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Articular Cartilage Contact Pressure after Tibial Tuberosity Transfer

A Cadaveric Study

Ryosuke Kuroda, MD^*, Helen Kambic, MS, Antonio Valdevit, MSc and Jack T. Andrish, MD^*,

^* Department of Orthopaedic Surgery, The Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
Department of Biomedical Engineering, The Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio

Address correspondence and reprint requests to Jack T. Andrish, MD, The Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Section of Sports Medicine/A41, 9500 Euclid Avenue, Cleveland, OH 44195

Medial transfer of the tibial tuberosity has been commonly used for treatment of recurrent dislocation of the patella and patellofemoral malalignment. In this study, six fresh human cadaveric knees were used. Static intrajoint loads were recorded using Fuji Prescale pressure-sensitive film for contact pressure and contact area determination in a closed kinetic chain knee testing protocol. Peak pressures, average contact pressures, and contact areas of the patellofemoral and tibiofemoral joints were calculated on native intact knee specimens and after tibial tuberosity transfer. All native intact knee specimens had a normal Q angle. Medialization of the tibial tuberosity significantly increased the patellofemoral contact pressure. Medial displacement of the tibial tuberosity also significantly increased the average contact pressure of the medial tibiofemoral compartment and changed the balance of tibiofemoral joint loading. The results of our study suggest that caution should be used when transferring a patellar tendon in the face of a preexisting normal Q angle as this will result in abnormally high peak pressure within the tibiofemoral joint. Overmedialization of the tibial tuberosity should be avoided in the varus knee, the knee after medial meniscectomy, and the knee with preexisting degenerative arthritis of the medial compartment.

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