Jordy van Sambeeck

Chapter 4 60 (MPFL) reconstruction, lateral release, vastus medialis obliquus (VMO) plasty or a trochlear osteotomy. Patient charts were reviewed for data collection. Follow-up was obtained at 6 weeks and 4 months postoperatively in case of fusion without further complications. Longer follow-up was only on indication. Surgical technique The tibial tubercle transfer was performed making a V-shaped osteotomy of the attachment of the patellar tendon on the tibial tubercle using a saw and osteotome (Fig. 1A), as earlier described by Caton and Van de Groes [7, 12]. Through an anteromedial approach, the patellar tendon is identified and the periosteum is released. The tibial tubercle is completely detached on three sides with an oscillating saw and osteotome to be able to perform a distal transfer. A piece of bone from the tibia is removed in order to correct the Caton–Deschamps index to 1 as planned preoperatively. This bone block was placed in the gap on the proximal side to enhance stability and to provide a more stable situation of the tuberosity (Fig. 1B). The osteotomy was fixed using two small fragment lag screws. The screws were countersunk and not placed in the same line to prevent breakage of the tubercle and irritation of the screw heads. Stable compression was obtained. Figure 1. Schematic drawing of the V-shaped tibial tubercle osteotomy for transfer, A: the red dashed line reflects the cut for complete detaching the tibial tubercle. The blue dashed line marks the small bone block that is transferred from distal to proximal. B: situation after distalisation of the tubercle with the bone part from distal put back proximally.