SpringerLink
Log in

Correction of tibial tubercle trochlea groove distance is related to torsional correction in high tibial derotational osteotomy

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

High tibial osteotomy with internal tibial derotation (high tibial derotation osteotomy = HTDRO) is a common surgical treatment in patients with patellofemoral malalignment alone or in combination with patellofemoral instability. Operative techniques and theoretical calculations may assume that correction of the tibial tubercle-trochlear groove (TTTG) distance is related to the amount of torsional correction. The purpose of this investigation was to predict the change in TTTG distance in HTDRO through a clinical study.

Methods

Twenty-one consecutive cases of derotational HTO were evaluated by torsional CT scanning in terms of the pre- and postoperative tibial torsion and TTTG distance. Changes in the TTTG distance were related to the changes in the amount of torsional correction. The change in patellar height was measured pre- and postoperatively, and the Caton–Deschamps Index (CDI) was calculated.

Results

The mean change in tibial torsion was 13.9°, and the mean change in the TTTG distance was 6.3 mm. A strong relationship (0.90) between the change in torsion and the change in TTTG distance from pre- to postoperative status was found (p < 0.001). No statistically significant change in CDI could be seen between the preoperative [mean value (MV) 1.0] and postoperative (MV 1.1) periods.

Conclusions

In patients with patellofemoral instability or patellofemoral maltracking with both a high tibial external torsion and a high TTTG distance, a derotational HTO can correct both bony deformities. Patella height does not change significantly with this surgical technique. With 1° of torsional correction, the TTTG distance decreases 0.45 mm with our surgical technique of derotational HTO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Arendt EA, Askenberger M, Agel J, Tompkins MA (2018) Risk of redislocation after primary patellar dislocation: a clinical prediction model based on magnetic resonance imaging variables. Am J Sports Med 46:3385–3390

    Article  PubMed  Google Scholar 

  2. Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314

    Article  PubMed  Google Scholar 

  3. Balcarek P, Radebold T, Schulz X, Vogel D (2019) Geometry of torsional malalignment syndrome: trochlear dysplasia but not torsion predicts lateral patellar instability. Orthop J Sports Med 7:2325967119829790

    Article  PubMed  PubMed Central  Google Scholar 

  4. Biedert RM, Tscholl PM (2017) Patella alta: a comprehensive review of current knowledge. Am J Orthop (Belle Mead NJ) 46:290–300

    PubMed  Google Scholar 

  5. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Reparatrice Appar Mot 68:317–325

    CAS  PubMed  Google Scholar 

  6. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  PubMed  Google Scholar 

  7. Dickschas J, Harrer J, Pfefferkorn R, Strecker W (2012) Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg 132:289–298

    Article  PubMed  Google Scholar 

  8. Dickschas J, Tassika A, Lutter C, Harrer J, Strecker W (2017) Torsional osteotomies of the tibia in patellofemoral dysbalance. Arch Orthop Trauma Surg 137:179–185

    Article  PubMed  Google Scholar 

  9. Diederichs G, Köhlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57

    Article  PubMed  Google Scholar 

  10. Fink C, Veselko M, Herbort M, Hoser C (2014) MPFL reconstruction using a quadriceps tendon graft: part 2: operative technique and short term clinical results. Knee 21:1175–1179

    Article  PubMed  Google Scholar 

  11. Frings J, Krause M, Akoto R, Frosch KH (2019) Clinical Results after combined distal femoral osteotomy in patients with patellar maltracking and recurrent dislocations. J Knee Surg 32:924–933

    Article  PubMed  Google Scholar 

  12. Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497

    Article  PubMed  Google Scholar 

  13. Grawe B, Stein BE (2015) Tibial tubercle osteotomy: indication and techniques. J Knee Surg 28:279–284

    Article  PubMed  Google Scholar 

  14. Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K et al (2020) The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc 28:897–904

    Article  PubMed  Google Scholar 

  15. Jud L, Singh S, Tondelli T, Fürnstahl P, Fucentese SF, Vlachopoulos L (2020) Combined correction of tibial torsion and tibial tuberosity-trochlear groove distance by supratuberositary torsional osteotomy of the tibia. Am J Sports Med 48:2260–2267

    Article  PubMed  Google Scholar 

  16. Leite CBG, Santos TP, Giglio PN, Pécora JR, Camanho GL, Gobbi RG (2021) Tibial tubercle osteotomy with distalization is a safe and effective procedure for patients with patella alta and patellar instability. Orthop J Sports Med 9:2325967120975101

    Article  PubMed  PubMed Central  Google Scholar 

  17. Metcalfe AJ, Clark DA, Kemp MA, Eldridge JD (2017) Trochleoplasty with a flexible osteochondral flap: results from an 11-year series of 214 cases. Bone Joint J 99-b:344–350

    Article  CAS  PubMed  Google Scholar 

  18. Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity-trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803

    Article  PubMed  PubMed Central  Google Scholar 

  19. Paulos L, Swanson SC, Stoddard GJ, Barber-Westin S (2009) Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques. Am J Sports Med 37:1288–1300

    Article  PubMed  Google Scholar 

  20. Portney LG, Watkins MP (2009) Foundations of clinical research: applications to practice, vol 892. Pearson/Prentice Hall, Upper Saddle River, pp 1–892

  21. Schmeling A, Frings J, Akoto R, Frosch KH (2020) Patellar dislocation : causes and treatment. Unfallchirurg 123:969–983

    Article  CAS  PubMed  Google Scholar 

  22. Schröter S, Nakayama H, Ihle C, Ateschrang A, Maiotti M, Harrer J et al (2020) Torsional osteotomy. J Knee Surg 33:486–495

    Article  PubMed  Google Scholar 

  23. Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125

    Article  PubMed  Google Scholar 

  24. Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J 2nd, Bach BR Jr et al (2014) Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med 42:2006–2017

    Article  PubMed  Google Scholar 

  25. Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE (2015) The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 43:921–927

    Article  PubMed  Google Scholar 

  26. Strecker W, Dickschas J (2015) Torsional osteotomy : operative treatment of patellofemoral maltracking. Oper Orthop Traumatol 27:505–524

    Article  CAS  PubMed  Google Scholar 

  27. Thompson P, Metcalfe AJ (2019) Current concepts in the surgical management of patellar instability. Knee 26:1171–1181

    Article  PubMed  Google Scholar 

  28. Waidelich HA, Strecker W, Schneider E (1992) [Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load]. Rofo 157:245–251

    Article  CAS  PubMed  Google Scholar 

  29. Winkler PW, Lutz PM, Rupp MC, Imhoff FB, Izadpanah K, Imhoff AB et al (2021) Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity. Knee Surg Sports Traumatol Arthrosc 29:1678–1685

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2b, 96125, Lichtenfels, Germany

    Felix Ferner, Markus Jasinski, Felix Huettner & Joerg Harrer

  2. Sozialstiftung Bamberg, Bamberg, Germany

    Joerg Dickschas

  3. Department of Orthopedics, University Medical Center, Rostock, Germany

    Christoph Lutter

Authors
  1. Felix Ferner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joerg Dickschas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Markus Jasinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felix Huettner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joerg Harrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Lutter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Felix Ferner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferner, F., Dickschas, J., Jasinski, M. et al. Correction of tibial tubercle trochlea groove distance is related to torsional correction in high tibial derotational osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 1176–1182 (2023). https://doi.org/10.1007/s00167-022-07190-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07190-1

Keywords

Search

Navigation