Proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy.

Autor: Uppstrom TJ; Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA. tyler.j.uppstrom@gmail.com., Cash BM; Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA., Jahandar A; Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA., Fletcher C; Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA., Nguyen JT; Biostatistics Core, Hospital for Special Surgery, New York, NY, USA., Maher SA; Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA., Strickland SM; Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA., Gomoll AH; Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2023 Oct; Vol. 31 (10), pp. 4239-4245. Date of Electronic Publication: 2023 Jun 10.
DOI: 10.1007/s00167-023-07467-z
Abstrakt: Purpose: The purpose of this study was to quantify differences in mechanical stability of a wedge-shaped distalization tibial tubercle osteotomy (TTO) with a standard technique, versus a modified technique with use of a proximal bone block and distally angled screw trajectory.
Methods: Ten fresh-frozen cadaver lower extremity specimens (five matched pairs) were utilized. Within each specimen pair, one specimen was randomly assigned to undergo a standard distalization osteotomy fixed with two bicortical 4.5-mm screws oriented perpendicular to the long axis of the tibia, and the other to undergo a distalization osteotomy with modified fixation utilizing a proximal bone block and distally angled screw trajectory. Each specimen's patella and tibia were mounted on a servo-hydraulic load frame using custom fixtures (MTS Instron). The patellar tendon was dynamically loaded to 400 N at a rate of 200 N/second for 500 cycles. Following the cyclic loading, loading to failure was done at 25 mm/min.
Results: The modified distalization TTO technique demonstrated significantly higher average load to failure compared to the standard distalization TTO technique (1339 N vs. 844.1 N, p < 0.001). Average maximum tibial tubercle displacement during cyclic loading was significantly smaller in the modified TTO technique group compared to the standard TTO technique (1.1 mm vs. 4.7 mm, p < 0.001).
Conclusion: This study demonstrates that distalization TTO utilizing a modified technique with a proximal bone block and distally aimed screws is biomechanically superior to standard distalization TTO without proximal bone block and screw trajectory perpendicular to the long axis of the tibia. This increased stability may aid in reducing the reported higher complication rates (including loss of fixation, delayed union and nonunion) following distalization TTO, although future clinical outcome studies are warranted.
(© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)
Databáze: MEDLINE
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