Tibial Tuberosity Osteotomy for Patellofemoral Realignment Alters Tibiofemoral Kinematics

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Background: Tibial tuberosity realignment surgery is performed to improve patellofemoral alignment, but it could also alter tibiofemoral kinematics. Hypothesis: After tuberosity realignment in the malaligned knee, the reoriented patellar tendon will pull the tuberosity back toward the preoperative position, thereby altering tibiofemoral kinematics. Study Design: Controlled laboratory study. Methods: Ten knees were tested at 40°, 60°, and 80° of flexion in vitro. The knees were loaded with a quadriceps force of 586 N, with 200 N divided between the medial and lateral hamstrings. The position of the tuberosity was varied to represent lateral malalignment, with the tuberosity 5 mm lateral to the normal position; tuberosity medialization, with the tuberosity 5 mm medial to the normal position; and tuberosity anteromedialization, with the tuberosity 10 mm anterior to the medial position. Tibiofemoral kinematics were measured using magnetic sensors secured to the femur and tibia. A repeated measures analysis of variance with a post hoc Student-Newman-Keuls test was used to identify significant (P < .05) differences in the kinematic data between the tuberosity positions at each flexion angle. Results: Medializing the tibial tuberosity primarily rotated the tibia externally compared with the lateral malalignment condition. The largest average increase in external rotation was 13° at 40° of flexion, with the increase significant at each flexion angle. The varus orientation also increased significantly by an average of 1.5° at 40° and 80°. The tibia shifted significantly posteriorly at 40° and 60° by an average of 4 mm and 2 mm, respectively. Shifting the tuberosity from the medial to the anteromedial position translated the tibia significantly posteriorly by an average of 2 mm at 40°. Conclusion: After tibial tuberosity realignment in the malaligned knee, the altered orientation of the patellar tendon alters tibiofemoral kinematics. Clinical Relevance: The kinematic changes reduce the correction applied to the orientation of the patellar tendon and could alter the pressure applied to tibiofemoral cartilage.