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Archives of Orthopaedic and Trauma Surgery

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17-03-2021 | Orthopaedic Surgery

Treatment of acquired patella baja by proximalization tibial tubercle osteotomy significantly improved knee joint function but overall patient-reported outcome measures remain diminished after two to four years of follow-up

Authors: Sebastian Schmidt, Natalie Mengis, Jules N. Rippke, Felix Zimmermann, Danko D. Milinkovic, Peter Balcarek

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

Abstract

Introduction

Acquired patella baja is often characterized by painful limitation of knee joint range of motion and anterior knee pain (AKP). Only few studies have evaluated the effectiveness of surgical treatment in terms of patient-reported outcome measures (PROM’s) and sports activity. Thus, the goal of this study was to assess PROM’s and sports activity after proximalization tibial tubercle osteotomy (P-TTO) in patients with symptomatic patella baja.

Methods

Between 2016 and 2018, a case series of 11 patients (male/female 4/7; age 48 ± 12 years) were treated by P-TTO and were retrospectively evaluated after a mean of 33.7 months (range 24–51 months). The Tegner activity score and the Kujala anterior knee pain scale were used in addition to a visual analogue scale (VAS; 0–10) regarding self-reported knee joint function and intensity of AKP. Radiographic assessment included the measure of patellar height using the Caton–Deschamps (CD) and Blackburne–Peel (BP) index.

Results

Postoperatively both the CD and the BP index increased to normality (p < 0.0001; p = 0.0012). Knee joint flexion improved from 100 ± 32° preoperatively to 123 ± 14° postoperatively (p = 0.0235). AKP decreased from 6.5 ± 2.1 points preoperatively to 3.7 ± 2.1 points postoperatively (p = 0.0061). This was accompanied by a significant increase in self-reported knee joint function from 1.8 ± 1.2 points preoperatively to 6.8 ± 2.3 points postoperatively (p = 0.0001) and an increase of the Tegner activity score from 1.8 ± 1.6 points preoperatively to 3.9 ± 1.5 points postoperatively (p = 0.0074). Although the Kujala score improved significantly by an average of 31.55 points (p = 0.001) overall score results remained reduced at 65.6 ± 17.9 points at final follow-up.

Conclusion

P-TTO yielded significant improvements in terms of AKP, subjective knee joint function and sports activity. However, the overall Kujala score results remained reduced, indicating that surgical correction of patellar height is not sufficient to relieve all patients’ complaints. In addition, the incidence of postoperative complications was high.

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Title: Treatment of acquired patella baja by proximalization tibial tubercle osteotomy significantly improved knee joint function but overall patient-reported outcome measures remain diminished after two to four years of follow-up
Authors: Sebastian Schmidt
Natalie Mengis
Jules N. Rippke
Felix Zimmermann
Danko D. Milinkovic
Peter Balcarek
Publication date: 17-03-2021
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03863-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of acquired patella baja by proximalization tibial tubercle osteotomy significantly improved knee joint function but overall patient-reported outcome measures remain diminished after two to four years of follow-up

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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