AANA Lab Course 913 - Advanced Knee Course-Tibial Tubercle Osteotomies_ Indications and Techniques Faculty Lecture

Tibial Tubercle Osteotomies_ Indications and Techniques Faculty Lecture_ Cory Edgar, MD, PhD

Pdf Summary

This comprehensive review by Dr. Cory Edgar focuses on tibial tubercle osteotomies (TTOs), their indications, techniques, and their role in treating anterior knee pain and patellar instability. The article discusses three major TTO methods: anteriorizing (Maquet technique), medializing (Elmslie-Trillat technique), and anteromedializing (Fulkerson technique). These procedures are aimed at correcting biomechanical issues such as abnormal patella position (patella alta or baja) and malalignment that contribute to anterior knee pain and patellar tracking problems.<br /><br />Key measurements like the Blackburn-Peel ratio and the Caton-Deschamps index help quantify patella height, crucial for diagnosing patella alta (ratio >1.3) or baja (<0.6), guiding surgical planning. Patellar instability is multifactorial, with risk factors including trochlear dysplasia (classified by Dejour), medial ligament laxity, malalignment, and increased tibial tubercle–trochlear groove (TT-TG) distance (>15-20 mm abnormal). Quadriceps strength, hip and foot positioning, and dynamic knee valgus influence knee mechanics but cannot be corrected solely by osteotomy.<br /><br />Surgical management often requires combining soft tissue procedures like medial patellofemoral ligament (MPFL) repair/reconstruction with TTO to optimize patellar tracking and stability. Cases with severe trochlear dysplasia may need trochleoplasty, while malalignment or version may require distal femoral osteotomy or derotational surgery. Careful preoperative assessment, including imaging and functional examination, informs the surgical approach.<br /><br />The article outlines the technique for anteromedialization osteotomy with distalization to address patella alta, emphasizing precise osteotomy cuts, screw placement, and the importance of protecting surrounding tissues. Rehabilitation focuses on quadriceps strengthening and neuromuscular control to prevent recurrence.<br /><br />Overall, the review highlights that while TTOs are powerful tools for managing patellar maltracking and instability, success depends on careful patient selection, addressing coexisting pathologies, and tailored surgical and rehabilitation strategies.

Keywords

tibial tubercle osteotomy

anterior knee pain

patellar instability

Maquet technique

Elmslie-Trillat technique

Fulkerson technique

patella alta

trochlear dysplasia

medial patellofemoral ligament reconstruction

patellar tracking