Anteromedialisation tibial tubercle osteotomy
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Fulkerson originally designed the tibial tuberosity anteromedialization technique to address patellofemoral pain associated with patellofemoral chondrosis in conjunction with patellofemoral tilt and/or chronic patellar subluxation. It was devised to overcome the significant complication rate associated with the Maquet (anteriorisation) procedure.
The anteromedialisation transferred areas of patellofemoral loading through medialisation, which also improves patellofemoral joint congruity (improved joint contact area), and anteriorisation to transfer forces proximally, while theoretically decreasing the absolute magnitude of the patellofemoral resultant force.
This theoretical decrease in resultant force and increase in contact area would thus decrease joint surface stress, potentially decreasing the condition of overload contributing to pain.
Currently, interest has been renewed in anteromedialisation in conjunction with cartilage restoration of the patello- femoral compartment. Results of cartilage procedures are improved when the patellofemoral forces are minimised.
The examination of patient should include assessment of coronal alignment, rotational alognment, patella height and the Q-angle. Evidence of retinacula tightnes should also be undertaken.
All patients will undergo a pre-operative MRI and rotational CT scan in order to assess patient alignment. The MRI is used to assess Patella height and the chondral surfaces of the patella. The CT scan is used to assess the patients rotational profile and the Tibial Tubercle Trochlea Distance.
Prior to surgery all patients should undergo a period of conservative treatment which includes physiotherapy, directed at core stability, hip rotators and lower limb strengthening. This can be combined with oral analgesia, activity modification (to avoid impact and open chain exercise) and potentially intra-articular injections.
Author: Professor Martyn Snow FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital ,Birmingham ,UK.
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Question 1 of 12
Which one of the following indications for Anteromedialising osteotomy is incorrectCorrectIncorrect
Question 2 of 12
Which one of the following investigations is the most accurate for assessing Tibial Tubercle Trochlea DistanceCorrectIncorrect
Question 3 of 12
In relation to diagnostic arthroscopy, which one of the following pathologies needs to be ruled out?CorrectIncorrect
Question 4 of 12
Which one of the following answers regarding when to perform a lateral release is correct?CorrectIncorrect
Question 5 of 12
Which one of the following answers regarding the minimum length of the proposed osteotomy is correct?CorrectIncorrect
Question 6 of 12
In the relation to surgical technique in the presence of significant lateral facet osteoarthritis which one of the following answers is the correct minimum anteriorisation that should be undertaken?CorrectIncorrect
Question 7 of 12
Which one of the following answers is correct in relation to the osteotomy angle required to achieve the maximum anteriorisation ?CorrectIncorrect
Question 8 of 12
Which one of the following answers is the correct direction that the tubercle osteotomy should be moved in?CorrectIncorrect
Question 9 of 12
In relation to tibial tubercle fixation which one of the following methods of fixation is recommended.CorrectIncorrect
Question 10 of 12
In relation to post-op rehabilitation. The knee flexion should be limited for 4 weeks. Which one of the following is the maximum the knee should be allowed to flex?CorrectIncorrect
Question 11 of 12
Which one of the following is correct in relation to the length of time patients should be partial weight bearing following surgery.?CorrectIncorrect
Question 12 of 12
In relation to the technique of lateral reticular lengthening which one of the following describes how the technique should be carried out ?CorrectIncorrect