Surgical realignment of Patellar Subluxation with Tilt: Anteromedialization of Tibial Tubercle by Flat Osteotomy and Insertion of Local Bone Graft

To determine its efficacy, surgery (anteromedial tibial tubercle transfer by flat osteotomy, elevation with a local bone graft, and lateral release) for the correction of patellar subluxation and tilt was performed on 27 knees of 21 patients. Evaluation of the surgical results occurred over a 50-month period (range, 24-72 months). All patients received a preoperative CT scan (12 also received a postoperative CT scan) and a preoperative arthroscopic evaluation in which chondromalacia of the patella was tracked and graded according to Insall criteria. The tibial tuberosity osteotomy site and bone graft were fixed with one cortical screw in 25 knees and with 2 screws in 2 knees, and all knees healed well without nonunion. Congruence and tile angles were improved from an average of +36 degrees (25 to 44)and 3degrees (0 to 6) preoperatively, respectively, to-13 degrees (3to -30) and 12 degrees (8 to 15) postoperatively. Kujala functional score of patellofemoral joint was improved from 55 preoperatively to 87 postoperatively (P＜0.05). Second-look arthroscopy in 12 patients (1 year postoperatively) showed no obvious progression of chondromalacia. Pain was much alleviated from a mean score of 7.8 preoperatively to 2.3 postoperatively (P＜0.05). The average of tibial tubercle medaialization was 10.5mm and elevation was 10 mm. We conclude that the functional result of this treatment for patellar sublux-ation and tilt was good or excellent, markedly reduced anterior knee pain, and much improved patellofemoral alignment.

並列關鍵字

Patellar subluxation ； patellar tilt ； isteotomy ； realignment

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