Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2013

01.11.2013 | Knee

The treatment of acquired patella baja with proximalize the tibial tuberosity

verfasst von: Michael Drexler, Tim Dwyer, Meir Marmor, Amir Sternheim, Hugh U. Cameron, John C. Cameron

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 11/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Acquired patella baja may result in decreased range of motion of the knee, extensor lag, and anterior knee pain. The aim of the study was to evaluate the efficacy of tibial tubercle osteotomy with proximal displacement.

Methods

Between 1998 and 2011, a proximalization of the tibial tuberosity was performed in 15 patients (15 knees) with patella baja diagnosed using the Blackburne–Peel ratio. Clinical outcomes included the Tegner Lysholm knee scoring scales, the WOMAC questionnaire, the short form-12 (SF-12), and a visual analogue score (VAS) pain scale.

Results

Fifteen proximalizations of the tibial tuberosity were performed, with a mean follow-up period of 64 months (5–160). The mean patient age was 59 years (41–86 years). The mean preoperative Blackburne–Peel ratio of 0.4 (0.1–0.6) was improved to a mean of 1.0 (0.8–1.2) post-operatively, which was associated with significant improvements in the Lysholm knee scoring scale from 13.3 ± 13.0 to 86.7 ± 10.4 points (p < 0.0001). Quality of life, as measured using the SF-12 outcome, also improved significantly (p < 0.0001), as did all WOMAC questionnaire score subscales (p < 0.0001). The VAS preoperative status for pain improved from 8.3 ± 2.0 to 1.5 ± 1.8. No patient had delayed or non-union of the osteotomy site.

