Osteotomies Around the Patellofemoral Joint

  • Roland M. Biedert
  • Philippe M. Tscholl


A normal patellofemoral gliding mechanism with perfect stability is guaranteed by the complex interaction of skeletal geometry, soft tissues, and neuromuscular control.10 During knee flexion, the patella moves from a medial to a lateral tilted positionas knee flexion approaches 90°.29,32,33,51,53Abnormal skeletal geometry – such as increased femoral anteversion, trochlear dysplasia, patella alta or infera, increased tibial external torsion, increased tibial tubercle lateralization, and variations of combined deformities – may lead to patellofemoral complaints.10 Altered vectors and forces acting on the patellofemoral joint (PFJ) can cause cartilage failure with secondary osteoarthritis instability and musculotendinous insufficiency. Osteotomy with soft tissue balancing might be the best treatment, depending on the underlying pathology. Surgery aimsto eliminate the present pathomorphology.


Knee Flexion Tibial Tubercle Trochlear Dysplasia Trochlear Groove Lateral Patellar 
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  1.  1.
    Albee FH. The bone graft wedge in the treatment of habitual dislocation of the patella.Med Rec. 1915;88:257-259.Google Scholar
  2.  2.
    Barnett AJ, Prentice M, Mandalia V, et al. Patellar height measurement in trochlear dysplasia.Knee Surg Sports Traumatol Arthrosc. 2009;17:1412-1415.PubMedCrossRefGoogle Scholar
  3.  3.
    Bereiter H. Die Trochleaplastik bei Trochleadysplasie zur Therapie der rezidivierenden Patellaluxation. In: Wirth CJ, Rudert M, eds.Das Patellofemoral Schmerzsyndrom. Darmstadt: Steinkopff; 2000:162-177.Google Scholar
  4.  4.
    Bereiter H, Gautier E. Die Trochleaplastik als chirurgische Therapie der rezidivierenden Patellaluxation bei Troch­leadysplasie des Femurs.Arthroskopie. 1994;7:281-286.Google Scholar
  5.  5.
    Bernageau J, Goutallier D, Debeyre J, et al. Nouvelle technique d’ecploration de l’articulation fémoro-patellaire. Incindinces axiales quadriceps contracté et décontracté.Rev Chir Orthop Reparatrice Appar Mot. 1969;61(suppl 2):286-290.Google Scholar
  6.  6.
    Biedert RM. Is there an indication for lateral release and how I do it. Paper presented at: International Patellofemoral Study Group; 2000; Garmisch-Partenkirchen,Germany.Google Scholar
  7.  7.
    Biedert RM.Patellofemoral Disorders: Diagnosis and Treatment. New York: Wiley; 2000.Google Scholar
  8.  8.
    Biedert RM. Measurements of the length of the proximal and distal trochlea and the trochlear depth on sagittal MRI in patients wieht lateral patellar subluxation. Paper presented at: International Patellofemoral Study Group; 2005; Lausanne, Switzerland.Google Scholar
  9.  9.
    Biedert RM. Trochlea dysplasia: indications for trochleoplasty (deepening) and raising/shortening/lengthening of flat/short lateral trochlea. Paper presented at: International Patellofemoral Study Group; 2006; Boston, MA, USA.Google Scholar
  10. 10.
    Biedert RM. Osteotomies.Orthopade. 2008;37:872-883.PubMedCrossRefGoogle Scholar
  11. 11.
    Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height.Knee Surg Sports Traumatol Arthrosc. 2006;14:707-712.PubMedCrossRefGoogle Scholar
  12. 12.
    Biedert RM, Bachmann M. Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging.Knee Surg Sports Traumatol Arthrosc. 2009;17:1225-1230.PubMedCrossRefGoogle Scholar
  13. 13.
    Biedert RM, Gruhl C. Axial computed tomography of the patellofemoral joint with and without quadriceps contraction.Arch Orthop Trauma Surg. 1997;116:77-82.PubMedCrossRefGoogle Scholar
  14. 14.
    Biedert RM, Netzer P, Gal I, et al. The lateral condyle index: a new index for assessing the length of the lateral articular trochlea.Paper presented at: International Patellofemoral Study Group; 2006; Boston, MA, USA.PubMedCrossRefGoogle Scholar
  15. 15.
    Blackburne JS, Peel TE. A new method of measuring patellar height.J Bone Joint Surg. 1977;59-B:241-242.Google Scholar
  16. 16.
    Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome.J Pediatr Orthop. 2004;24:392-396.PubMedCrossRefGoogle Scholar
  17. 17.
    Carrillon Y, Abidi H, Dejour D, et al. Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience.Radiology. 2000;216:582-585.PubMedGoogle Scholar
  18. 18.
    Caton J, Deschamps G, Chambat P, et al. Patella infera. Apropos of 128 cases.Rev Chir Orthop Reparatrice Appar Mot. 1982;68:317-325.PubMedGoogle Scholar
  19. 19.
    Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities.Sports Med Arthrosc. 2007;15:39-46.PubMedCrossRefGoogle Scholar
  20. 20.
    Dejour D, Locatelli E. Patellar instability in adults.Surg Tech Orthop Traumatol. 2001;55:1-6.Google Scholar
  21. 21.
    Dejour H, Walch G, Neyret P, et al. Dysplasia of the femoral trochlea.Rev Chir Orthop Reparatrice Appar Mot. 1990;76:45-54.PubMedGoogle Scholar
  22. 22.
    Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study.Knee Surg Sports Traumatol Arthrosc. 1994;2:19-26.PubMedCrossRefGoogle Scholar
  23. 23.
    Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomoradigraphic analysis. In: Feagin JA Jr, ed.The Curcial Ligaments. Diagnosis and Treatment of Ligament Injuries About the Knee. New York: Churchill Livingstone; 1994:261-367.Google Scholar
  24. 24.
    Delgado ED, Schoenecker PL, Rich MM, et al. Treatment of severe torsional malalignment syndrome.J Pediatr Orthop. 1996;16:484-488.PubMedCrossRefGoogle Scholar
  25. 25.
    Diks MJF, Wymenga AB, Anderson PG. Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella.Knee Surg Sports Traumatol Arthrosc. 2003;11:384-388.PubMedCrossRefGoogle Scholar
  26. 26.
    Donell ST, Joseph G, Hing CB, et al. Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results.Knee. 2006;13:266-273.PubMedCrossRefGoogle Scholar
  27. 27.
    Feinstein WK, Noble PC, Kamaric E, et al. Anatomic alignment of the patellar groove.Clin Orthop Relat Res. 1996;331:64-73.PubMedCrossRefGoogle Scholar
  28. 28.
    Fulkerson JP, Becker GJ, Meaney JA, et al. Anteromedial tibial tubercle transfer without bone graft.Am J Sports Med. 1990;18:490-496.PubMedCrossRefGoogle Scholar
  29. 29.
    Goodfellow J, Hungerford DS, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint.J Bone Joint Surg. 1976;58-B:287-290.Google Scholar
  30. 30.
    Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane. A clinical analysis.Am J Sports Med. 1994;22:61-66.PubMedCrossRefGoogle Scholar
  31. 31.
    Grelsamer RP, Tedder JL. The lateral trochlear sign. Femoral trochlear dysplasia as seen on a lateral view roentgenograph.Clin Orthop Relat Res. 1992;281:159-162.PubMedGoogle Scholar
  32. 32.
    Heegaard J, Leyvraz PF, Curnier A, et al. The biomechanics of the human patella during passive knee flexion.J Biomech. 1995;28:1265-1279.PubMedCrossRefGoogle Scholar
  33. 33.
    Heegaard J, Leyvraz PF, Van Kampen A, et al. Influence of soft structures on patellar three-dimensional tracking.Clin Orthop Relat Res. 1994;299:235-243.PubMedGoogle Scholar
  34. 34.
    Hille E, Schulitz KP, Henrichs C, et al. Pressure and contract-surface measurements within the femoropatellar joint and their variations following lateral release.Arch Orthop Trauma Surg. 1985;104:275-282.PubMedCrossRefGoogle Scholar
  35. 35.
    Hoppenfeld S, DeBoer P.Surgical Exposures in Orthopaedics: The Anatomic Approach. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar
  36. 36.
