Evaluation of Posteriorization Following Pure Distalization Tibial Tubercle Osteotomy.

Nathan H Varady,Nicolas Pascual-Leone,Ava G Neijna,Andreas H Gomoll,Sabrina M Strickland
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Abstract

BACKGROUND There are theoretical concerns that tibial tubercle osteotomy with pure distalization (TTO-d) may posteriorize the tibial tubercle (and thus increase patellofemoral contact pressure); however, whether TTO-d actually results in posteriorization of the tibial tubercle has never been empirically investigated. PURPOSE To assess the relative amount of anteriorization or posteriorization of the tibial tubercle that occurs after TTO-d. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Consecutive patients, with preoperative and postoperative lateral knee radiographs, who underwent TTO-d between 2015 and 2023 by 2 surgeons were identified. Measurements of posteriorization were performed by 2 physician raters using a magnetic resonance imaging-validated technique. Comparisons were made with the Student t test, and agreement was assessed with the intraclass correlation coefficient. RESULTS A total of 38 patients (86.8% women) were included, with a mean age of 29.3 ± 9.7 years. The mean Caton-Deschamps index significantly decreased from 1.32 ± 0.13 preoperatively to 1.02 ± 0.10 postoperatively (P < .001). There was no significant change in sagittal alignment (ie, anteriorization/posteriorization) from preoperatively (21.6 mm) to postoperatively (22.4 mm) (P = .14). The mean amount of anteriorization/posteriorization was 0.82 ± 1.40 mm anterior (range, 1 mm posterior to 4 mm anterior). There were 31 patients (81.6%) who experienced no change or slight anteriorization; no patient experienced >1 mm of posteriorization. Interrater reliability was excellent (intraclass correlation coefficient = 0.93). CONCLUSION Contemporary TTO-d resulted in the successful correction of patella alta without appreciable posteriorization of the tibial tubercle. These results support the positive clinical outcomes seen with TTO-d, including for chondral lesions, and may reduce concerns about inadvertent posteriorization when performing this procedure. While overdistalization with the formation of patella baja can increase patellofemoral contact pressure beyond native ranges, the current results suggest that restoration of a normal patellar height is unlikely to do so.
胫骨结节纯远端截骨后置效果评价。
有理论认为纯远端胫骨结节截骨术(TTO-d)可能会使胫骨结节后移(从而增加髌股接触压力);然而,TTO-d是否真的导致了胫骨结节的后置,尚无实证研究。目的评价TTO-d术后胫骨结节的前后固定相对量。研究设计横断面研究;证据水平,3。方法选取2015年至2023年间由2名外科医生进行TTO-d手术的连续患者,术前和术后均有膝关节侧位片。2名医师评分员使用磁共振成像验证技术进行后置测量。采用学生t检验进行比较,用班级内相关系数评估一致性。结果共纳入38例患者,其中女性占86.8%,平均年龄29.3±9.7岁。平均卡顿-德尚指数由术前的1.32±0.13降至术后的1.02±0.10,差异有统计学意义(P < 0.001)。矢状面排列(即前置/后置)从术前(21.6 mm)到术后(22.4 mm)无显著变化(P = .14)。前置/后置的平均数量为0.82±1.40 mm(范围,前置1 mm至4 mm)。31例(81.6%)患者无变化或轻微前化;没有患者出现bbb101mm的后移。组间信度极好(组内相关系数= 0.93)。结论:现代TTO-d能成功矫正上髌骨,且无明显的胫骨结节后移。这些结果支持了TTO-d的积极临床结果,包括对软骨病变的治疗,并可能减少对实施该手术时无意后置的担忧。虽然髌骨下端形成的过远端会使髌骨股骨接触压力超出正常范围,但目前的结果表明,恢复正常的髌骨高度不太可能这样做。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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