Computational simulation of medial versus anteromedial tibial tuberosity transfer for patellar instability

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
John J EliasAndrew J Cosgarea

Abstract

The study utilizes dynamic simulation of knee function to determine how tibial tuberosity medialization and anteromedialization influence patellar tracking and contact pressures for knees with patellar instability. Dual limb squatting was simulated with six multibody dynamic simulation models representing knees being treated for patellar instability. Each knee exhibited lateral patellar maltracking in the pre-operative condition based on the bisect offset index. The patellar tendon attachment points on the tibia were medialized by 10 mm to represent tibial tuberosity medialization, with an additional 5 mm of anteriorization applied for anteromedialization. The patellofemoral contact pressure distribution was quantified using discrete element analysis. Data were analyzed with repeated measures analysis of variance with post-hoc tests and linear regressions. Tibial tuberosity medialization and anteromedialization significantly (p < 0.05) decreased the bisect offset index for nearly all flexion angles up to 80°, with the largest changes near full extension. Both procedures significantly decreased the maximum lateral pressure at 55°, but increased the maximum medial pressure from 30 to 80°. The pre-operative to post-operative incre...Continue Reading

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Citations

Oct 20, 2019·Journal of Biomechanical Engineering·Allison ClouthierMichael J Rainbow
Nov 19, 2019·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Oliver AlvarezClare K Fitzpatrick
Aug 20, 2021·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Giuseppe SalvatoreAra Nazarian
Mar 7, 2020·The Journal of Knee Surgery·Miho J TanakaJohn J Elias
Sep 25, 2021·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·John J EliasJason L Koh

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