chapter 13: Surgical Treatment of Patellofemoral Chondrosis and Arthrosis

Osteotomy of the Patella

Hejgaard and Arnoldi (95) reported that simple longitudinal osteotomy of the patella may give significant relief of patellar pain associated with increased intraosseous pressure. Further confirmation of such findings is necessary before advocating this technique.

Vaquero and Arriaza (96) described a thinning osteotomy of the patella. By taking a 7 mm segment out of the mid‑patella, they reported a 16 to 27% reduction of contact pressure in the patellofemoral joint in thirteen cadaver knee specimens. They refer to this as a "double parallel coronal osteotomy of the patella." I have no experience with this technique.

Anterolateral Transfer of the Tibial Tubercle

I have done 18 anterolateral tibial tubercle transfers to correct an overly medialized tib­ial tubercle (most commonly following a failed Hauser procedure). These patients have excessive medial contact stress on the patella which can result in a bone on bone medial patellofemoral arthrosis. Such patients benefit from transferring the patel­lar tendon anterolaterally. A tibial pedicle similar to that used for anteromedial tibial tubercle transfer, but angling the osteotomy to permit anterolateral shift of the patellar tendon, has been helpful in the management of these difficult patients (Fig. 13.43).  A back cut to release the osteotomy shingle is frequently necessary on the medial side, depending on the obliquity of the osteotomy cut. This procedure has been extremely helpful as a salvage procedure in the very troubled patients with intractable pain following excessive medial or posteromedial tibial tubercle transfer.



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