Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome

Recurrent patella subluxation may be secondary to excessive external tibial torsion. The purpose of this study is to evaluate the clinical and radiographic outcome of patients undergoing tibial derotation osteotomy and tibial tuberosity transfer for recurrent patella subluxation in association with excessive external tibial torsion. A combined tibial derotation osteotomy and tibial tuberosity transfer was performed in 15 knees (12 patients) with recurrent patella subluxation secondary to excessive external tibial torsion. Clinical evaluation was carried out using preoperative and post-operative Knee Society Score (KSS), Kujala Patellofemoral score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the short form-12 (SF-12) and a visual analogue score (VAS) pain scale. The median follow-up period was 84 months (range 15-156) and median patient age was 34 years (range 19-57 years). The median preoperative external tibial torsion was 62A degrees (range 55A degrees-70A degrees), with a median rotational correction of 36A degrees (range 30A degrees-45A degrees) after surgery. Significant improvement (p < 0.05) was found in the KSS part I (37 +/- A 14 to 89 +/- A 11 points), KSS part II (25 +/- A 26 to 85 +/- A 14 points), Kujala score, the SF-12 outcome, WOMAC score and VAS score (8.8 +/- A 1.9 to 2.4 +/- A 1.5). Two patients had a nonunion of the tibial osteotomy site; one patient required bone grafting, while another patient required revision to total knee arthroplasty. Patients presenting with recurrent patella subluxation secondary to excessive external tibial torsion > 45A degrees who underwent tibial derotation osteotomy and tibial tuberosity transfer achieved a satisfactory outcome in terms of pain relief and improved function. A significant complication was seen in 2/15 patients. Case series, Level IV.