Tibial Tubercle Osteotomy

  • Tibial tubercle osteotomy (TTO) is a surgical procedure that is often done to help individuals who are have patella instability or are dealing with osteoarthritis. This procedure moves the attachment point of the patella tendon.
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Brief overview of the episode:

Tibial tubercle osteotomy also know as tibial tuberosity osteotomy or TTO is a procedure that changes the attachment point of the patella tendon in hopes to improve the stability and tracking of the patella. This surgery becomes an option in the case of individuals who are recurrent patella dislocators or who are dealing with retro-patella arthritis and have not had improvement with non-surgical treatment.

This is done by separating the tibial tubercle from the tibia and moving it medial or lateral (less common) and then affixing it in place with screws. There are currently two acceptable techniques the Emslie-Trillat and the Fulkerson. With the Emslie-Trillat a straight cut is made across the tubercle. With the Fulkerson the cut is done in an anteromedial fashion. A third technique exists called the Maquet technique in which the tubercle is anteriorized by fully separating it and placing a bone graft behind it. This method should not be used at is has lead to necrosis and is much more likely to fail.

On average this surgery is performed more frequently with women under 30. It has been reported that 75% or more of individuals who under go a TTO will return to prior or improved level or sport function.

 

Other episodes you might enjoy:  

Patella Dislocation: Episode 128

Patellofemoral / Patellotibial Ligaments: Episode 113

Patella Femoral Pain Syndrome: Episode 32

 

 

Patella Dislocation

  • Patella Dislocations make up between 2-3% of all knee injuries. They are most common in young female athletes and are usually due to a number of factors: genetics, mechanics, activity and trauma.
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Brief overview of the episode:

Patella dislocations account for between 2-3% of all knee injuries, they occur most frequently in younger, female, athletes. Some of the common causes include: shallow trochlear groove, trauma and a powerful quad contraction with knee flexion and external rotation.

As with most dislocation, unfortunately, if you have had one you are more likely to have another. This does not necessarily mean that you will have a second only that your chance is higher. To better prevent a dislocation it is important to address not just quad and hamstring strength but to increase hip strength.

The most important of which is hip abduction. This will prevent the knee from moving into adduction and internal rotation. A position that places the patella in a shallower portion of the trochlear groove and makes it easier to dislocate.

Other episodes you might enjoy:  

Patellofemoral / Patellotibial Ligaments: Episode 113

Patella Fracture: Episode 85

Patella Femoral Pain Syndrome: Episode 32

 

 

Patellofemoral / Patellotibial Ligaments

  • In this episode: We are discussing the patellofemoral and patellotibial ligaments, specifically the medial patellofemoral ligament. These ligaments functions together to hold the patella (knee cap) in place. They are often damaged when the patella is dislocated or with a sudden twisting of the knee.

  • Chip Review @ (18:24): Snyder of Berlin – Bar B Q (Thank you Lisa Neiley)

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Brief overview of the episode:

            The patellotibial and patellofemoral ligaments are not discussed often. They are however, hugely important in maintaining patellar position. Someone who has dislocated their patella is almost certain to have torn one of these ligaments.

            Typically the medial patellofemoral ligament (MPFL) is the one damaged most often. This has to do with many knee injuries resulting from uncontrolled or poorly control knee valgus (knocked knee position). The data suggests that 96% of all lateral patella dislocation will result in at least a partial tear of the MPFL.

            50-60% of patellar lateral restraining force comes from the MPFL and this is why someone who dislocated his or her patella once is at an increased likelihood of dislocating again. The MPFL is most effective between 0-30deg of knee flexion. Beyond this point bony structures and the MCL, LCL, ACL or PCL are more effective.

            Over the last few years surgical MPFL reconstructions have started to become more common and this trend is likely to continue as the importance of this structure is better understood, assessed for and treated.

 All data and statistics taken from:

Collin Krebs, Meaghan TranovichKyle Andrews, and Nabil Ebraheim. “The medial patellofemoral ligament: Review of the literature” J Orthop. 2018 Jun; 15(2): 596–599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990246/

Other episodes you might enjoy:  

Patella Femoral Pain Syndrome: Episode 32

Shin Splint: Episode 17

Ice or Heat?: Episode 23

ACL Recovery: Episode 13

 

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