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. 2024 Feb 15;12(2):23259671241227201.
doi: 10.1177/23259671241227201. eCollection 2024 Feb.

Decreased Effective Patellar Tendon Length following Distalization Tibial Tubercle Osteotomy without Patellar Tendon Tenodesis

Tyler J Uppstrom  1 , Connor F Fletcher  1 , Daniel W Green  2 , Andreas H Gomoll  1 , Sabrina M Strickland  1
Affiliations

Decreased Effective Patellar Tendon Length following Distalization Tibial Tubercle Osteotomy without Patellar Tendon Tenodesis

Tyler J Uppstrom et al. Orthop J Sports Med. .

Abstract

Background: Distalization tibial tubercle osteotomy (TTO) is an effective treatment for improving patellar height in patients with patella alta associated with patellofemoral instability and cartilage lesions. The addition of a patellar tendon tenodesis has been suggested; nonetheless, concerns exist regarding possible increased patellofemoral cartilage stresses.

Purpose: To evaluate pre- and postoperative patellar tendon length and alignment parameters on magnetic resonance imaging (MRI), as well as patient-reported outcome measures (PROMs) after distalization TTO without patellar tendon tenodesis.

Study design: Case series; Level of evidence, 4.

Methods: Twenty skeletally mature patients who underwent distalization TTO with or without anteromedialization at our institution between December 2014 and August 2021 were included. All patients underwent pre- and postoperative MRIs of the affected knee. The Caton-Deschamps index (CDI), the axial and sagittal tibial tubercle-trochlear groove (TT-TG) distances, the distances from the tibial plateau to the patellar tendon insertion and the tibial tubercle, and the patellar tendon length were assessed. PROMs included the International Knee Documentation Committee Subjective Knee Evaluation Form, the Knee injury and Osteoarthritis Outcome Score-Quality of Life subscale, the Kujala Anterior Knee Pain Scale, and the Veterans RAND 12-Item Health Survey mental and physical component scores.

Results: The mean patient age at surgery was 27.4 years (range, 14-42 years). Radiographic parameters demonstrated improved patellar height (CDI decreased from 1.36 to 1.11; P < .001) after distalization TTO. The distance from the tibial plateau to the patellar tendon insertion significantly decreased from 20.1 mm preoperatively to 17.9 mm postoperatively (P < .020), and the patellar tendon length decreased from 53.4 mm preoperatively to 46.0 mm postoperatively (P < .001). The patellar tendon insertion was not distalized after distalization TTO, likely because of scarring of the patellar tendon proximal to the osteotomy site. Patients demonstrated significant pre- to postoperative improvements on all PROMs (P≤ .024 for all ). There were 4 (20%) complications-2 cases of arthrofibrosis, 1 postoperative infection, and 1 osteotomy delayed union.

Conclusion: Distalization TTO without patellar tendon tenodesis was associated with improved radiographic outcomes and PROMs. It provides an additional tool for surgical management of patellofemoral pathology with associated patella alta.

Keywords: distalization; patella alta; patellofemoral instability; tibial tubercle osteotomy.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: D.W.G. has received consulting fees from OrthoPediatrics; nonconsulting fees from Arthrex and Synthes; and royalties from Arthrex and Pega Medical. A.H.G. has received research support from JRF Ortho and Vericel; consulting fees from Bioventus, Vericel, Smith & Nephew, Flexion Therapeutics, JRF Ortho, Moximed, and Organogenesis; nonconsulting fees from Pacira Pharmaceuticals and Linvatec; royalties from Organogenesis; and honoraria from Vericel, Fidia Pharma, and JRF Ortho. S.M.S. has received research support from Vericel; consulting fees from Smith & Nephew, Vericel, and Flexion Therapeutics; nonconsulting fees from Smith & Nephew; royalties from Vericel; and honoraria from Vericel and JRF Ortho and has investment holdings in Engage and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the Hospital for Special Surgery (ref No. 2020-0264-AM3).

Figures

Figure 1.
Figure 1.
A schematic diagram demonstrating measurement of the CDI (yellow arrows; the ratio of A/B), the patellar tendon length (red arrows), the distance from the tibial plateau to the proximal patellar tendon insertion (green arrows), and the distance from the tibial plateau to the proximal aspect of the tibial tubercle (blue arrows) on pre- and postoperative MRI. CDI, Caton-Deschamps index; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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