Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics

Saandeep Mani, Marcus S. Kirkpatrick, Archana Saranathan, Laura G. Smith, Andrew J. Cosgarea, John J. Elias

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Tibial tuberosity realignment surgery is performed to improve patellofemoral alignment, but it could also alter tibiofemoral kinematics. Hypothesis: After tuberosity realignment in the malaligned knee, the reoriented patellar tendon will pull the tuberosity back toward the preoperative position, thereby altering tibiofemoral kinematics. Study Design: Controlled laboratory study. Methods: Ten knees were tested at 40°, 60°, and 80° of flexion in vitro. The knees were loaded with a quadriceps force of 586 N, with 200 N divided between the medial and lateral hamstrings. The position of the tuberosity was varied to represent lateral malalignment, with the tuberosity 5 mm lateral to the normal position; tuberosity medialization, with the tuberosity 5 mm medial to the normal position; and tuberosity anteromedialization, with the tuberosity 10 mm anterior to the medial position. Tibiofemoral kinematics were measured using magnetic sensors secured to the femur and tibia. A repeated measures analysis of variance with a post hoc Student-Newman-Keuls test was used to identify significant (P <.05) differences in the kinematic data between the tuberosity positions at each flexion angle. Results: Medializing the tibial tuberosity primarily rotated the tibia externally compared with the lateral malalignment condition. The largest average increase in external rotation was 13° at 40° of flexion, with the increase significant at each flexion angle. The varus orientation also increased significantly by an average of 1.5° at 40° and 80°. The tibia shifted significantly posteriorly at 40° and 60° by an average of 4 mm and 2 mm, respectively. Shifting the tuberosity from the medial to the anteromedial position translated the tibia significantly posteriorly by an average of 2 mm at 40°. Conclusion: After tibial tuberosity realignment in the malaligned knee, the altered orientation of the patellar tendon alters tibiofemoral kinematics. Clinical Relevance: The kinematic changes reduce the correction applied to the orientation of the patellar tendon and could alter the pressure applied to tibiofemoral cartilage.

Original languageEnglish (US)
Pages (from-to)1024-1031
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume39
Issue number5
DOIs
StatePublished - May 1 2011

Fingerprint

Osteotomy
Biomechanical Phenomena
Tibia
Patellar Ligament
Knee
Femur
Cartilage
Analysis of Variance
Students
Pressure

Keywords

  • patellofemoral malalignment
  • tibiofemoral kinematics
  • tuberosity osteotomy
  • tuberosity realignment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Mani, S., Kirkpatrick, M. S., Saranathan, A., Smith, L. G., Cosgarea, A. J., & Elias, J. J. (2011). Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. American Journal of Sports Medicine, 39(5), 1024-1031. https://doi.org/10.1177/0363546510390188

Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. / Mani, Saandeep; Kirkpatrick, Marcus S.; Saranathan, Archana; Smith, Laura G.; Cosgarea, Andrew J.; Elias, John J.

In: American Journal of Sports Medicine, Vol. 39, No. 5, 01.05.2011, p. 1024-1031.

Research output: Contribution to journalArticle

Mani, S, Kirkpatrick, MS, Saranathan, A, Smith, LG, Cosgarea, AJ & Elias, JJ 2011, 'Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics', American Journal of Sports Medicine, vol. 39, no. 5, pp. 1024-1031. https://doi.org/10.1177/0363546510390188
Mani, Saandeep ; Kirkpatrick, Marcus S. ; Saranathan, Archana ; Smith, Laura G. ; Cosgarea, Andrew J. ; Elias, John J. / Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. In: American Journal of Sports Medicine. 2011 ; Vol. 39, No. 5. pp. 1024-1031.
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