Document Title: Bellemans-AJSM-May97.shtml

Article Title: Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment

Authors: Johan Bellemans, MD, Frank Cauwenberghs, MD, Eric Witvrouw, PT, Peter Brys, MD, and Jan Victor, MD.

Publication: American Journal of Sports Medicine, Baltimore, Maryland

Date: May-June, 1997

Volume 25, Number 5, pages 375-381

(Figures included. Reference-denoting numbers appear in the same point size as the document text.)

This article provides superb insight into the problem of chronic anterior knee pain generated by patellar problems. The article touches on the topics of knee alignment and osteotomies, in addition to patellar concerns. It also gives the Kujala scoring system (which Kujala originally presented in a 1993 AJARS article). Note that anterior knee pain can have causes other than patellar malalignment. For example, it is possible for the articular cartilage on the underside of the patella (and perhaps also in the femoral groove, also known as the trochlea) to have been damaged, thus resulting in chondromalacia (or patellofemoral pain). Although a maltracking patella can cause such cartilage damage, another possible cause is simply weak musculature (e.g. weak vastus medialis obliquus, the innermost portion of the quadriceps group).

ABSTRACT

We performed a prospective analysis of 29 Fulkerson anteromedial tibial tubercle transfers in patients with chronic anterior knee pain. The average followup was 32 months (range, 25 to 44). Fourteen patients (Group 1) had subluxation-type malalignment (congruence angle >20 degrees, tilt angle >8 degrees) and were treated with an isolated anteromedial tibial tubercle transfer. Fifteen patients (Group 2) had combined subluxation and tilt malalignment (congruence angle >20 degrees, tilt agnle <8 degrees) and underwent anteromedial tibial tubercle transfer combined with a lateral release. Pre- and postoperative evaluations included clinical and radiographic examinations, Lysholm and Kujala patellofemoral scores, and standing-alignment computed tomography scans in 15 degrees of flexion taken transversely at the midpatellar plane. In all but one patient, a dramatic improvement in Lysholm and Kujala scores was noted. The congruence angle improved in all patients except one, with an average improvement of 16 degrees in Group 1 and of 14 degrees in Group 2. The tilt angle remained relatively unchanged (change -0.5 degrees) in Group 1, but it improved by 11 degrees in Group 2. We conclude that an isolated anteromedial tibial tubercle transfer can consistently improve patellar subluxation and, when combined with a lateral release, can improve patellar subluxation and tilt, resulting in improved functional scores for patients with chronic anterior knee pain.

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