title: Influence of age on clinical outcomes of three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of three-dimensional (3D) transfer of the tibial tuberosity for patellar instability with patella alta, with a focus on the influence of age at initial surgery.
  
  
  METHODS
  Three-dimensional surgery was performed on 28 knees with a mean follow-up of 46 months. Patients were separated into three groups based on the age at initial surgery: group A, 10 knees and an average age of 16.3 ± 1.8 (14-19) years; group B, 10 knees and an average age of 22.1 ± 2.5 (20-28) years; and group C, eight knees and an average age of 44.0 ± 2.2 (40-46) years. Patellofemoral geometry improvement focused on patella alta by determining the Insall-Salvati ratio and Caton-Deschamps index, rotational malalignment by measuring the tibial tubercle-trochlear groove (TT-TG) distance, and lateral patellar subluxation by measuring the patellar tilt. Clinical outcomes were evaluated by the Lysholm and Kujala scores, which were compared before and after surgery. Cartilage degeneration was evaluated by the International Cartilage Repair Society grading system at initial arthroscopy.
  
  
  RESULTS
  The patellar height, TT-TG, and patellar tilt significantly improved in all groups postoperatively (p < 0.05). The Lysholm and Kujala scores also significantly improved postoperatively; however, both scores were lower in group C than in the other groups (p < 0.05). Particularly, pain scores were more severe in group C than in the other groups, and the severity of cartilage degeneration correlated with the pain scores (p < 0.05). Cartilage damage differed significantly between the groups at initial arthroscopy; particularly, group C included grades III and IV cartilage degeneration (p < 0.05).
  
  
  CONCLUSIONS
  Age at initial surgery may be the predicting factor for poor clinical outcomes of 3D transfer surgery. The clinical outcome may depend on the age at surgery, which correlated with cartilage damage; thus, surgeons should be given this information when patients are considered undergoing patella surgery.
  
  
  METHODS
  Therapeutic case series, Level IV.
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan. otsuki.shuhei@gmail.com.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Otsuki
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Nakajima
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Fujiwara
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Iida
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Neo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002357:Cartilage Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000002:abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cartilage degeneration; Patella alta; Patellar instability; Three-dimensional transfer; Tibial tuberosity
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