Anterior tibial tubercle elevation in the young adult.

A modification of Maquet's procedure, longitudinal proximal tibial osteotomy, was performed on 36 adults under the age of 40. The tibial tubercle was elevated between 2.0 and 2.5 cm. Fourteen were operated on for significant osteochondral injury to the underside of the patella, including patellar fracture; 16 were operated on because of osteoarthrotic change in the patellofemoral joint secondary to recurrent subluxation. Six were operated on because of pain persisting after previous patellectomy. Follow-up ranged between 2 and 5 years, was at least 2 years, and averaged 3.53 years. A good result was determined to be one in which the patient had no pain requiring medication or activity limitation; a poor result was designated when the patient had pain requiring medication or activity limitation. The success rate among the trauma or fracture group was 94 per cent, among the subluxation group 88 per cent, and among the postpatellectomy group 66 per cent. Failures included unrecognized osteoarthrosis of the tibiofemoral joint, psychiatric problems, a reflex sympathetic dystrophy, a compensation neurosis, a failure to correct excessive knee valgus with recurrent subluxation, and a fall displacing the operation. Serious complications, osteomyelitis and a displaced graft resulting from a postoperative fall, occurred at a rate of 5 per cent; minor complications, tenuous skin healing and tibial tubercle shingle fractures, occurred at a rate of 19 per cent. This operation is indicated only for patients with osteoarthrosis of the patellofemoral joint and is contraindicated in the presence of tibiofemoral osteoarthrosis. High success rates are attributed to careful attention to indications and contraindications and to the design and details of performing the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)