AI Article Synopsis
- Antero-medialisation osteotomy combined with distalisation requires stable fixation due to the loss of support for the osteotomy fragment.
- Finite element analysis was used to compare different screw fixation techniques on tibial tubercle osteotomy, identifying various configurations based on screw types and placements.
- Results indicated that using a 1/3 tubular plate with four 3.5-mm screws resulted in the least displacement, suggesting that plate fixation could enable quicker recovery through earlier range of motion and weight-bearing activities.
Article Abstract
Background: Antero-medialisation osteotomy combined with a distalisation procedure may require a more stable fixation as the osteotomy fragment loses both proximal and distal support. This finite element analysis aimed to compare the mechanical behaviour of different fixation techniques in tibial tubercle antero-medialisation osteotomy combined with distalisation procedure.
Methods: Tibial tubercle osteotomy combined with distalisation was modelled based on computerised tomography data, which were acquired from a patient with patellar instability requiring this procedure. Six different fixation configurations with two 3.5-mm cortical screws (1), two 4.5-mm cortical screws (2), three 3.5-mm cortical screws (3), three 4.5-mm cortical screws (4), three 3.5-mm screws with 1/3 tubular plate (5), and four 3.5-mm screws with 1/3 tubular plate (6) were created. A total of 1654 N of force was applied to the patellar tendon footprint on the tibial tubercle. Sliding, gap formation, and total deformation between the osteotomy components were analyzed.
Results: Maximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm) were seen with two 3.5-mm screw fixation, followed by two 4.5-mm screws, three 3.5-mm screws, and three 4.5-mm screws, respectively, in the screw-only group. Overall, the minimum displacement was observed with the four 3.5-mm screws with 1/3 tubular plate fixation model.
Conclusions: Plate fixation might be recommended for tibial tubercle antero-medialisation osteotomy combined with distalisation procedure because it might allow early active range of motion exercises and weight-bearing.
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| http://dx.doi.org/10.1016/j.knee.2022.06.002 | DOI Listing |
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