Distalising tibial tubercle osteotomy decreases patellar tendon force

a treatment rationale for recalcitrant patellar tendinopathy

Michael J. Dan*, Joseph Cadman, James McMahon, William C. H. Parr, David Broe, Mervyn Cross, Richard Appleyard, William R. Walsh

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Patellar tendinopathy is an overuse condition affecting athletes, often with a high morbidity if left untreated. High-level evidence fails to support the use of surgery. A tibial tubercle osteotomy (TTO) has been suggested as a surgical option to improve patient outcomes. Our aim was to explore whether a distalising TTO will alter the patellar tendon to quadriceps tendon force ratio and the sagittal patellar tilt. Methods: Six cadaver limbs were placed in a custom jig with a mechanical testing machine applying cyclical loads of 200–500 N to the quadriceps tendon. The knee was fixed at 0, 15, 30, 45, 60, 75 and 90° of flexion and a buckle transducer recorded the resultant patellar tendon force. Testing was performed with the native tibial tubercle position and with the tubercle distalised by 11 mm. Testing was also performed with the tubercle anteriorised by 10 mm at both of these tubercle positions, a total of four different testing positions. Results: There was a significant decrease in the patellar tendon to quadriceps tendon force ratio from 30–60° of knee flexion. There was a significant increase in the sagittal patellar tilt at 30° of knee flexion with distalisation. Conclusion: This biomechanical study shows that the patellar tendon to quadriceps tendon force ratio can be altered with a distalising tibial tubercle osteotomy. A tibial tubercle osteotomy may be a biomechanical treatment option for recalcitrant patellar tendinopathy by decreasing the load through the patellar tendon, allowing the athlete to maintain higher training volumes and loads.

Original languageEnglish
Pages (from-to)871-877
Number of pages7
JournalKnee
Volume27
Issue number3
DOIs
Publication statusPublished - Jun 2020

Keywords

  • Biomechanics
  • Distalising tibial tubercle osteotomy
  • Patellar tendinopathy
  • Surgery
  • Tibial tubercle osteotomy

Fingerprint Dive into the research topics of 'Distalising tibial tubercle osteotomy decreases patellar tendon force: a treatment rationale for recalcitrant patellar tendinopathy'. Together they form a unique fingerprint.

Cite this