CC BY-NC-ND 4.0 · Joints 2018; 06(02): 080-084
DOI: 10.1055/s-0038-1661340
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta

Davide Enea
1   Orthopaedic Unit, Casa di Cura “Villa Igea” Hospital, Ancona, Italy
Pier Paolo Canè
2   Department of Orthopaedic, “Sol et Salus” Hospital, Torre Pedrera, Italy
Marco Fravisini
2   Department of Orthopaedic, “Sol et Salus” Hospital, Torre Pedrera, Italy
Antonio Gigante
3   Clinical Orthopaedics, Department of Clinical and Molecular Science (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
Luca Dei Giudici
1   Orthopaedic Unit, Casa di Cura “Villa Igea” Hospital, Ancona, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
22 June 2018 (online)


Purpose The aim of the study was to test the distalization and medialization of the tibial tuberosity (DMTT) for the treatment of patellar instability associated with patella alta, focusing on residual instability and pain.

Methods Twenty-four consecutive patients (26 knees) suffering from patellofemoral instability and patella alta were treated by DMTT. Two groups were identified, which differed for documented history of frank patella dislocation. The groups were named objective patellar instability (OPI) (history of dislocation) and potential patella instability (PPI) (no dislocation). Outcome was measured with visual analogue scale (VAS), Kujala score, and Tegner score. Comparison between groups was performed using Student's t-test, Wilcoxon rank score, and Fisher's exact test (significance at p < 0.05).

Results At 50 ± 18 and 41 ± 18 months of follow-up, respectively, both PPI and OPI groups obtained a significant pain reduction and functional improvement. The PPI group showed a significant decrease of the subjective instability. No procedure-related complications were reported.

Conclusion This study suggests that DMTT is a viable option for PPI patients with patella alta. The outcome was comparable between PPI and OPI cases; however, decrease in subjective instability was significantly greater in PPI patients.

Level of Evidence Level III, retrospective comparative study.

  • References

  • 1 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
  • 2 Zaffagnini S, Colle F, Lopomo N. , et al. The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc 2013; 21 (09) 2164-2171
  • 3 Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases [in French]. Rev Chir Orthop Repar Appar Mot 1982; 68 (05) 317-325
  • 4 Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC. Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2545-2550
  • 5 Caton J, Mironneau A, Walch G, Levigne C, Michel CR. Idiopathic high patella in adolescents. Apropos of 61 surgical cases [in French]. Rev Chir Orthop Repar Appar Mot 1990; 76 (04) 253-260
  • 6 Marteau E, Burdin P, Brilhault JM. Gracilis tendon transfer associated with distal alignment for patella alta with recurrent dislocations: an original surgical technique. Orthop Traumatol Surg Res 2011; 97 (4, Suppl): S5-S11
  • 7 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 (02) 346-351
  • 8 Pritsch T, Haim A, Arbel R, Snir N, Shasha N, Dekel S. Tailored tibial tubercle transfer for patellofemoral malalignment: analysis of clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2007; 15 (08) 994-1002
  • 9 Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 2010; 34 (02) 305-309
  • 10 Otsuki S, Nakajima M, Oda S. , et al. Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta. J Orthop Sci 2013; 18 (03) 437-442
  • 11 Diks MJ, Wymenga AB, Anderson PG. Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella. Knee Surg Sports Traumatol Arthrosc 2003; 11 (06) 384-388
  • 12 Grelsamer RP. Patellar malalignment. J Bone Joint Surg Am 2000; 82-A (11) 1639-1650
  • 13 Scuderi GR. Surgical treatment for patellar instability. Orthop Clin North Am 1992; 23 (04) 619-630
  • 14 AL-Sayyad MJ, Cameron JC. Functional outcome after tibial tubercle transfer for the painful patella alta. Clin Orthop Relat Res 2002; (396) 152-162
  • 15 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43-B: 752-757
  • 16 Freedman BR, Sheehan FT, Lerner AL. MRI-based analysis of patellofemoral cartilage contact, thickness, and alignment in extension, and during moderate and deep flexion. Knee 2015; 22 (05) 405-410
  • 17 Palmer SH, Servant CT, Maguire J, Machan S, Parish EN, Cross MJ. Surgical reconstruction of severe patellofemoral maltracking. Clin Orthop Relat Res 2004; (419) 144-148
  • 18 Skelley N, Friedman M, McGinnis M, Smith C, Hillen T, Matava M. Inter- and intraobserver reliability in the MRI measurement of the tibial tubercle-trochlear groove distance and trochlea dysplasia. Am J Sports Med 2015; 43 (04) 873-878
  • 19 Caplan N, Lees D, Newby M. , et al. Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2377-2381
  • 20 Saranathan A, Kirkpatrick MS, Mani S. , et al. The effect of tibial tuberosity realignment procedures on the patellofemoral pressure distribution. Knee Surg Sports Traumatol Arthrosc 2012; 20 (10) 2054-2061