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The Effects of Medialization and Anteromedialization of the Tibial Tubercle on Patellofemoral Mechanics and Kinematics

Arun J. Ramappa, MD^*,, Maria Apreleva, PhD, Fraser R. Harrold, MD, Peter G. Fitzgibbons, MD, David R. Wilson, DPhil^, and Thomas J. Gill, MD

From the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, the Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada, and the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

^* Address correspondence to Arun J. Ramappa, MD, Beth Israel Deaconess Medical Center, Shapiro 2, 330 Brookline Avenue, Boston, MA 02215 (e-mail: aramappa{at}bidmc.harvard.edu).

Background: Medialization and anteromedialization of the tibial tubercle are used to correct patellar subluxation in adults.

Purpose: To compare the effects of the 2 osteotomies on patellofemoral joint contact pressures and kinematics.

Study Design: Controlled laboratory study.

Methods: Tibial tubercle osteotomies were performed on 10 cadaveric human knees. The knees were tested between 0° and 90° of flexion while dynamic patellofemoral joint contact pressure and kinematic data were simultaneously obtained. Four conditions were tested: normal knee alignment, simulated increased Q angle, postmedialization of the tibial tubercle, and postanteromedialization of the tubercle.

Results: An increased Q angle laterally translated the patella, shifted force to the lateral facet, and increased patella contact pressures. Both medialization and anteromedialization partially corrected the abnormal contact pressures. Medialization partially corrected the shift of force to the lateral facet induced by an increased Q angle, whereas the anteromedialization could not. Both medialization and anteromedialization corrected the patella maltracking.

Conclusion: Medialization and anteromedialization are equivalent in their ability to correct abnormal patellar mechanics and kinematics.

Key Words: knee • biomechanics • patellofemoral • osteotomy

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