ROLE OF TIBIAL TUBERCLE INTERNAL ROTATION TO TREAT RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH TROCHLEAR DYSPLASIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHENHong , ZHAODaohong , ZHANGJun , YANGZhengdong , WUZhidan , XIEJingming

Department of Orthopaedics, Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P. R. China;

Corresponding author：

CHENHong, Email: fyychenghong@163.com

Keywords：

Recurrent patellar dislocation; Tibial tubercle internal rotation; Trochlear dysplasia

DOI：

10.7507/1002-1892.20150008

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Objective To introduce and analyze the role of tibial tubercle internal rotation to treat recurrent patellar dislocation associated with trochlear dysplasia. Methods Between February 2007 and April 2011, 28 patients with recurrent patellar dislocation underwent tibial tubercle translocation through medial transfer, rotation and elevation of the tibial tuberosity and the medial patellofemoral ligament (MPFL) reconstruction. There were 4 males and 24 females with an average age of 21.8 years (range, 17-28 years). The disease duration ranged from 6 months to 8 years (mean, 4 years). The patients suffered from 3-10 times patellar dislocation. The result of apprehension test was positive; Lysholm score was (51.64±3.79); Kujala score was (56.89±3.79). According to Dejour classification, 11 cases were rated as type B, 14 cases as type C, and 3 cases as type D; the tibial tuberosity-trocholear distance (TT-TG) was (20.53±2.58) mm; and the patellar tilt angle (PTA) was (29.34±2.54)°. Results Primary healing of incision was obtained in the others except 1 case of mild infection. Twenty-seven patients were followed up 41.8 months on average (range, 27-74 months). No recurrent dislocation was found, and the result of apprehension test was negative. The knee range of motion restored to normal totally. The postoperative Kujala score and Lysholm score were significantly improved to 88.97±3.06 and 88.95±2.98 (t=-42.005, P=0.000; t=-43.122, P=0.000) respectively. TT-TG and PTA restored to normal[(11.77±2.24) mm and (7.99±2.57)°], showing significant differences when compared with preoperative ones(t=13.032, P=0.000; t=29.533, P=0.000). Conclusion The technique of tibial tubercle translocation and MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation associated with trochlear dysplasia. Especially, tibial tubercle internal rotation can improve the patella stability and knee function.

Citation： CHENHong, ZHAODaohong, ZHANGJun, YANGZhengdong, WUZhidan, XIEJingming. ROLE OF TIBIAL TUBERCLE INTERNAL ROTATION TO TREAT RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH TROCHLEAR DYSPLASIA. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 31-34. doi: 10.7507/1002-1892.20150008 Copy

1.	Deie M, Ochi M, Sumen Y, et al. A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7):522-528.
2.	Ntagiopoulos PG, Dejour D. Current concepts on trochleoplasty procedures for the surgical treatment of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2531-2539.
3.	Dejour H, Walch G, Neyret P, et al. Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot, 1990, 76(1):45-54.
4.	张辉, 洪雷, 耿向苏, 等. 内侧髌股韧带重建治疗复发性髌骨脱位. 中国修复重建外科杂志, 2011, 25(8):24-28.
5.	Tsuda E, Ishibashi Y, Yamamoto Y, et al. Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(10):2062-2070.
6.	Barber FA, McGarry JE. Elmslie-Trillat procedure for the treatment of recurrent patellar instability. J Arthrosc Relat Surg, 2008, 24(1):77-81.
7.	Csintalan RP, Latt LD, Fornalski S, et al. Medial Patellofemoral Ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg, 2013, 1013-1021.
8.	Ntagiopoulos PG, Byn P, Dejour D. Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med, 2013, 41(5):998-1004.
9.	Matsushita T, Kuroda R, Oka S, et al. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2438-2444.
10.	Servien E, Fritsch B, Lustig S, et al. In vivo positioning analysis of medial patellofemoral ligament reconstruction. Am J Sports Med, 2011, 39(1):134-139.
11.	Kreuz PC, Peterson L, van der Werf-Grohmann N, et al. Clinical and electromyographic results of proximal and distal realignment procedures in young patients with recurrent patellar dislocations. Am J Sports Med, 2013, 41(7):1022-1026.
12.	Tecklenburg K, Feller JA, Whitehead TS, et al. Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg (Br), 2010, 92(10):1376-1380.
13.	Feller JA, Amis AA, Andrish JT, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy, 2007, 23(5):542-553.
14.	Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg, 2011, 19(1):8-16.
15.	Dejour DH. The patellofemoral joint and its historical roots:the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc, 2013, 21(7):1482-1494.
16.	von Knoch F, Bhm T, Bürgi ML, et al. Trochleoplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4-to 14-year follow-up study. J Bone Joint Surg (Br), 2006, 88(10):1331-1335.
17.	Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7):529-533.
18.	Schüttler KF, Struewer J, Roessler PP, et al. Patellofemoral osteoarthritis after Insall's proximal realignment for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11):2623-2628.

1. Deie M, Ochi M, Sumen Y, et al. A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7):522-528.
2. Ntagiopoulos PG, Dejour D. Current concepts on trochleoplasty procedures for the surgical treatment of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2531-2539.
3. Dejour H, Walch G, Neyret P, et al. Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot, 1990, 76(1):45-54.
4. 张辉, 洪雷, 耿向苏, 等. 内侧髌股韧带重建治疗复发性髌骨脱位. 中国修复重建外科杂志, 2011, 25(8):24-28.
5. Tsuda E, Ishibashi Y, Yamamoto Y, et al. Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(10):2062-2070.
6. Barber FA, McGarry JE. Elmslie-Trillat procedure for the treatment of recurrent patellar instability. J Arthrosc Relat Surg, 2008, 24(1):77-81.
7. Csintalan RP, Latt LD, Fornalski S, et al. Medial Patellofemoral Ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg, 2013, 1013-1021.
8. Ntagiopoulos PG, Byn P, Dejour D. Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med, 2013, 41(5):998-1004.
9. Matsushita T, Kuroda R, Oka S, et al. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2438-2444.
10. Servien E, Fritsch B, Lustig S, et al. In vivo positioning analysis of medial patellofemoral ligament reconstruction. Am J Sports Med, 2011, 39(1):134-139.
11. Kreuz PC, Peterson L, van der Werf-Grohmann N, et al. Clinical and electromyographic results of proximal and distal realignment procedures in young patients with recurrent patellar dislocations. Am J Sports Med, 2013, 41(7):1022-1026.
12. Tecklenburg K, Feller JA, Whitehead TS, et al. Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg (Br), 2010, 92(10):1376-1380.
13. Feller JA, Amis AA, Andrish JT, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy, 2007, 23(5):542-553.
14. Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg, 2011, 19(1):8-16.
15. Dejour DH. The patellofemoral joint and its historical roots:the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc, 2013, 21(7):1482-1494.
16. von Knoch F, Bhm T, Bürgi ML, et al. Trochleoplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4-to 14-year follow-up study. J Bone Joint Surg (Br), 2006, 88(10):1331-1335.
17. Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7):529-533.
18. Schüttler KF, Struewer J, Roessler PP, et al. Patellofemoral osteoarthritis after Insall's proximal realignment for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11):2623-2628.

Chinese Journal of Reparative and Reconstructive Surgery

ROLE OF TIBIAL TUBERCLE INTERNAL ROTATION TO TREAT RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH TROCHLEAR DYSPLASIA

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