Fulkerson and colleagues reported the clinical results of anteromedial tibial tubercle transfer without bone graft and measured how it changed patellofemoral contact pressure in cadaver knees.
Series of 30 patients (mean age 28) followed a mean 35 months (26 to 50) for patellofemoral pain with patellar degeneration, plus a five‑knee cadaver pressure study.
Key Findings
Results were good or excellent in 93% of patients by their own report and in 89% on objective scoring.
Of the 8 patients with advanced patellar arthrosis, 75% had a good result and none an excellent one.
Stiffness needed manipulation in 9 of the first 25 patients, who were immobilized for 4 weeks. The authors report no stiffness problem since starting immediate motion, in 26 later patients, 5 of them in this series.
Screws were removed for discomfort in 16 of 30 patients. One tubercle fractured late through the screw hole and one avulsed on day 3, both treated by reoperation.
Two patients developed deep venous thrombosis. No skin slough, infection or compartment syndrome occurred in 51 consecutive cases.
In 5 cadaver knees, about 15 mm of anteriorization cut lateral facet pressure by 65% at 10° of flexion. Beyond 30°, facet pressures stayed balanced but were not significantly lower than before transfer.
Board pearl
In the authors' view anteromedial transfer is reserved for failed nonoperative care, when simpler surgery such as lateral release would not correct the problem. When anteriorizing, they recommend 12 to 15 mm.
Authors' conclusion
This surgical procedure is mechanically and clinically successful for alleviating intractable pain related to patellar malalignment and articular degeneration. This procedure enables the majority of appropriately selected patients with malalignment and patellar articular degeneration to resume increased levels of activity with substantially diminished pain.
Fulkerson and colleagues reported the clinical results of anteromedial tibial tubercle transfer without bone graft and measured how it changed patellofemoral contact pressure in cadaver knees.
Series of 30 patients (mean age 28) followed a mean 35 months (26 to 50) for patellofemoral pain with patellar degeneration, plus a five‑knee cadaver pressure study.
Key Findings
Results were good or excellent in 93% of patients by their own report and in 89% on objective scoring.
Of the 8 patients with advanced patellar arthrosis, 75% had a good result and none an excellent one.
Stiffness needed manipulation in 9 of the first 25 patients, who were immobilized for 4 weeks. The authors report no stiffness problem since starting immediate motion, in 26 later patients, 5 of them in this series.
Screws were removed for discomfort in 16 of 30 patients. One tubercle fractured late through the screw hole and one avulsed on day 3, both treated by reoperation.
Two patients developed deep venous thrombosis. No skin slough, infection or compartment syndrome occurred in 51 consecutive cases.
In 5 cadaver knees, about 15 mm of anteriorization cut lateral facet pressure by 65% at 10° of flexion. Beyond 30°, facet pressures stayed balanced but were not significantly lower than before transfer.
Board pearl
In the authors' view anteromedial transfer is reserved for failed nonoperative care, when simpler surgery such as lateral release would not correct the problem. When anteriorizing, they recommend 12 to 15 mm.
Authors' conclusion
This surgical procedure is mechanically and clinically successful for alleviating intractable pain related to patellar malalignment and articular degeneration. This procedure enables the majority of appropriately selected patients with malalignment and patellar articular degeneration to resume increased levels of activity with substantially diminished pain.