Conclusions

A series of patients with patella baja, treated with proximalization of the tibial tuberosity, achieved satisfactory outcomes in terms of pain relief and improved function, without major complication.
Literatur
1.
Zurück zum Zitat Ahmad CS, Kwak SD, Ateshian GA, Warden WH, Steadman JR, Mow VC (1998) Effects of patellar tendon adhesion to the anterior tibia on knee mechanics. Am J Sports Med 26(5):715–724PubMed Ahmad CS, Kwak SD, Ateshian GA, Warden WH, Steadman JR, Mow VC (1998) Effects of patellar tendon adhesion to the anterior tibia on knee mechanics. Am J Sports Med 26(5):715–724PubMed
2.
Zurück zum Zitat Aho K, Sainio K, Kianta M, Varpanen E (1983) Pneumatic tourniquet paralysis. Case report. J Bone Joint Surg Br 65(4):441–443PubMed Aho K, Sainio K, Kianta M, Varpanen E (1983) Pneumatic tourniquet paralysis. Case report. J Bone Joint Surg Br 65(4):441–443PubMed
3.
Zurück zum Zitat Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed
4.
Zurück zum Zitat Berg EE, Mason SL, Lucas MJ (1996) Patellar height ratios. A comparison of four measurement methods. Am J Sports Med 24(2):218–221PubMedCrossRef Berg EE, Mason SL, Lucas MJ (1996) Patellar height ratios. A comparison of four measurement methods. Am J Sports Med 24(2):218–221PubMedCrossRef
5.
Zurück zum Zitat Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59(2):241–242PubMed Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59(2):241–242PubMed
6.
7.
Zurück zum Zitat Cameron HU, Jung YB (1988) Patella baja complicating total knee arthroplasty. A report of two cases. J Arthroplasty 3(2):177–180PubMedCrossRef Cameron HU, Jung YB (1988) Patella baja complicating total knee arthroplasty. A report of two cases. J Arthroplasty 3(2):177–180PubMedCrossRef
8.
Zurück zum Zitat Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325PubMed Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325PubMed
9.
Zurück zum Zitat Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238PubMed Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238PubMed
10.
Zurück zum Zitat Dejour D, Levigne C, Dejour H (1995) Postoperative low patella. Treatment by lengthening of the patellar tendon. Rev Chir Orthop Reparatrice Appar Mot 81(4):286–295PubMed Dejour D, Levigne C, Dejour H (1995) Postoperative low patella. Treatment by lengthening of the patellar tendon. Rev Chir Orthop Reparatrice Appar Mot 81(4):286–295PubMed
11.
Zurück zum Zitat Ficat RPHD (1977) Disorders of the patellofemoral joint. Williams & Wilkinson, Baltimore Ficat RPHD (1977) Disorders of the patellofemoral joint. Williams & Wilkinson, Baltimore
12.
Zurück zum Zitat Hockings M, Cameron JC (2004) Patella baja following chronic quadriceps tendon rupture. Knee 11(2):95–97PubMedCrossRef Hockings M, Cameron JC (2004) Patella baja following chronic quadriceps tendon rupture. Knee 11(2):95–97PubMedCrossRef
13.
Zurück zum Zitat Hughston JC, Walsh WM (1979) Proximal and distal reconstruction of the extensor mechanism for patellar subluxation. Clin Orthop Relat Res 144:36–42PubMed Hughston JC, Walsh WM (1979) Proximal and distal reconstruction of the extensor mechanism for patellar subluxation. Clin Orthop Relat Res 144:36–42PubMed
14.
Zurück zum Zitat Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104PubMed Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104PubMed
15.
Zurück zum Zitat Lancourt JE, Cristini JA (1975) Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 57(8):1112–1115PubMed Lancourt JE, Cristini JA (1975) Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 57(8):1112–1115PubMed
16.
17.
Zurück zum Zitat Mariani PP, Del Signore S, Perugia L (1994) Early development of patella infera after knee fractures. Knee Surg Sports Traumatol Arthrosc 2(3):166–169PubMedCrossRef Mariani PP, Del Signore S, Perugia L (1994) Early development of patella infera after knee fractures. Knee Surg Sports Traumatol Arthrosc 2(3):166–169PubMedCrossRef
18.
Zurück zum Zitat Meyer SA, Brown TD, Pedersen DR, Albright JP (1997) Retropatellar contact stress in simulated patella infera. Am J Knee Surg 10(3):129–138PubMed Meyer SA, Brown TD, Pedersen DR, Albright JP (1997) Retropatellar contact stress in simulated patella infera. Am J Knee Surg 10(3):129–138PubMed
19.
Zurück zum Zitat Noyes FR, Wojtys EM, Marshall MT (1991) The early diagnosis and treatment of developmental patella infera syndrome. Clin Orthop Relat Res 265:241–252PubMed Noyes FR, Wojtys EM, Marshall MT (1991) The early diagnosis and treatment of developmental patella infera syndrome. Clin Orthop Relat Res 265:241–252PubMed
20.
Zurück zum Zitat Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15(4):331–341PubMedCrossRef Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15(4):331–341PubMedCrossRef
21.
Zurück zum Zitat Paulos LE, Wnorowski DC, Greenwald AE (1994) Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup. Am J Sports Med 22(4):440–449PubMedCrossRef Paulos LE, Wnorowski DC, Greenwald AE (1994) Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup. Am J Sports Med 22(4):440–449PubMedCrossRef
22.
Zurück zum Zitat Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society international set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthr Cartil 12(5):389–399PubMedCrossRef Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society international set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthr Cartil 12(5):389–399PubMedCrossRef
23.
Zurück zum Zitat Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 71(2):245–248PubMed Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 71(2):245–248PubMed
24.
Zurück zum Zitat Seil R, Muller B, Georg T, Kohn D, Rupp S (2000) Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc 8(4):231–236PubMedCrossRef Seil R, Muller B, Georg T, Kohn D, Rupp S (2000) Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc 8(4):231–236PubMedCrossRef
25.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed
26.
Zurück zum Zitat Tria AJ Jr, Alicea JA, Cody RP (1994) Patella baja in anterior cruciate ligament reconstruction of the knee. Clin Orthop Relat Res 299:229–234PubMed Tria AJ Jr, Alicea JA, Cody RP (1994) Patella baja in anterior cruciate ligament reconstruction of the knee. Clin Orthop Relat Res 299:229–234PubMed
27.
Zurück zum Zitat Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRef Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRef
28.
Zurück zum Zitat Weale AE, Murray DW, Newman JH, Ackroyd CE (1999) The length of the patellar tendon after unicompartmental and total knee replacement. J Bone Joint Surg Br 81(5):790–795PubMedCrossRef Weale AE, Murray DW, Newman JH, Ackroyd CE (1999) The length of the patellar tendon after unicompartmental and total knee replacement. J Bone Joint Surg Br 81(5):790–795PubMedCrossRef
29.
Zurück zum Zitat Yoo JH, Chang JD, Seo YJ, Baek SW (2011) Reconstruction of a patellar tendon with Achilles tendon allograft for severe patellar infera—a case report. Knee 18(5):350–353PubMedCrossRef Yoo JH, Chang JD, Seo YJ, Baek SW (2011) Reconstruction of a patellar tendon with Achilles tendon allograft for severe patellar infera—a case report. Knee 18(5):350–353PubMedCrossRef
Metadaten
Titel
The treatment of acquired patella baja with proximalize the tibial tuberosity
verfasst von
Michael Drexler
Tim Dwyer
Meir Marmor
Amir Sternheim
Hugh U. Cameron
John C. Cameron
Publikationsdatum
01.11.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 11/2013
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2278-x

Weitere Artikel der Ausgabe 11/2013

Knee Surgery, Sports Traumatology, Arthroscopy 11/2013 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.