Combined operation involving tibial tubercle distalization for recurrent patellar dislocation with patella alta_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DAI Zhu , LEI Yunliang , LIAO Ying , CHEN Zhiwei , FU Dehong , LI Zhou

Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421001, P.R.China;

Corresponding author：

DAI Zhu, Email: oliverdai@hotmail.com

Keywords：

Recurrent patellar dislocation; patella alta; tibial tubercle distalization; effectiveness

DOI：

10.7507/1002-1892.201808002

Video：

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Objective To explore the clinical effects of combined operation involving tibial tubercle distalization for the recurrent patellar dislocation with patella alta.Methods Between April 2010 and May 2016, 14 cases of recurrent patellar dislocation with patella alta were treated with combined operation involving tibial tubercle distalization. There were 5 males and 9 females with an average age of 18.5 years (range, 13-26 years). The left knee was involved in 9 cases and the right knee in 5 cases. The patella had dislocated 3.3 times on average (range, 2-5 times). The interval between the first dislocation and admission was 19.7 months on average (range, 4-60 months), and the main symptoms were knee pain and limited knee movement. Preoperative X-ray films, CT, and MRI examinations of knee joint showed that the epiphyseal plate closed in all patients. Of all patients, 3 patients had avulsion fracture of the inner edge of patella, and 2 patients had free body in articular cavity. The tibial tuberosity-trochlear groove (TT-TG) distance, patellar-trochlear-groove distance, Caton-Deschamps index, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Kujala score, and Tegner score were compared pre- and post-operation.Results All patients had primary wound healing. All patients were followed up 24-72 months with an average of 34.6 months. X-ray film and CT examination showed that the patellar dislocation was corrected and the osteotomy of the tibial tubercle healed with an average healing time of 3.8 months (range, 3-5 month). At 1 day and 1 year after operation, the TT-TG distance, patellar-trochlear-groove distance, and Caton-Deschamps index showed significant differences when compared with preoperative values (P<0.05), but there was no significant difference between 1 day and 1 year after operation (P>0.05). At the 1 year and 2 years after operation, the knee ROM, Lysholm score, IKDC score, Kujala score, and Tegner score showed significant differences when compared with preoperative values (P<0.05), and there was no significant difference between the 1 year and 2 years after operation (P>0.05).Conclusion Combined operation involving tibial tubercle distalization is a safe and reliable method, which has satisfactory short-term effectiveness for the recurrent patellar dislocation with patella alta.

Citation： DAI Zhu, LEI Yunliang, LIAO Ying, CHEN Zhiwei, FU Dehong, LI Zhou. Combined operation involving tibial tubercle distalization for recurrent patellar dislocation with patella alta. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 312-317. doi: 10.7507/1002-1892.201808002 Copy

1.	Koh JL, Stewart C. Patellar instability. Clin Sports Med, 2014, 33(3): 461-476.
2.	Mayer C, Magnussen RA, Servien E, et al. Patellar tendon tenodesis in association with tibial tubercle distalization for the treatment of episodic patellar dislocation with patella alta. Am J Sports Med, 2012, 40(2): 346-351.
3.	Clark D, Metcalfe A, Wogan C, et al. Adolescent patellar instability: current concepts review. Bone Joint J, 2017, 99-B(2): 159-170.
4.	Bartsch A, Lubberts B, Mumme M, et al. Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review Arch Orthop Trauma Surg, 2018, 138(11): 1563-1573.
5.	Magnussen RA, De Simone V, Lustig S, et al. Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2545-2550.
6.	Otsuki S, Nakajima M, Fujiwara K, et al. Influence of age on clinical outcomes of three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8): 2392-2396.
7.	Luyckx T, Didden K, Vandenneucker H, et al. Is there a biomechanical explanation for anterior knee pain in patients with patella alta?: influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg (Br), 2009, 91(3): 344-350.
8.	Stefanik JJ, Zhu Y, Zumwalt AC, et al. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken), 2010, 62(9): 1258-1265.
9.	Yin L, Liao TC, Yang L, et al. Does patella tendon tenodesis improve tibial tubercle distalization in treating patella alta? A computational study. Clin Orthop Relat Res, 2016, 474(11): 2451-2461.
10.	戴祝, 尤迪, 廖瑛, 等. 髌骨复发性脱位伴陈旧性骨软骨骨折的治疗. 中国修复重建外科杂志, 2016, 30(1): 10-14.
11.	Weber AE, Nathani A, Dines JS, et al. An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg (Am), 2016, 98(5): 417-427.
12.	阮文辉, 李宏波, 谢鹏, 等. 成人复发性髌骨脱位的术前影像学评估与联合手术. 中华骨与关节外科杂志, 2016, 9(1): 57-61.
13.	Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev, 2018, 26(1): 8-15.
14.	高志涛, 李彦林, 王国梁, 等. 内侧髌股韧带重建治疗髌骨脱位影响因素研究进展. 中国修复重建外科杂志, 2018, 32(8): 1047-1051.
15.	Andrish J. Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc Rev, 2017, 25(2): 100-104.
16.	Simmons E Jr, Cameron JC. Patella alta and recurrent dislocation of the patella. Clin Orthop Relat Res, 1992, (274): 265-269.
17.	Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop, 2010, 34(2): 305-309.
18.	Duchman K, Bollier M. Distal realignment: indications, technique, and results. Clin Sports Med, 2014, 33(3): 517-530.
19.	Damasena I, Blythe M, Wysocki D, et al. Medial patellofemoral ligament reconstruction combined with distal realignment for recurrent dislocations of the patella: 5-year results of a randomized controlled trial. Am J Sports Med, 2017, 45(2): 369-376.
20.	Hernigou J, Chahidi E, Kashi M, et al. Risk of vascular injury when screw drilling for tibial tuberosity transfer. Int Orthop, 2018, 42(5): 1165-1174.

1. Koh JL, Stewart C. Patellar instability. Clin Sports Med, 2014, 33(3): 461-476.
2. Mayer C, Magnussen RA, Servien E, et al. Patellar tendon tenodesis in association with tibial tubercle distalization for the treatment of episodic patellar dislocation with patella alta. Am J Sports Med, 2012, 40(2): 346-351.
3. Clark D, Metcalfe A, Wogan C, et al. Adolescent patellar instability: current concepts review. Bone Joint J, 2017, 99-B(2): 159-170.
4. Bartsch A, Lubberts B, Mumme M, et al. Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review Arch Orthop Trauma Surg, 2018, 138(11): 1563-1573.
5. Magnussen RA, De Simone V, Lustig S, et al. Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2545-2550.
6. Otsuki S, Nakajima M, Fujiwara K, et al. Influence of age on clinical outcomes of three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8): 2392-2396.
7. Luyckx T, Didden K, Vandenneucker H, et al. Is there a biomechanical explanation for anterior knee pain in patients with patella alta?: influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg (Br), 2009, 91(3): 344-350.
8. Stefanik JJ, Zhu Y, Zumwalt AC, et al. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken), 2010, 62(9): 1258-1265.
9. Yin L, Liao TC, Yang L, et al. Does patella tendon tenodesis improve tibial tubercle distalization in treating patella alta? A computational study. Clin Orthop Relat Res, 2016, 474(11): 2451-2461.
10. 戴祝, 尤迪, 廖瑛, 等. 髌骨复发性脱位伴陈旧性骨软骨骨折的治疗. 中国修复重建外科杂志, 2016, 30(1): 10-14.
11. Weber AE, Nathani A, Dines JS, et al. An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg (Am), 2016, 98(5): 417-427.
12. 阮文辉, 李宏波, 谢鹏, 等. 成人复发性髌骨脱位的术前影像学评估与联合手术. 中华骨与关节外科杂志, 2016, 9(1): 57-61.
13. Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev, 2018, 26(1): 8-15.
14. 高志涛, 李彦林, 王国梁, 等. 内侧髌股韧带重建治疗髌骨脱位影响因素研究进展. 中国修复重建外科杂志, 2018, 32(8): 1047-1051.
15. Andrish J. Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc Rev, 2017, 25(2): 100-104.
16. Simmons E Jr, Cameron JC. Patella alta and recurrent dislocation of the patella. Clin Orthop Relat Res, 1992, (274): 265-269.
17. Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop, 2010, 34(2): 305-309.
18. Duchman K, Bollier M. Distal realignment: indications, technique, and results. Clin Sports Med, 2014, 33(3): 517-530.
19. Damasena I, Blythe M, Wysocki D, et al. Medial patellofemoral ligament reconstruction combined with distal realignment for recurrent dislocations of the patella: 5-year results of a randomized controlled trial. Am J Sports Med, 2017, 45(2): 369-376.
20. Hernigou J, Chahidi E, Kashi M, et al. Risk of vascular injury when screw drilling for tibial tuberosity transfer. Int Orthop, 2018, 42(5): 1165-1174.

Chinese Journal of Reparative and Reconstructive Surgery

Combined operation involving tibial tubercle distalization for recurrent patellar dislocation with patella alta

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