Abstract
Background
Antero-medialisation osteotomy combined with a distalisation procedure may require
a more stable fixation as the osteotomy fragment loses both proximal and distal support.
This finite element analysis aimed to compare the mechanical behaviour of different
fixation techniques in tibial tubercle antero-medialisation osteotomy combined with
distalisation procedure.
Methods
Tibial tubercle osteotomy combined with distalisation was modelled based on computerised
tomography data, which were acquired from a patient with patellar instability requiring
this procedure. Six different fixation configurations with two 3.5-mm cortical screws
(1), two 4.5-mm cortical screws (2), three 3.5-mm cortical screws (3), three 4.5-mm
cortical screws (4), three 3.5-mm screws with 1/3 tubular plate (5), and four 3.5-mm
screws with 1/3 tubular plate (6) were created. A total of 1654 N of force was applied
to the patellar tendon footprint on the tibial tubercle. Sliding, gap formation, and
total deformation between the osteotomy components were analyzed.
Results
Maximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm)
were seen with two 3.5-mm screw fixation, followed by two 4.5-mm screws, three 3.5-mm
screws, and three 4.5-mm screws, respectively, in the screw-only group. Overall, the
minimum displacement was observed with the four 3.5-mm screws with 1/3 tubular plate
fixation model.
Conclusions
Plate fixation might be recommended for tibial tubercle antero-medialisation osteotomy
combined with distalisation procedure because it might allow early active range of
motion exercises and weight-bearing.
Keywords
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Article info
Publication history
Published online: June 29, 2022
Accepted:
June 1,
2022
Received in revised form:
May 22,
2022
Received:
January 4,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
