Tibial Tubercle Osteotomy With Distalization Is Effective Pr
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A Study was conducted to evaluate radiographic, clinical, and functional outcomes in patients who had patellar instability with patella alta and underwent tibial tubercle osteotomy with distalization (TTO-d) as well as medial patellofemoral ligament reconstruction.

25 patients were included in this study (mean age at surgery, 28.7 years; range, 14-33 years) with patellar instability and patella alta who underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, and amount of distalization were assessed. Clinical and functional variables included J-sign, anterior knee pain, apprehension test, Tegner activity level, and Kujala score.

Results:
--The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm; the mean CDI changed from 1.37 preoperatively to 1.02 postoperatively; and the mean amount of tibial tubercle distalization was 8.80 mm (range, 4-16 mm).

--Lateral release (71.0%), medialization of tibial tubercle (54.8%), and autologous chondrocyte implantation (12.9%) were other associated procedures.

--The J-sign improved in 30 cases (96.8%), and there was a complete resolution of anterior knee pain in 22 cases (71.0%). An exploratory analysis showed that patellar cartilage defect severity was correlated with persistent pain.

--The apprehension test became negative in all cases. The median Kujala score increased from 52 to 77, and the median Tegner activity level improved from 3 to 4. No cases of osteotomy nonunion were reported.

--One case (3.2%) of patellar instability recurrence and 3 cases (6.5%) with painful hardware were observed.

Conclusively, TTO-d resulted in strong radiographic, clinical, and functional findings that provided patients with patella alta with sufficient patellar stability. TTO-d tends to be a safe and reliable low complication risk procedure that offers an additional method for personalised treatment of patellar instability.

Source: https://pubmed.ncbi.nlm.nih.gov/33553451/
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