Realignment for Patellofemoral Arthritis
Patient Selection
Multiple causes of patellofemoral arthritis
Limb alignment
Bony architecture of trochlea and patella
Integrity of surrounding soft tissues
Surgical treatment indicated in patients for whom nonsurgical measures—activity modification, bracing treatment, physical therapy, medications, and injections—have failed
Patellar realignment consists of anteromedialization of the tibial tubercle with osteotomy
First described by Fulkerson for patellar instability
Excellent option for patients with isolated lateral facet arthritis
Other procedures for patellofemoral arthritis include lateral release, cartilage restoration, patellofemoral arthroplasty, total knee arthroplasty, and patellar realignment
Indications
Isolated distal/lateral patella facet or lateral trochlear chondrosis with no chondrosis of the proximal/medial patellofemoral joint
Central patellar wear in patients with patellar subluxation seen on radiographs
Contraindications
Severe medial and/or proximal patellar chondrosis
Standard osteotomy contraindications—Nicotine use, osteoporosis, nonspecific pain, complex regional pain syndrome, infection, inflammatory arthropathies, patella baja, or arthrofibrosis
Relative contraindications
Varus knee, medial compartment arthritis, post–medial meniscectomy knee
Severe medial and/or lateral compartment arthritis of the knee—requires a more global procedure
Preoperative Imaging
Radiography
45° flexion weight-bearing PA shows degree of tibiofemoral joint space narrowing
Merchant view assesses patellar tilt, subluxation, and trochlear dysplasia
Lateral view evaluates patellar height and trochlear dysplasia
Magnetic Resonance Imaging
Assess for medial patellofemoral ligament injury or other ligamentous or meniscal pathologies
Find degree and location of articular cartilage loss
Determine tibial tuberosity–trochlear groove distance—Lateral offset of tibial tuberosity from the deepest point in the trochlear groove; greater than 20 mm nearly always is associated with patellar instability
CT
Rarely ordered in treatment of patellofemoral arthritis
Occasionally ordered in treatment of patellofemoral instability in patients with correlating femoral anteversion, increased tibial torsion, and patellar maltracking
Can determine tibial tuberosity–trochlear groove distance, femoral anteversion, and patellar tracking at different knee flexion angles
Procedure
Room Setup/Patient Positioning
Supine position
Tourniquet (for osteotomy portion of case only)
 | Video 22.1 Anterior Medialization via Tibial Tubercle Osteotomy. Albert Lin, MD; Robin West, MD (21 min) |
Special Instrumentation/Equipment/Implants
30° and 70° arthroscopes
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
