Supratubercle anterior closing wedge osteotomy may not induce patella alta
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Key takeaways:
- Supratubercle anterior closing wedge osteotomy did not significantly change patellar height 6 months after failed ACL surgery.
- The osteotomy also decreased tibial translation and posterior tibial slope.
DENVER — Presented results showed supratubercle anterior closing wedge proximal tibial osteotomy did not decrease patellar height at 3 months and 6 months postoperatively for patients with failed revision ACL reconstruction.
At the American Orthopaedic Society for Sports Medicine Annual Meeting, Nicholas I. Kennedy, MD, from the Mayo Clinic in Rochester, Minnesota, presented results from a retrospective cohort comparison of 16 patients who underwent supratubercle anterior closing wedge osteotomy and 28 patients who underwent medial opening wedge osteotomy after failed revision ACL reconstruction.
“The concern from a supratubercle standpoint is that you would induce iatrogenic patella alta,” Kennedy said.
Kennedy and colleagues used radiographs to assess Caton-Deschamps and Insall-Salvati indices, posterior tibial slope and anterior tibial translation before surgery and postoperatively at 1 day, 3 months and 6 months.
Kennedy said patients who underwent closing wedge osteotomy had a significant increase in patellar height at postoperative day 1. However, they found a linear decrease during the next 6 months and, ultimately, no significant differences between preoperative patella height and 6-month patella height.
“If you look at [patients who underwent opening wedge osteotomy], this is similar. We saw a decrease in patella height with time, or likely with patella scarring, and you had a statistically significant [decrease in patella height] at 6 months compared to preoperatively,” he said.
Among patients who underwent closing wedge osteotomy, Kennedy and colleagues found anterior tibial translation significantly decreased by an average of 9 mm and posterior tibial slope significantly decreased by an average of 11.8° from preoperative measures to 6 months postoperatively.
“This is a relatively small cohort, as a lot of our closing wedge cohorts are. We have short follow-up, but long-term follow-up is needed and we’re looking at reassessing these patients now at the greater than 15-month time point,” Kennedy said. “We have no comparison cohort that was a closing wedge cohort, ie an infratubicle vs. the transtubicle technique, and future studies should look at that as well.”
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Tollefson L, et al. Paper 34. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-14, 2024; Denver.
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