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Osteotomy treatment outcomes for patellar DJD dependent on location
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KOLOA, Hawaii — The optimal treatment outcomes following a tibial tubercle osteotomy for patellar degenerative joint disease is dependent on the location of the lesions, according to a New York orthopedic surgeon.
 Nicholas A. Sgaglione |
At Orthopedics Today Hawaii 2011, Nicholas A. Sgaglione, MD, said, “Where the lesion is, will determine how the patient does. In a study by Pidoriano, if the lesions are distal and over the lateral facet, their outcomes are clinically much better. When the lesions were medial, the results dropped off precipitously. When the lesions are proximal, they were poor.”
Sgaglione said that anterior knee pain is “probably the most common thing we all see in the office.” And usually the treatment is nonoperative.
Indications
“My indications for surgery are failed conservative treatment, a proper diagnosis, [and] a rehab compliant patient,” Sgaglione said. “When a patient comes to you and says they have been in therapy for 2 years, beware because it may not be therapeutic therapy and the most important thing is to review what the therapist is doing.”
In terms of the workup, he said, there are a number of physical exam measurements that need to be made, including looking at gait, laxity, alignment, crepitus, hypermobility, instability, apprehension and tenderness.
Imaging studies needed include plain X-rays in the AP, lateral, oblique and axial skyline at 20° to 30°, “which is where you first get contact,” he said.
Tibial tubercle, trochlear groove index
“No patellar DJD talk would be complete without talking about the tibial tubercle and trochlear groove [TT-TG] index. Abnormal is greater than 20°, and if you are going to do a distal alignment and follow those patients you want to correct that,” Sgaglione said.
He said that using a tibial tubercle osteotomy for anteromedialization of the patella allows you to offset the pressure points. “This is a clever way to do this because you can both anteriorize and anteromedialize depending on the slope of the shim cut — more medialization with a shallow cut and more anteriorization with a deeper cut.” – by Lee Beadling
References:
- Pidoriano AJ,et al. Am J Sports Med. 1997;25(4):533-537.
- Sgaglione NA. Patella DJD: Distal realignment vs. Macquet-Role of biologic resurfacing. Presented at Orthopedics Today Hawaii 2011. Jan. 16-19. Koloa, Hawaii.
Disclosure: Sgaglione collects royalties from Biomet and is a consultant for Smith & Nephew Endoscopy and Conmed Linvatec Orthopaedics.
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