Osteotomy of the anterior tuberosity of the tibia (TT), when indicated, is an effective and safe procedure to prevent recurrent patellar instability. Through medialization, antero-medialization or distalization of the TT, it is possible to redistribute the force vectors that impact on the patella, restoring normal anatomy and the correct alignment of the extensor apparatus. The aim of the present work is to develop the algorithm in the indications to treat patellofemoral instability, surgical technique and complications of TT transposition and to evaluate a group of patients operated on by our team.
Material And Method
We retrospectively analyzed the medical records of 79 patients (minimum 24 month follow-up) who underwent surgery for patellofemoral instability and who underwent a TT osteotomy and in whom the same surgical technique was used. All patients were ordered for X-rays, CTs and MRIs. 34% were female and 66% male, and aged 14 to 48 years. Regarding physical activity prior to surgery: 18% performed high-impact competitive activity, 12% did not perform physical activity and the remaining 70% only performed occasional recreational physical activity.
All patients presented an increased TG (trochlear-groove) -TT distance more than 20 mm with an increased Q angle associated with episodes of recurrent patellar dislocation and anterior knee pain. 51 patients (64%) underwent just an osteotomy of the TT. The most frequent complication was the recurrence of pain (of less intensity and frequency than that presented before surgery). We recorded two cases of material loosening that required a second surgery and one case of persistent discharge from the surgical wound that did not require reoperation. Lastly, the degree of postoperative patients’ satisfaction was evaluated with an average Kujala score whose results were 87 (50 to 98).
The osteotomy of the TT is an effective procedure with a low rate of postoperative complications to treat recurrent patellar dislocation, allowing the patient to return to sports activities with a low percentage of postoperative morbidity.
These alterations that can be corrected, are only two causes of instability. We must understand the biomechanics of the pathology and know that the problem is multifactorial. So we must correct all the factors or those of greatest relevance to a particular patient. Taking into account all the causes that generate instability will lead us to a correct indication of the osteotomy.