Clinical Improvement Is Achieved Following Tibial Tubercle Distomedialization for Patellar Maltracking and Patella Alta Without Instability

Tarik Bayoumi, Dennis C van Duijvenbode, Joyce L Benner, Kirsten D S Boerma-Argelo, Michel H J Stavenuiter, Jelle P van der List, Tarik Bayoumi, Dennis C van Duijvenbode, Joyce L Benner, Kirsten D S Boerma-Argelo, Michel H J Stavenuiter, Jelle P van der List

Abstract

Purpose: To determine short-term patient-reported outcomes following distomedial tibial tubercle transfer (TTT) in patients with patellar maltracking and patella alta without instability.

Methods: A single-surgeon case series study was performed on patients receiving distomedial TTT for the indication of patellar maltracking and patella alta without instability, after nonresponse to conservative treatment. Patient-reported outcomes were assessed preoperatively and at 3-, 6-, 12-, and 24-month follow-up using Kujala, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) pain scores. Generalized estimating equations analyses were performed to study improvement over time. Minimal clinically important differences obtained from literature were used to determine clinical relevance.

Results: A total of 40 patients were included. Eight patients were lost to follow-up; thus, outcomes of 32 patients were analyzed. Mean follow-up was 22 months, median age was 21 years, and 75% were female. Mean Kujala score increased pre- to postoperatively from 55 ± 12 to 79 ± 16 (P < .001), KOOS from 48 ± 14 to 79 ± 15 (P < .001), and VAS from 64 ± 17 to 25 ± 21 (P < .001), respectively. Eighty-four percent had clinical improvement of Kujala score, 91% of KOOS, and 78% of VAS score. A plateau phase in pain reduction was reached at 3 months, and in functional improvement at 6 months follow-up, after which no further significant improvement was observed. Complication rate was 3% and removal of hardware rate was 72%. Conclusions: In this case series study, distomedial TTT led to clinically relevant functional improvement and pain reduction in patients with patellar maltracking and patella alta without instability. However, the removal of hardware rate was high (72%).

Level of evidence: Level IV, therapeutic case series.

© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.

Figures

Fig 1
Fig 1
Tibial tubercle distomedialization in a right knee with patellar maltracking and patella alta. (A) Osteotomy of the tibia tubercle (arrow) with oblique saw cuts. (B) Marked position of the preoperatively planned distomedialization (arrow) for the tibia tubercle with the patellar tendon attached (asterisk), and osteotomy of the second bone block. (C) The second bone block is countersunk in the cutout of the tibia tubercle (arrow). (D) The tibial tubercle is transferred medially and distally and fixated with a partially treated cancellous screw (arrow). The second bone block is mechanically fixated in the cutout of the tibial tubercle (asterisk).
Fig 2
Fig 2
(A) Preoperative radiograph of a left knee with patella alta. Patella alta was defined as CDI >1.3. This index is measured as the ratio between the distance from the tibial articular surface to the lowest point of articular cartilage on the patella (x), to the length of the articular surface of the patella (y). CDI = x/y. (B) Radiograph of the same knee 3 months postoperatively following distomedial transfer of the tibial tubercle (asterisk) with partially treated cancellous screw fixation (arrow). (CDI, Caton-Deschamps Index.)
Fig 3
Fig 3
Overall mean results over time in: (A) Kujala. (B) KOOS. C (VAS pain score). (KOOS, Knee injury and Osteoarthritis Outcome Score; VAS, visual analog scale for pain.)

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Source: PubMed

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