title: Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome.
abstract: OBJECTIVE
  Recurrent patella subluxation may be secondary to excessive external tibial torsion. The purpose of this study is to evaluate the clinical and radiographic outcome of patients undergoing tibial derotation osteotomy and tibial tuberosity transfer for recurrent patella subluxation in association with excessive external tibial torsion.
  
  
  METHODS
  A combined tibial derotation osteotomy and tibial tuberosity transfer was performed in 15 knees (12 patients) with recurrent patella subluxation secondary to excessive external tibial torsion. Clinical evaluation was carried out using preoperative and post-operative Knee Society Score (KSS), Kujala Patellofemoral score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the short form-12 (SF-12) and a visual analogue score (VAS) pain scale.
  
  
  RESULTS
  The median follow-up period was 84 months (range 15-156) and median patient age was 34 years (range 19-57 years). The median preoperative external tibial torsion was 62° (range 55°-70°), with a median rotational correction of 36° (range 30°-45°) after surgery. Significant improvement (p < 0.05) was found in the KSS part I (37 ± 14 to 89 ± 11 points), KSS part II (25 ± 26 to 85 ± 14 points), Kujala score, the SF-12 outcome, WOMAC score and VAS score (8.8 ± 1.9 to 2.4 ± 1.5). Two patients had a nonunion of the tibial osteotomy site; one patient required bone grafting, while another patient required revision to total knee arthroplasty.
  
  
  CONCLUSIONS
  Patients presenting with recurrent patella subluxation secondary to excessive external tibial torsion >45° who underwent tibial derotation osteotomy and tibial tuberosity transfer achieved a satisfactory outcome in terms of pain relief and improved function. A significant complication was seen in 2/15 patients.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: , 640 Roselwan Av. Unit 717, Toronto, ON, M5N1K9, Canada, mt.drexler@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Drexler
authors.forename: T
authors.initials: T
authors.lastname: Dwyer
authors.forename: O
authors.initials: O
authors.lastname: Dolkart
authors.forename: Y
authors.initials: Y
authors.lastname: Goldstein
authors.forename: E L
authors.initials: EL
authors.lastname: Steinberg
authors.forename: R
authors.initials: R
authors.lastname: Chakravertty
authors.forename: J C
authors.initials: JC
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D031222:Patellar Dislocation / Q000601:surgery*; D012008:Recurrence; D012399:Rotation; D013977:Tibia / Q000601:surgery* / Q000637:transplantation