Both Medialization and Anteromedialization Tibial Tubercle Osteotomies are Effective Surgical Management for Skeletally Mature Patients with Patellofemoral Instability when Combined with Medial Patellofemoral Ligament Reconstruction

Si Heng Sharon Tan; Angeline Ai Ling Aw; Xin Chun Amelia Goh; Luke Yi Hao Tan; Andrew Kean Seng Lim; James Hoipo Hui

doi:10.1055/s-0042-1755356

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2023; 36(12): 1297-1301
DOI: 10.1055/s-0042-1755356

Original Article

Both Medialization and Anteromedialization Tibial Tubercle Osteotomies are Effective Surgical Management for Skeletally Mature Patients with Patellofemoral Instability when Combined with Medial Patellofemoral Ligament Reconstruction

Authors

Si Heng Sharon Tan

¹Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore
Angeline Ai Ling Aw

¹Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore
Xin Chun Amelia Goh

¹Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore
Luke Yi Hao Tan

¹Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore
Andrew Kean Seng Lim

¹Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore
James Hoipo Hui

¹Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore

Abstract

The study aimed to compare the midterm outcomes of medialization and anteromedialization tibial tubercle osteotomies when used in the management of recurrent patellofemoral instability. The hypothesis is that both techniques would result in significant improvement for patellofemoral instability, but anteromedialization would result in a lower incidence of early osteoarthritis. In the cohort study, all skeletally mature patients aged 18 years old or younger who underwent tibial tubercle osteotomy for recurrent patellofemoral instability within a 10-year period in a single institution were included. All patients underwent either medialization or anteromedialization tibial tubercle osteotomy. The preoperative and postoperative outcomes of the tibial tubercle osteotomies were compared. All patients included in the study had a minimum of 5-year follow-up duration before the conclusion of the study. There was no statistically significant difference in the rates of preoperative and postoperative patellofemoral dislocation when either technique was employed (p = 0.999). Additionally, both the preoperative and postoperative Kujala scores were similar (p = 0.166 and p = 0.554, respectively). The knees did not have a statistically significant difference in their patellar tilt angles and tibial tubercle-trochlear groove distances preoperatively or postoperatively when either technique was used (p = 0.165 and 0.149, respectively). There was also no incidence of osteoarthritis identified in either of the groups (p = 0.999). Both anteriorization and anteromedialization tibial tubercle osteotomies were effective surgical management for patellofemoral instability when combined with medial patellofemoral ligament reconstruction. There were no significant differences in clinical, functional, and radiological outcomes when either medialization or anteromedialization tibial tubercle osteotomy was performed.

Keywords

tibial tubercle osteotomy - tibial tuberosity osteotomy - tibial tubercle medialisation - tibial tubercle anteromedialisation

Full Text

References

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