Sage Journals: Discover world-class research

Abstract

Background: Anteromedialization is recommended for cartilage restoration of patellofemoral defects, with the presumption that it decreases contact pressures across the trochlea. No study has evaluated pressures on the trochlear side of the patellofemoral joint after anteromedialization of the tibial tubercle.

Hypothesis: Anteromedialization of the tibial tubercle decreases contact pressure across the trochlea.

Study Design: Controlled laboratory study.

Methods: Ten cadaveric knees were tested by placing an electroresistive pressure sensor on the femoral side of the patellofemoral joint. A validated model of nonweightbearing resisted extension was simulated by loading the extensor mechanism at 89.1 N and 178.2 N. Knees were tested 3 times per load at 30°, 60°, 90°, and 105°. The center of force and pressure across the patellofemoral articulation were compared before and after a reproducible and consistent anteromedialization.

Results: The mean center of force shifted medially after anteromedialization at 89.1 N and 178.2 N. At 89.1 N, the mean total contact pressure decreased significantly (P < .05) at all angles, and at 178.2 N, it decreased significantly at 30°, 60°, and 90° of knee flexion. The mean lateral trochlear contact pressure decreased significantly (P < .05) at all flexion angles at both 89.1 N and 178.2 N. The mean central trochlear contact pressure decreased significantly (P < .05) at 30° with the 89.1-N and 178.2-N loads but increased significantly (P < .05) at 90° with the 89.1-N load. The mean medial trochlear contact pressure increased significantly (P < .05) at all flexion angles at 89.1 N and 178.2 N.

Conclusion: Anteromedialization shifts the contact force to the medial trochlea and decreases the mean total contact pressure.

Clinical Relevance: Anteromedialization decreases the mean total contact pressure while shifting contact pressure toward the medial trochlea. This study suggests that anteromedialization is appropriate for unloading the lateral trochlea. However, this procedure appears to have minimal benefit on central chondral defects, and it may actually increase the load in patients with medial defects.

Keywords

patellofemoral contact pressure anteromedialization cartilage transplantation patellofemoral joint

Get full access to this article

View all access options for this article.

References

Bellemans J

Cauwenberghs F

Witvrouw E

Brys P

Victor J

. Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sports Med. 1997;25:375-381.

Cameron HU

Huffer B

Cameron GM

. Anteromedial displacement of the tibial tubercle for patellofemoral arthralgia. Can J Surg. 1986;29:456-458.

DeMarco AL

Rust DA

Bachus KN

. Measuring contact pressure and contact area in orthopaedic application: Fuji Film vs Tekscan. Trans Orthop Res Soc25. 2000.

Farr J

. Anteromedialization of the tibial tubercle for treatment of patellofemoral malpositioning and concomitant isolated patellofemoral arthrosis. Tech Orthop. 1997;12:151-164.

Ferguson AB Jr

Brown TD

Fu FH

Rutkowski R

. Relief of patellofemoral contact stress by anterior displacement of the tibial tubercle. J Bone Joint Surg Am. 1979;61:159-166.

Frankel VH

. Biomechanics of the knee. Orthop Clin North Am. 1971;2:175-190.

Fulkerson JP

. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res. 1983;177:176-181.

Fulkerson JP

. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. 2002;30:447-456.

Fulkerson JP

Becker GJ

Meaney JA

Miranda M

Folcik MA

. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med. 1990;18:490-496; discussion 496-497.

10.

Fulkerson JP

Schutzer SF

Ramsby GR

Bernstein RA

. Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy. 1987;3:19-24.

11.

Garretson RB III

Katolik LI

Verma N

Beck PR

Bach BR

Cole BJ

. Contact pressure at osteochondral donor sites in the patellofemoral joint. Am J Sports Med. 2004;32:967-974.

12.

Gill TJ

DeFrate LE

Wang C

et al.

The effect of posterior cruciate ligament reconstruction on patellofemoral contact pressures in the knee joint under simulated muscle loads. Am J Sports Med. 2004;32:109-115.

13.

Harris ML

Morberg P

Bruce WJ

Walsh WR

. An improved method for measuring tibiofemoral contact areas in total knee arthroplasty: a comparison of K-scan sensor and Fuji film. J Biomech. 1999;32:951-958.

14.

Hsieh YF

Draganich LF

Ho SH

Reider B

. The effects of removal and reconstruction of the anterior cruciate ligament on the contact characteristics of the patellofemoral joint. Am J Sports Med. 2002;30:121-127.

15.

Kohn D

Steimer O

Seil R

. Anterior medial correction the tibial tuberosity [in German]. Orthopade. 2004;33:218-223.

16.

Matsuda S

Ishinishi T

Whiteside LA

. Contact stresses with an unresurfaced patella in total knee arthroplasty: the effect of femoral component design. Orthopedics. 2000;23:213-218.

17.

Molina A

Ballester J

Martin C

Munoz I

Vazquez J

Torres J

. Biomechanical effects of different surgical procedures on the extensor mechanism of the patellofemoral joint. Clin Orthop Relat Res. 1995;320:168-175.

18.

Morshuis WJ

Pavlov PW

de Rooy KP

. Anteromedialization of the tibial tuberosity in the treatment of patellofemoral pain and malalignment. Clin Orthop Relat Res. 1990;255:242-250.

19.

Peterson L

Minas T

Brittberg M

Nilsson A

Sjogren-Jansson E

Lindahl A

. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;374:212-234.

20.

Pidoriano AJ

Weinstein RN

Buuck DA

Fulkerson JP

. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med. 1997;25:533-537.

21.

Sakai N

Koshino T

Okamoto R

. Pain reduction after anteromedial displacement of the tibial tuberosity: 5-year follow-up in 21 knees with patellofemoral arthrosis. Acta Orthop Scand. 1996;67:13-15.

22.

Simonian PT

Sussmann PS

Wickiewicz TL

Paletta GA

Warren RF

. Contact pressures at osteochondral donor sites in the knee. Am J Sports Med. 1998;26:491-494.

23.

Skyhar MJ

Warren RF

Ortiz GJ

Schwartz E

Otis JC

. The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg Am. 1993;75:694-699.

24.

Torzilli PA

Deng X

Warren RF

. The effect of joint-compressive load and quadriceps muscle force on knee motion in the intact and anterior cruciate ligament-sectioned knee. Am J Sports Med. 1994;22:105-112.

25.

Wilson DR

Eichler MJ

Hayes WC

. Accuracy of the Iscan pressure measurement system. Trans Orthop Res Soc 23. 1998.

Trochlear Contact Pressures After Anteromedialization of the Tibial Tubercle

Abstract

Keywords

Get full access to this article

References