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Trochlear contact pressures after straight anteriorization of the tibial tuberosity
John-Paul H Rue1, Anne Colton, Stephanie M Zare
1Department of Orthopaedic Surgery, National Naval Medical Center, Bethesda, Maryland, USA.
Background:
Anteromedialization of the tibial tuberosity has been shown to decrease mean total contact pressures of the lateral trochlea and to shift contact pressures to the medial trochlea.
Hypothesis:
Modifying the anteromedialization osteotomy to a straight anteriorization osteotomy of the tibial tuberosity can decrease trochlear contact pressures without a resultant medial shift of forces to the medial trochlear contact area.
Study Design:
Controlled laboratory study.
Methods:
Ten cadavers were tested before and after straight anteriorization tibial tuberosity osteotomy by loading the extensor mechanism with 89.1 and 178.2 N at 0 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion following a validated patellofemoral joint loading protocol. Contact pressures were measured with electroresistive pressure sensors placed directly on the trochlea.
Results:
The mean trochlear contact pressures after osteotomy decreased significantly (P < .05) for loads of 89.1 and 178.2 N at both 30 degrees (23% and 20%, respectively) and 60 degrees (18.7% and 31.9%, respectively) of knee flexion. The peak contact pressures decreased significantly (P < .05) for loads of 89.1 and 178.2 N at 30 degrees (24.3% and 27.0%, respectively) and 60 degrees (31.9% and 24.5%, respectively) and for loads of 89.1 N at 90 degrees (13.4%) of knee flexion.
Conclusion:
The authors demonstrated significantly decreased trochlear contact forces after straight anteriorization osteotomy of the tibial tuberosity, without a significant resultant medial shift of the center of force.
Clinical Relevance:
Straight anteriorization of the tibial tuberosity may be a useful adjunct for patients with medial articular defects of the patellar or trochlea in whom anteromedialization would be otherwise contraindicated.
