title: Tibial tubercle osteotomy hinged on the tibialis anterior muscle and fixed by circumferential cable cerclage in revision total knee arthroplasty.
abstract: BACKGROUND
  Difficulties in knee exposure during revision total knee arthroplasty (RTKA) may require tibial tubercle osteotomy (TTO). The main objective of this study was to assess union after TTO hinged on the lateral soft tissues and fixed using circumferential cable cerclage during RTKA.
  
  
  OBJECTIVE
  Non-union is uncommon with this technique.
  
  
  METHODS
  We retrospectively included consecutive patients who underwent RTKA between 2008 and 2010 with TTO. Chevron osteotomy was performed and the fragment was left hinged laterally on the tibialis anterior muscle then fixed using circumferential cerclage with one or two steel cables. The primary evaluation criterion was TTO union as assessed on radiographs. Secondary evaluation criteria were time to union, osteotomy fragment migration, patellar height, and the IKS score at last follow-up. We included 65 patients with a mean age of 72±11.3 years including 39 (60%) undergoing septic revision and 26 (40%) aseptic revision. Mean follow-up was 27.8±10.7 months; there was 1 early death, which was unrelated to the surgery, and another patient was lost to follow-up.
  
  
  RESULTS
  TTO union was achieved in 59/63 (93.7%) patients. Fragment migration occurred in 4 (6.3%) patients. Mean time to union was 16.9±5.1 weeks overall, 12.4±2.0 in the aseptic revision group, and 18.9±4.8 in the septic revision group (P=0.0005). Patellar height at last follow-up was not significantly changed compared to the preoperative value (P=0.09). At last follow-up, the mean IKS knee and function scores were significantly improved (P<10-5).
  
  
  CONCLUSIONS
  TTO hinged on the lateral soft tissues and fixed by circumferential cable cerclage ensured union in the vast majority of patients, with a low rate of tubercle migration.
  
  
  METHODS
  IV, retrospective study.
authors.affiliation: Hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
authors.forename: Y P
authors.initials: YP
authors.lastname: Le Moulec
authors.affiliation: Hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la santé, 78035 Versailles, France.
authors.forename: T
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. Electronic address: klouche_shahnaz@yahoo.fr.
authors.forename: S
authors.initials: S
authors.lastname: Klouche
authors.affiliation: Hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la santé, 78035 Versailles, France.
authors.forename: P
authors.initials: P
authors.lastname: Hardy
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D009984:Orthopedic Fixation Devices; D016348:Osseointegration; D010027:Osteotomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*
keywords: Revision total knee arthroplasty; Surgical Approach; Tibial tuberosity osteotomy