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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
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated