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Modified Technique of Tibial Tuberosity Transfer.

ABSTRACT: Tibial tuberosity transfer is a well-established procedure in the treatment of patellar instability and in selected cases of anterior knee pain. Several techniques have been advocated in the literature. Some of the common complications associated with this procedure have been pain and discomfort due to prominent screw heads, necessitating their removal; nonunion and delayed union of the osteotomy; and failure of fixation. Tibial fractures have also been reported in some case reports. We present our technique of tibial tuberosity transfer using two 4-mm cannulated screws for stabilization of the tuberosity fragment. We have used this technique either for isolated tibial tuberosity transfer or as part of a combined procedure along with medial patellofemoral ligament reconstruction in treating patellar instability. Using this technique, we have encountered no patients with wound problems, nonunion, delayed union, or loss of fixation and only 1 patient with a metal work problem needing a second procedure for its removal. We attribute our good outcomes to the preservation of the soft-tissue attachments to the tuberosity fragment; minimal soft-tissue dissection, which allows rapid bony consolidation of the osteotomy, which in turn allows accelerated rehabilitation; and the use of 4-mm cannulated screws for fixation of the osteotomy, minimizing the potential for metal work problems.

SUBMITTER: Pemmaraju G

PROVIDER: S-EPMC4680919 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPreviously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique.MethodsClinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment.ResultsThe mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with -0.5 ± 1.7 mm in the conventional group (t = -7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (χ = 4.95, P = 0.035).ConclusionsThe modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side.

Project description:BackgroundSeveral methods have been described to measure external rotation of the tibial tuberosity; all use femoral landmarks.PurposeTo develop reproducible tibial-based methods to measure external rotation of the tibial tuberosity in patients with patellar instability.Study designCross-sectional study; Level of evidence, 3.MethodsIncluded were magnetic resonance images of 61 patients with patellar instability and 61 age- and sex-matched healthy controls. Three novel methods using tibial landmarks to measure the rotation of the tibial tuberosity (plateau axis-tuberosity axis [PA-TA] angle, tibial geometric center-tuberosity axis [GC-TA] angle, and plateau axis-midtuberosity point [PA-MT] angle) as well as a femoral-based rotational measurement (surgical transepicondylar axis-tuberosity axis [sTEA-TA] angle) and the tibial tuberosity-trochlear groove (TT-TG) distance were measured and compared in instability patients and controls using unpaired t tests, and the cutoff values for predicting instability were calculated using receiver operating characteristic curves. The correlations between the angle measurements and the TT-TG distance were analyzed.ResultsInstability patients had significantly higher external rotation of the tibial tuberosity compared with controls with regard to the PA-TA angle (18.2° ± 9.6° versus 13.1° ± 6.8°; P = .001), GC-TA angle (8.4° ± 4.5° versus 11.5° ± 3.9°; P = .0001) and sTEA-TA angle (122° ± 8.5° versus 113.6° ± 6.3°; P = .0001). The mean TT-TG distance was also significantly higher in the instability group (18.2 ± 5.4 versus 11.5 ± 2.7 mm; P = .001). The cutoff values were 17.5° (area under the receiver operating characteristic curve [AUC] = 0.66) for PA-TA angle, 8.5° (AUC = 0.705) for GC-TA angle, 118.8° (AUC = 0.79) for sTEA-TA angle, and 15.2 mm for TT-TG distance (AUC = 0.863). PA-TA angle was significantly correlated with all other measurements (r = 0.35-0.71; P ≤ .006 for all), whereas sTEA-TA angle had the strongest correlation with TT-TG distance (r = 0.78; P = .001).ConclusionThe tibial tuberosity was externally rotated in patellar instability patients compared with age- and sex-matched controls, and this intrinsic malalignment of the proximal tibia was demonstrated in the tibial-based measurements.

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Modified Technique of Tibial Tuberosity Transfer.

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