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Tibial tubercle advancement osteotomy with bone allograft for patellofemoral arthritis: a retrospective cohort study of 50 knees.
[trochlear dysplasia]
Forty
consecutive
patients
(
21
females
and
19
males
)
in
a
single
centre
underwent
50
tibial
tubercle
advancement
osteotomy
procedures
for
patellofemoral
arthritis
between
January
1993
and
April
2007
.
Twenty
knees
with
patellar
maltracking
also
underwent
medialisation
of
the
tibial
tubercle
(
6
-
12
mm
)
in
addition
to
the
standard
10
-
15
mm
elevation
.
Femoral
head
bone
allograft
blocks
were
utilised
in
all
cases
,
and
all
patients
achieved
bony
union
without
further
surgery
.
Forty
-
five
knees
had
previously
undergone
arthroscopy
,
18
with
arthroscopic
lateral
releases
.
Ninety
-
four
percentage
of
knees
had
sustained
improvement
in
visual
analogue
pain
scores
(
mean
improvement
of
37
.
4
,
P
<
0
.
05
)
at
a
mean
follow-up
of
81
months
(
range
26
-
195
months
)
,
with
96
%
of
patients
still
satisfied
;
and
92
%
of
knees
had
sustained
improvement
in
Shelbourne
and
Trumper
anterior
knee
function
scores
(
mean
improvement
of
39
.
8
,
P
<
0
.
05
)
.
Overall
clinical
outcomes
were
rated
excellent
/
good
in
77
%
,
fair
in
35
%
and
poor
in
8
%
of
knees
.
Two
knees
required
arthroplasty
surgery
over
the
follow-up
period
(
at
18
months
and
8
years
)
,
and
their
anterior
knee
pain
and
function
scores
were
not
included
in
the
analyses
.
Six
knees
(
12
%
)
suffered
major
complications
:
1
temporary
common
peroneal
neuropraxia
;
2
intraoperative
tibial
metaphyseal
fractures
;
and
3
tibial
tuberosity
fractures
(
at
8
days
,
3
weeks
and
3
months
)
.
Four
knees
(
8
%
)
suffered
superficial
wound
infections
,
31
knees
had
some
numbness
around
the
midline
scar
,
7
knees
had
scar
pain
lasting
up
to
12
months
,
and
22
knees
(
44
%
)
experienced
some
discomfort
relating
to
the
metalwork
,
which
was
removed
in
all
these
cases
.
Tibial
tubercle
advancement
osteotomy
can
be
an
effective
treatment
for
anterior
knee
pain
and
for
patients
with
arthroscopic
evidence
of
patellar
chondral
damage
.
It
can
provide
excellent
/
good
long
-term
functional
results
in
the
majority
of
patients
,
with
very
high
satisfaction
levels
and
sustained
improvement
in
pain
symptoms
.
The
use
of
femoral
head
bone
allograft
is
both
effective
in
obtaining
bony
union
and
by
definition
avoids
the
donor-site
morbidity
.
Knees
with
patellar
malalignment
may
also
undergo
individualised
medialisation
of
the
tibial
tubercle
such
that
the
patella
lies
in
the
centre
of
the
femoral
trochlea
,
and
may
benefit
from
lateral
trochleaplasty
surgery
in
the
presence
of
trochlear
dysplasia
.
However
,
the
major
operative
complication
rate
is
high
at
12
%
,
and
fracture
of
the
tibial
tubercle
is
associated
with
a
poorer
outcome
.
One
can
expect
10
%
of
operated
knees
to
have
had
some
clinical
deterioration
in
the
patellofemoral
joint
by
a
mean
follow-up
of
93
months
.
Diseases
Validation
Diseases presenting
"previously undergone arthroscopy"
symptom
trochlear dysplasia
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