Effects of retinacular release and tibial tubercle elevation in patellofemoral degenerative joint disease.
Release of the patellar retinaculum and tibial tubercle elevation have both been advocated for the treatment of patellofemoral degeneration. Questions remain, however, regarding the magnitude and predictability of such effects in diseased joints. Using cadaver knee joints exhibiting a range of patellofemoral cartilage degeneration, we investigated the effects on joint contact pressures on release of the patellar retinaculum, followed by tibial tubercle elevations of 1.25 and 2.5 cm. Retinacular release failed to alter the joint-loading parameters significantly. Tibial tubercle elevation reduced the patello-femoral joint contact area and contact force, but failed to cause a consistent change in contact pressure. Tibial tubercle elevation also caused a migration of the joint contact area superolaterally on the retropatellar surface. This migration occurred in conjunction with ventral tilting of the inferior pole of the patella as the tubercle was elevated, suggesting that significant changes in joint kinematics may result from this procedure.
Lewallen
D G
DG
Department of Orthopaedic Surgery, Charles A. Dana Research Institute, Boston, Massachusetts.
Riegger
C L
CL
Myers
E R
ER
Hayes
W C
WC
D000368:Aged; D002102:Cadaver; D005260:Female; D005269:Femur / Q000503:physiopathology*; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000503:physiopathology*; D013977:Tibia / Q000503:physiopathology*