Abstract
BackgroundTibial Tubercle Osteotomy has shown much promise in revision total knee replacement. Methods of repair previously described include screw and wire fixation. Both methods have significant complications.MethodsThis article describes suture fixation of the osteotomy using Ethibond sutures placed medially with a lateral periosteal hinge.ResultsThis method of fixation relies upon an adequate osteotomy segment including the entire insertion of the patella tendon. The lateral periosteal hinge is maintained and adds to the stability of the construct. A minimum of two number 5 Ethibond sutures are passed medially through drill holes to secure the osteotomy segment. No post-operative immobilisation is required.ConclusionEthibond sutures provide adequate fixation of the tibial tubercle osteotomy segment in revision knee arthroplasty with reduced risk of complication as compared to conventional fixation methods.
Highlights
Tibial Tubercle Osteotomy has shown much promise in revision total knee replacement
Tibial tubercle osteotomy is a technique gaining popularity in knee revision surgery which allows exposure and access to the medullary canal of the tibia, with reduced risk of extensor lag compared to techniques involving the quadriceps [1]
Wire fixation is associated with soft tissue injury caused by the tails of the wires after they are tied, proximal migration of the osteotomy segment, and anterior knee pain [3]
Summary
Tibial Tubercle Osteotomy has shown much promise in revision total knee replacement. Methods of repair previously described include screw and wire fixation. Tibial tubercle osteotomy is a technique gaining popularity in knee revision surgery which allows exposure and access to the medullary canal of the tibia, with reduced risk of extensor lag compared to techniques involving the quadriceps [1]. Screw fixation is associated with anterior knee pain, necessitating screw removal, osteotomy segment fracture, and tibial shaft fracture [2]. Wire fixation is associated with soft tissue injury caused by the tails of the wires after they are tied, proximal migration of the osteotomy segment, and anterior knee pain [3]
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