2017 ISAKOS Biennial Congress ePoster #1716

 

Tibial Tubercle Transposition in Treatment of Patellofemoral Malalignment: Anteromedialization Versus Distalization. Clinical and Functional Outcome Comparison

Luca Dei Giudici, MD, Ancona ITALY
Davide Enea, MD, Ancona, AN ITALY
Marco Fravisini, MD, Rimini, RM ITALY
Pier Paolo Canè, Rimini, RN ITALY
Antonio Gigante, Ancona, IT ITALY

Clinical Orthopaedic, DISCLIMO, Università Politecnica delle Marche, Ancona, AN, ITALY

FDA Status Cleared

Summary

Comparison of anteromedialization and distomedialization of the tibial tubercle transposition fot patellofemoral malalignment

ePosters will be available shortly before Congress

Abstract

Objective

tibial tubercle transposition (TTT) generally has good to excellent outcomes despite several techniques variation. To date there is still an open debate about the better technique, being none of the methods considered the golden standard. Purpose of the present study was to compare the clinical outcomes of two different standardized techniques of tibial tubercle transposition at a medium follow up in two cohorts of patients affected by patello-femoral malalignment.

Methods

a retrospective analysis was conducted comparing two cohorts of patients from two different centers that underwent TTT for patellofemoral malalignment. Strict inclusion and exclusion criteria were applied; enrolled patients were divided in two groups. Group A underwent osteotomy and a standard 0,9mm medialization and 0,5mm anteriorization; Group B underwent osteotomy and a standard 10mm of distalization and 0,7mm of medialization; arthroscopic lateral retinacular release was also performed in every case. When a secondary procedure for a concomitant but not expected lesion was needed the patient was treated accordingly but intraoperatively excluded from the study. Rehabilitation protocol was standardized. For each patient the following data were recorded: sex, age, affected side, presence of a traumatic mechanism, history of patellar dislocation and number of episodes, history of subjective instability, diagnosed deformity, Tegner Activity Level Score, site of referred pain, intensity of pain according to NRS, articular blocks, stiffness, metereopathy, date of the surgery, patellar height according to Caton-Deschamps Index before and after surgery, TT-TG, eventual secondary surgery, use of NSAIDs, type and duration of physical therapy, intrarticular injection. Kujala score was submitted. to patients prior to surgery and after 7 years. Statistical analysis was performed by an academic professional analyst, using Wilcoxon test and parametric t-tests for the objectivable outcomes.

Results

Pre-operative and post-operative evaluations were conducted dividing each group in two subgroups, for a better outcome evaluation, made by patients with instability symptoms and those without. Mean follow up for Group A, made of 16 patients, was 111,18 months (SD=73,2), while mean follow up for Group B, made of 26 patients, was 48 months (SD=18,5); in both groups a statistically relevant difference was found for NRS and Kujala scores, particularly higher in the unstable subgroups. Lastly, Kujala’ outcome and its magnitude were compared between Group A and Group B, and a statistically significant difference was not found (p-value=0,554, linear model).

Conclusion

In conclusion, the present paper demonstrates a substantial overlapping in the outcomes for anteromedial transposition of the tibial tubercle and distalization-medialization, in the setting of a symptomatic patello-femoral malalignment. While for patients affected by instability this is more evident, those with patello-femoral pain syndrome has a very limited benefit from a distalization surgery that therefore should be associated to other surgical corrections. The most probable explanation for the great outcomes despite the different techniques is the unloading of the articular cartilage, beside the malalignment correction, and indirectly pose for an early treatment. More clinical trials are needed to state the supremacy, if possible, of one type of correction over the others.