, REPUBLIC OF Jong-Min Kim, MD, PhD, KOREA, REPUBLIC OF Sang Hak Lee, MD, PhD, KOREA, REPUBLIC OF Moon Jong Chang, Prof., KOREA, REPUBLIC OF Kyu Sung Chung, MD, PhD, Prof., KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD, Prof., KOREA, REPUBLIC OF Chong Bum Chang, MD, PhD, KOREA, REPUBLIC OF
Medial PatelloTibial Ligament Reconstruction in Pediatric and Adolescent Patients with Patella Dislocation in Flexion ePoster Presentation Olivia C. Tracey, BA, UNITED STATES Joshua T. Bram, MD, UNITED STATES Emilie Lijesen, BS, UNITED STATES Akshitha Adhiyaman, BS, UNITED STATES Ruth H. Jones, BS, UNITED STATES Shae K Simpson, BS, UNITED STATES Ryann Davie, MD, UNITED STATES Yasir Alabdulkarim, MD, SAUDI ARABIA Daniel W. Green, MD, MS, UNITED STATES
Initial Results from the Creation of a Normative Database for the Banff Patellar Instability Instrument ePoster Presentation Mark Lafave, PhD, CAT(C), CANADA Laurie A. Hiemstra, MD, PhD, FRCSC, CANADA Sarah Kerslake, BPhty, MSc, CANADA Daniel Stolear, MA, CANADA
The Dejour Classification for Trochlear Dysplasia: Are We Speaking the Same Language? ePoster Presentation Juan Pablo Martinez-Cano, MD, MSc, PhD, COLOMBIA Betina B. Hinckel, MD, PhD, UNITED STATES Alejandro Gallego, MD, COLOMBIA Maria Tuca, MD, CHILE
Judet’s extensive quadriceps release and “à la carte” combined procedures for patellar dislocation In flexion ePoster Presentation Moritz Konkel, MD, SWITZERLAND Nicolas Cance, MD, FRANCE Franck P. D. A. Chotel, MD, PhD, Prof., FRANCE
Comparative Clinical and Radiographic Outcomes of Particulated Juvenile Articular Cartilage Implantation in Shouldered and Unshouldered Patella Cartilage Lesions ePoster Presentation Ryann Davie, MD, UNITED STATES Brittany Margaret Ammerman, MD, MBS, UNITED STATES Bennett Propp, BS, UNITED STATES Erick Marigi, MD, UNITED STATES William A. Marmor, MD, UNITED STATES Kiera A. Kingston, MD, UNITED STATES Natalie K. Pahapill, BS, UNITED STATES Alissa J. Burge, MD, UNITED STATES Audrey Christine Wimberly, MPH, UNITED STATES Joseph T. Nguyen, MPH, UNITED STATES Elizabeth Rose Dennis, MD MS, UNITED STATES Beth Ellen Shubin Stein, MD, UNITED STATES
Morphological risk of the femur causing anterior cruciate ligament (ACL) injuries : comparative 3-Dimensional mean model analysis of ACL and non-injured patients ePoster Presentation So Heun Lee, M.S - Ph.D.student, KOREA, REPUBLIC OF Min Jung, MD, PhD, KOREA, REPUBLIC OF Kwangho Chung, MD, KOREA, REPUBLIC OF Hyun-Soo Moon, MD, PhD, KOREA, REPUBLIC OF Se-Han Jung, MD, KOREA, REPUBLIC OF Sung-Hwan Kim, MD, PhD, KOREA, REPUBLIC OF
Straight Anteriorization Tibial Tubercle Osteotomy Is Safe and Effective for Patellofemoral Cartilage Lesions ePoster Presentation Nathan Varady, MD, MBA, UNITED STATES Arjun Khorana, BA, UNITED STATES Riley J. Williams, MD, UNITED STATES
Pure Distalization Tibial Tubercle Osteotomy Does Not Result In Posteriorization Of The Tibial Tubercle ePoster Presentation Nathan Varady, MD, MBA, UNITED STATES Nicolas Pascual-Leone, MD, UNITED STATES Ava Neijna, BA, UNITED STATES Andreas H. Gomoll, MD, UNITED STATES Sabrina M. Strickland, MD, UNITED STATES
The Lateral Patellar Retinaculum is Thicker in Pediatric and Adolescent Patients with Patellofemoral Instability ePoster Presentation Danielle E. Chipman, BS, UNITED STATES Peter Cirrincione, MD, UNITED STATES Emilie Lijesen, BS, UNITED STATES Shae K Simpson, BS, UNITED STATES Danielle S Gorelick, NP, UNITED STATES Douglas Mintz, MD, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Torsional Limb Deformities In Patients With Lateral Patellar Dislocation: An Expert Survey Of The International Patellofemoral Study Group. ePoster Presentation Guido Wierer, MD, AUSTRIA Danko Dan Milinkovic, MD, GERMANY Gerd Seitlinger, MD, AUSTRIA Michael C. Liebensteiner, MD, PhD, AUSTRIA William R. Post, MD, UNITED STATES Philipp Wilhelm Winkler, MD, Assoc. Prof., AUSTRIA
How Much Improvement in Patient-Reported Outcome Measures After Isolated Medial Patellofemoral Ligament Reconstruction is Associated with Surgeon-Defined Satisfactory Outcomes? A Jupiter Study ePoster Presentation Shital N. Parikh, MD, UNITED STATES Saral Patel, MD, UNITED STATES Matthew William Veerkamp, BA, UNITED STATES Eric J. Wall, MD, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES Philip Wilson, MD, UNITED STATES Ben E. Heyworth, MD, UNITED STATES Henry B. Ellis, MD, UNITED STATES Marc Tompkins, MD, UNITED STATES Jacqueline M. Brady, MD, UNITED STATES The JUPITER Group, UNITED STATES Beth Ellen Shubin Stein, MD, UNITED STATES

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The Effect Of Tibial Tubercle Osteotomy And Trochleoplasty On Femorotibial Rotation In Patients With Patellar Instability

The Effect Of Tibial Tubercle Osteotomy And Trochleoplasty On Femorotibial Rotation In Patients With Patellar Instability

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The Effect Of Tibial Tubercle Osteotomy And Trochleoplasty On Femorotibial Rotation In Patients With Patellar Instability

The Effect Of Tibial Tubercle Osteotomy And Trochleoplasty On Femorotibial Rotation In Patients With Patellar Instability

Background

Methods

Results

Conclusion