title: Extended exposure in difficult total knee arthroplasty using tibial tubercle osteotomy.
abstract: OBJECTIVE
  In some total knee arthroplasty cases, the usual medial parapatellar approach does not allow the appropriate patellar eversion and the desired exposure of the knee joint. Partial disinsertion of the patellar tendon doesn't substantially improve the surgical exposure and can lead to extensor apparatus weakening and complete secondary ruptures, while the V-Y quadricipital plasty leads to post-op immobilization of the knee, which delays the functional rehabilitation, with negative impact on the range of motion. The tibial tubercle osteotomy, however, allows an extension of the approach in total knee arthroplasty, without endangering the quadricipital extensor apparatus.
  
  
  METHODS
  In this study we analysed the post-operative results of 11 cases of primary total knee arthroplasty in which a frontal plane osteotomy of the tibial tubercle was performed in addition to the standard medial parapatellar approach, as a result of the patients associated conditions, like rheumatoid arthritis with an extension deficit higher than 150, previous knee synovectomy by arthrotomy, progressive genu varum with more than 150 deviation, varus deviation of the lower limb with previous closing wedge proximal tibial osteotomy or patellar fractures with vicious consolidation.
  
  
  RESULTS
  Overall, the results were more than satisfactory with a significant increase in the patients mean range of motion and Knee Society Score. There were some post-op issues in some of the patients, but they were adressed accordingly, having no long-term impact on the results.
  
  
  CONCLUSIONS
  . We could thus conclude that, in special cases, the frontal plane tibial tubercle osteotomy is an effective technique which can provide a wide approach with appropriate protection of the knee extensor apparatus.
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania ; Department of Orthopaedic Surgery, Emergency University Hospital, Bucharest, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Radulescu
authors.affiliation: Department of Orthopaedic Surgery, Emergency University Hospital, Bucharest, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Badila
authors.affiliation: Department of Orthopaedic Surgery, Emergency University Hospital, Bucharest, Romania.
authors.forename: Octavian
authors.initials: O
authors.lastname: Nutiu
authors.affiliation: Department of Orthopaedic Surgery, Emergency University Hospital, Bucharest, Romania.
authors.forename: Ionut
authors.initials: I
authors.lastname: Japie
authors.affiliation: Department of Orthopaedic Surgery, Emergency University Hospital, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Terinte
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Radulescu
authors.affiliation: Department of Orthopaedic Surgery, Emergency University Hospital, Bucharest, Romania.
authors.forename: Robert
authors.initials: R
authors.lastname: Manolescu
keywords: arthroplasty; knee joint exposure; knee range of motion; tibial tubercle osteotomy