TY - JOUR
T1 - Variations in kinematics and function following patellar stabilization including tibial tuberosity realignment
AU - Elias, John J.
AU - Carrino, John A.
AU - Saranathan, Archana
AU - Guseila, Loredana M.
AU - Tanaka, Miho J.
AU - Cosgarea, Andrew J.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Purpose: The current study was performed to characterize the influence of patellar stabilization procedures on patellofemoral and tibiofemoral dynamic motion.Methods: Six knees were evaluated pre-operatively and 1 year or longer following stabilization via tibial tuberosity realignment, with simultaneous medial patellofemoral ligament reconstruction performed for five knees. Knees were imaged during extension against gravity using a dynamic CT scanner. Models representing each knee at several positions of extension were reconstructed from the images. Local coordinate systems were created within one femur, patella and tibia for each knee, with shape matching of the bones used to transfer the coordinate axes to the other models. The patellar lateral shift and tilt and tibial external rotation were quantified based on the reference axes and interpolated to flexion angles from 5° to 40°. Pre-operative and post-operative data were compared with the paired t tests.Results: Surgical realignment significantly decreased the average patellar lateral shift and tilt at low flexion angles. At 5°, surgical realignment decreased the average lateral shift from 15.5 (6.3) to 8.5 (4.7) mm and decreased the average lateral tilt from 20.8 (9.4)° to 13.8 (6.4)°. The changes were statistically significant (p < 0.05) at 5° and 10° of flexion, as well as 20° for lateral shift. The average tibial external rotation also increased significantly at 30° and 40° following surgery.Conclusion: Patellar stabilization including a component of tuberosity realignment reduces patellar lateral shift and tilt at low flexion angles, but the long-term influence of increased tibial external rotation on tibiofemoral function is currently unknown.Level of evidence: Prospective comparative study, Level II.
AB - Purpose: The current study was performed to characterize the influence of patellar stabilization procedures on patellofemoral and tibiofemoral dynamic motion.Methods: Six knees were evaluated pre-operatively and 1 year or longer following stabilization via tibial tuberosity realignment, with simultaneous medial patellofemoral ligament reconstruction performed for five knees. Knees were imaged during extension against gravity using a dynamic CT scanner. Models representing each knee at several positions of extension were reconstructed from the images. Local coordinate systems were created within one femur, patella and tibia for each knee, with shape matching of the bones used to transfer the coordinate axes to the other models. The patellar lateral shift and tilt and tibial external rotation were quantified based on the reference axes and interpolated to flexion angles from 5° to 40°. Pre-operative and post-operative data were compared with the paired t tests.Results: Surgical realignment significantly decreased the average patellar lateral shift and tilt at low flexion angles. At 5°, surgical realignment decreased the average lateral shift from 15.5 (6.3) to 8.5 (4.7) mm and decreased the average lateral tilt from 20.8 (9.4)° to 13.8 (6.4)°. The changes were statistically significant (p < 0.05) at 5° and 10° of flexion, as well as 20° for lateral shift. The average tibial external rotation also increased significantly at 30° and 40° following surgery.Conclusion: Patellar stabilization including a component of tuberosity realignment reduces patellar lateral shift and tilt at low flexion angles, but the long-term influence of increased tibial external rotation on tibiofemoral function is currently unknown.Level of evidence: Prospective comparative study, Level II.
KW - MPFL reconstruction
KW - Patellar tracking
KW - Patellofemoral instability
KW - Tibial rotation
KW - Tibial tuberosity realignment
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U2 - 10.1007/s00167-014-2905-9
DO - 10.1007/s00167-014-2905-9
M3 - Article
C2 - 24531362
AN - SCOPUS:84893642089
VL - 22
SP - 2350
EP - 2356
JO - Knee Surgery, Sports Traumatology, Arthroscopy
JF - Knee Surgery, Sports Traumatology, Arthroscopy
SN - 0942-2056
IS - 10
ER -