Abstract
Medial transfer of the tibial Tuberosity remains the treatment of choice for skeletally mature patients with patellar malalignment (recurrent dislocation, subluxation with or without patellar tilt). As many patients with patellar malalignment have patellar articular cartilage lesion or patella alta, anteriorisation and distalisation of the tibial tuberosity is advised.
Material and Methods: Tibial tuberosity transfer was performed in our center on 80 knees in 66 patients (40 females, 26 males) during the past 13 years (mean age 23 range 15 – 52). One surgeon supervised all the operations. The average follows-up was 6.2 years (one to thirteen years). All patients were examined clinically for the purpose of this study. The Lisholm and Karlsson scoring system were used to evaluate the results. Radiographs of both knees were also taken. Fifteen knees had no dislocation of the patella prior to the operation, seventeen knees had 1 to 10 eleven knees had 10 to 50, ten knees 50 to 100, and twenty-seven knees had more than hundred dislocations of the patella prior to surgery. Ten of these knees had daily dislocations of the patella.
All operations were done either by selective epidural anesthesia (only sensory and not motor) or general anesthesia without muscle relaxant using quadriceps muscle stimulation. The mean tibial tuberosity medialisation, anteriorisation and distalisation was 1.4 cm (0–2.5 cm) 0.4cm (0–1.1cm) and 0.87cm (0–1.2cm) respectively.
Results: When interviewed by an independent examiner 87% of the patients reported improvement and only 4.3% (3 patients) reported worsening of their condition after the operation.
84% of the patients stated they would have the operation again. All patients had full active range of motion on both knees without extension lag.
At the final evaluation visit the Lisholm and Karlsson scores were good and excellent in 72% and 72.5%, 18.8% and 23.5% had fair results and only 8.7% and 4.4% had poor results respectively. The poor results correlated well with the degree of the patella cartilage damage found during surgery, poor selection of patients and extreme ligamentous laxity. There were two complications: one non-union of the tibial tuberosity treated successfully with bone grafting and one non displaced fracture bellow the osteotomy, treated conservatively. Both had excellent results.
Conclusion: We conclude that distal patella re-alignment done by tibial tuberosity transfer is a reliable technique for the treatment of patello femoral pain secondary to mal-alignment.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
