[Tibial tubercle osteotomy]

Abstract

Objective: Tibial tubercle osteotomy facilitates access to the knee joint without excessive tension of the extensor apparatus with the lateral parapatellar approach and the medial parapatellar approach in case of contracture or revision arthroplasty.

Indications: Inadequate exposure of the knee joint with the lateral parapatellar approach and inadequate exposure of the knee joint with the medial parapatellar approach in case of contracture and revision arthroplasty.

Contraindications: Severe periarticular osteoporosis or bone atrophy after knee arthroplasty and damage to the patella tendon insertion due to previous operations.

Surgical technique: A bone block 8-10 cm long is excised with the tibial tubercle using an oscillating saw. A step cut inferior to the tibial plateau is created with a chisel. Refixation is performed with two cortical screws. Alternatively, in case of poor bone quality, refixation is accomplished with two cerclage wires.

Postoperative management: In case of stable refixation, full weight bearing is allowed with an extension brace for 2-4 weeks and passive flexion is increased as tolerated. In case of poor bone quality, it is recommended that full weight bearing be postponed for 6 weeks, whereby full flexion is regained in 30° steps at 2, 4, and 6 weeks postoperatively.

Results: From 2001-2004, 67 osteotomies of the tibial tubercle were performed for revision arthroplasty. During follow-up in 2010, no pseudarthrosis or dislocation was noticed. Postoperatively, two hematoma and one skin necrosis had to be revised. The risk of hematoma and pseudarthrosis or dislocation of the fragment can be minimized by using the correct operative technique.