Sliding osteotomy of the tibial tuberosity in patellofemoral instability

• Published in: Operative Orthopädie und Traumatologie 2015-12, Vol.27 (6), p.464-473
• Main Authors: Konrads, C, Reppenhagen, S, Hoberg, M, Rudert, M, Barthel, T
• Format: Article
• Language: ger
• Subjects: Bone Screws; Combined Modality Therapy - instrumentation; Combined Modality Therapy - methods; Evidence-Based Medicine; Humans; Joint Instability - surgery; Osteotomy - instrumentation; Osteotomy - methods; Patellar Ligament - surgery; Patellofemoral Joint - diagnostic imaging; Patellofemoral Joint - surgery; Tibia - surgery; Treatment Outcome
• ISSN: 1439-0981
• DOI: 10.1007/s00064-015-0421-9

The development of a stable patellofemoral joint by distal realignment with normal positioning of the patella. Patellofemoral instability with increased tibial tubercle to trochlear groove (TT-TG) distance ≥ 20 mm and higher Caton-Deschamps patellar height index ≥ 1.3. Open epiphyseal and apophyseal plates of the proximal tibia, normal TT-TG distance with normal patellar height, and high-grade chondral lesions of the patellofemoral joint (ICRS grades 3 and 4). Examination of the knee joint under anesthesia and evaluation of stability and mediolateral translation of the patella. Diagnostic knee arthroscopy and treatment of chondral or osteochondral lesions. Lateral approach to the tibial tuberosity with soft tissue mobilization and exposure of the patellar tendon. Osteotomy is performed in the frontal plane, creating a fragment at least 6 cm long. The tuberosity is slid into the desired position, medially and distally, if necessary, according to preoperative analysis and planning, followed by careful drilling of the posterior tibial cortex and lag screw osteosynthesis. Partial weight-bearing of 20 kg in a MECRON knee brace for 6 weeks. Mobilization 0/0/90° from the MECRON knee brace without active knee extension. Isometric training of the thigh muscles with the knee fully extended. With meticulous planning and implementation, and in cases of severe trochlear dysplasia combined with medial patellofemoral ligament reconstruction, the technique of sliding osteotomy of the tibial tuberosity has a high success rate.