Meniscal allograft with or without osteotomy: a 15-year follow-up study.

PURPOSE: To assess survivorship of meniscal allografts and the benefit of concomitant osteotomy. METHODS: A retrospective review was performed of all patients who had meniscal allograft surgery ± osteotomy. Fresh frozen meniscal allograft was sutured in place using an onlay technique. Osteotomies were performed in patients with malalignment. We recorded any further intervention required. Survivorship was assessed defining failure as being scheduled or having received a total knee arthroplasty (TKA). RESULTS: Mean age was 40 years. Primary diagnosis was degeneration after previous meniscal injury. Eighty-six allografts were performed, 43 of the medial meniscus and 41 of the lateral meniscus. One patient had implantation of both medial and lateral menisci. Simultaneous osteotomy was performed in 53 patients. Seven patients underwent simultaneous anterior cruciate ligament reconstruction. Mean follow-up was 180 months. At the time of writing, 61 allografts (71%) remain in situ with adequate function. Fifteen allografts required arthroscopy and meniscal debridement at a mean of 68 months postop. Twenty-four allografts (28%) went on to degenerate and required TKA at a mean of 149 months postop. There was no significant difference in the survival for isolated allograft ± osteotomy of either the medial meniscus, lateral meniscus or patients requiring arthroscopic intervention (n.s.). CONCLUSIONS: Meniscal allograft is a viable solution to meniscal loss in the young patient. Survivorship is good, providing a mean of 12.4 years prior to TKA in those requiring conversion with 71% of allografts still in situ at a mean of 15 years post-surgery. LEVEL OF EVIDENCE: Therapeutic, retrospective, Level IV.

The treatment of acquired patella baja with proximalize the tibial tuberosity.

PURPOSE: Acquired patella baja may result in decreased range of motion of the knee, extensor lag, and anterior knee pain. The aim of the study was to evaluate the efficacy of tibial tubercle osteotomy with proximal displacement. METHODS: Between 1998 and 2011, a proximalization of the tibial tuberosity was performed in 15 patients (15 knees) with patella baja diagnosed using the Blackburne-Peel ratio. Clinical outcomes included the Tegner Lysholm knee scoring scales, the WOMAC questionnaire, the short form-12 (SF-12), and a visual analogue score (VAS) pain scale. RESULTS: Fifteen proximalizations of the tibial tuberosity were performed, with a mean follow-up period of 64 months (5-160). The mean patient age was 59 years (41-86 years). The mean preoperative Blackburne-Peel ratio of 0.4 (0.1-0.6) was improved to a mean of 1.0 (0.8-1.2) post-operatively, which was associated with significant improvements in the Lysholm knee scoring scale from 13.3 ± 13.0 to 86.7 ± 10.4 points (p < 0.0001). Quality of life, as measured using the SF-12 outcome, also improved significantly (p < 0.0001), as did all WOMAC questionnaire score subscales (p < 0.0001). The VAS preoperative status for pain improved from 8.3 ± 2.0 to 1.5 ± 1.8. No patient had delayed or non-union of the osteotomy site. CONCLUSIONS: A series of patients with patella baja, treated with proximalization of the tibial tuberosity, achieved satisfactory outcomes in terms of pain relief and improved function, without major complication.

Patella baja following chronic quadriceps tendon rupture.

Patella baja is a complication of chronic quadriceps tendon rupture. In this case we present the treatment of this problem by the proximal transfer of the tibial tubercle allowing an environment in which the quadriceps tendon can heal.

Bilateral rotational osteotomies of the proximal tibiae and tibial tuberosity distal transfers for the treatment of congenital lateral dislocations of patellae: a case report and literature review.

Congenital dislocation of patella (CDP) causes varying degree of disability. Patients may present as late walkers with asymmetric gait, habitual or recurrent dislocators or even non-walkers if the condition is bilateral. Patellar instability is often associated with soft tissue or bony pathology. Soft tissue anomalies include lateral soft tissue contractures, shortened quadriceps as well as vastus medialis dysplasia (abnormal origin and insertion). Bony anomalies include shallow trochlear groove and hypoplastic patella or lateral femoral condyle. Soft tissue etiologies result in an imbalance of the dynamic forces acting on the patella while in bony etiologies the static stabilizers to resist lateral dislocation are compromised. External tibial torsion is an additional etiology, often under diagnosed due to the difficulty in measuring the Q angle of dislocated patella. We report a case of bilateral congenital lateral dislocations of the patellae treated with bilateral tibial rotational osteotomies with an 8 year and a 4 year follow up.

Functional outcome after tibial tubercle transfer for the painful patella alta.

Twenty-five patients with painful patella alta without symptomatic subluxation were identified in a prospective database. All patients had a distal tibial tubercle transfer and preoperative knee arthroscopy. The mean postoperative followup was 2.4 years. These patients were matched with healthy volunteers. Patellofemoral scores using the scoring systems of Kujala et al and Lysholm and Gillquist were collected prospectively. The Short Form-36 health survey and the Western Ontario and McMaster Universities Osteoarthritis Index were used postoperatively. Significant improvement in the patellofemoral scores was documented postoperatively; however, the healthy volunteers had significantly higher patellofemoral scores when compared with the patients who were treated surgically. For the three Short Form-36 survey parameters based on physical health (physical functioning, role physical, and bodily pain), there were no statistically significant differences between the patients and the United States age-matched norms; data are available in the Short Form-36 survey manual. Patients with Grade 2 chondromalacia (fissuring and fragmentation less than 1.25 cm) had significantly better scores in pain and function domains of the Western Ontario and McMaster Universities Osteoarthritis Index compared with patients with Grade 3 (fissuring and fragmentation greater than 1.25 cm) and Grade 4 (erosion down to bone) changes. Distal tibial tubercle transfer is a beneficial procedure for treating patients with painful patella alta.