    Insall J, Salvati E. Patella position in the normal knee joint.Radiology. 1971;101:101-104.PubMedGoogle Scholar
  37. 37.
    James SL, Bates BT, Osternig LR. Injuries to runners.Am J Sports Med. 1978;6:40-50.PubMedCrossRefGoogle Scholar
  38. 38.
    Kolowich PA, Paulos LE, Rosenberg TD, et al. Lateral release of the patella: indications and contraindications.Am J Sports Med. 1990;18:359-365.PubMedCrossRefGoogle Scholar
  39. 39.
    Lee TQ, Anzel SH, Bennett KA, et al. The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees.Clin Orthop Relat Res. 1994;302:69-74.PubMedGoogle Scholar
  40. 40.
    Lustig S, Servien E, Aït Si Selmi T, et al. Factors affecting reliability of TT-TG measurements before and after medialization: a CT scan study.Rev Chir Orthop Reparatrice Appar Mot. 2007;92:429-436.Google Scholar
  41. 41.
    Malaghem J, Maldague B. Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation.Radiology. 1989;170:507-510.Google Scholar
  42. 42.
    Masse Y. Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella.Rev Chir Orthop Reparatrice Appar Mot. 1978;64:3-17.PubMedGoogle Scholar
  43. 43.
    Müller W, Wirz D. Anatomie, Biomechanik und Dynamik des Patellofemoralgelenks. In: Wirth CJ, Rudert M, eds.Das Patellofemorale Schmerzsyndrom. Darmstadt: Steinkopff; 2000:3-19.Google Scholar
  44. 44.
    Pagenstert GI, Bachmann M. Klinische Untersuchung bei patellofemoralen Problemen.Orthopade. 2008;37:890-903.PubMedCrossRefGoogle Scholar
  45. 45.
    Percy EC, Strother RT. Patellalgia.Physician Sportsmed. 1985;13:43-59.Google Scholar
  46. 46.
    Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance: a comparative study between CT and MRI scanning.Knee. 2006;13(1):26-31.PubMedCrossRefGoogle Scholar
  47. 47.
    Schoettle PB, Zanetti M, Seifert B, et al. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning.Knee. 2006;13:26-31.PubMedCrossRefGoogle Scholar
  48. 48.
    Scuderi GR. Surgical treatment for patellar instability.Orthop Clin North Am. 1992;23:619-630.PubMedGoogle Scholar
  49. 49.
    Seil R, Muller B, Georg T, et al. Reliability and interobserver variability in radiological patellar height ratios.Knee Surg Sports Traumatol Arthrosc. 2000;8:231-236.PubMedCrossRefGoogle Scholar
  50. 50.
    Servien E, Neyret P, Si Selmi TA, et al. Radiographs. In: Biedert RM, ed.Patellofemoral Disorders: Diagnosis and Treatment. New York: Wiley; 2004:87-100.Google Scholar
  51. 51.
    Tecklenburg K, Dejour D, Hoser C, et al. Bony and cartilaginous anatomy of the patellofemoral joint.Knee Surg Sports Traumatol Arthrosc. 2006;14:235-240.PubMedCrossRefGoogle Scholar
  52. 52.
    van Huyssteen AL, Hendrix MR, Barnett AJ, et al. Cartilage-bone mismatch in the dysplastic trochlea. An MRI study.J Bone Joint Surg. 2006;88-B:688-691.CrossRefGoogle Scholar
  53. 53.
    van Kampen A, Huiskes R. The three-dimensional tracking pattern of the human patella.J Orthop Res. 1990;8:372-382.PubMedCrossRefGoogle Scholar
  54. 54.
    Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea.Knee Surg Sports Traumatol Arthrosc. 2005;13:529-533.PubMedCrossRefGoogle Scholar
  55. 55.
    Von Knoch E, Böhm T, Bürgi ML, et al. Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia.J Bone Joint Surg Br. 2006;88-B:1331-1335.CrossRefGoogle Scholar
  56. 56.
    Wagenaar F, Koeter S, Anderson P, et al. Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation.Knee. 2007;14:51-54.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Sportclinic Villa Linde, Swiss Olympic Medical Center Magglingen-BielUniversity of BaselBielSwitzerland

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