Three-dimentional reposition of tibial tubercle and surgical procedure of permanent dislocation of the patella

Abstract

Four knees of 3 patients were treated with medial patellofemoral ligament (MPFL) reconstruction and Fulkerson osteotomy for the dislocation of the permanent patella. Perioperative flexion limitation was treated with tibial tubercle elevation. In this study, we evaluated newly applied patella height and range of motion (ROM). Four knees of 3 patients (2 females and 1 male) underwent surgery. The mean age was 24.6 years (between 17 and 30 years). The mean follow-up period was 35 months (between 30 and 40 months). Mean preoperative ROM, mean perioperative ROM before tubercle elevation and mean postoperative ROM after tubercle elevation were 126 degrees (between 125 and 130 degrees), 71 degrees (between 60 and 80 degrees), and 131 degrees (between 130 and 135 degrees), respectively. Mean Lysholm score increased from 66 to 100. Tibial tubercle transfer/osteotomy and medial patellofemoral reconstruction are good treatment options for the dislocation of the permanent patella. In addition, during the recentering of the patella located in the outer part of the trochlea or rarely of the lateral condyle, the flexion can be restricted depending on the shortness of the extensor mechanisms. In our study, we elevated the tibial tubercle, and patella height remained within physiological limits. We believe tubercle elevation is a convenient solution for the flexion limitation that occurs during the reconstruction of the dislocation of the patella.