The document compares clinical outcomes of two tibial tubercle transposition techniques, anteromedialization (Fulkerson) and distomedialization (Dejour), in patients with symptomatic patellofemoral joint malalignment. It involved a retrospective review of 42 patients, with outcomes showing overlapping effectiveness between the two methods despite differences in surgical approaches. The findings indicate that while the procedures are effective, tailoring them to individual patient anatomy is crucial for optimal results.

1. Tibial tubercle transposition in treatment of
patellofemoral malalignment:
anteromedialization versus distomedialization.
Clinical and functional outcome comparison.
Dei Giudici L, Enea D, Fravisini M, Canè PP, Gigante A

2. DISCLOSURE
None of the Authors have conflict of
interest to declare

3. BACKGROUND
Patello femoral malalignment can be:
 Static:
 Alteration of passive joint stabilizers
 Trochlear dysplasia
 Increased TTTG
 Increased femoral and/or tibial torsion
 Valgus / Varus Knee
 Dynamic:
 Umbalanced muscular forces

4. BACKGROUND
Patello femoral malalignment
Altered load and pressure distribution on chondral surface
Chondral degeneration – anterior knee pain – impaired function
Dislocations and subluxations

5. BACKGROUND
Symptomatic patello femoral malalignment = surgical correction of the cause
- Altered TTTG
- Patella Alta
Tibial tubercle
transposition
Elmslie-Trillat Fulkerson
Hauser
Maquet
?No
gold
standard

6. METHODS
 AIM: compare clinical mid termt outcomes of two standardized transposition
(Fulkerson: antero-medialization – Dejour: disto-medialization) in patients with
symptomatic PFJ malalignment
 DESIGN: retrospective review of cases referred to 2 distinct centers
 INCLUSION
 Symptomatic unilateral condition
 Minimum 6 months of
conservative treatment
 TTTG > 20 mm on CT scan
 Signed informed consent
 EXCLUSION
 Age <17 yo
 Other intrarticular disorders
 Previous knee surgeries
 Reumathic and infective dieseases
 Uncompleted record files

7. METHODS
 GROUP A: Fulkerson Osteotomy – 0,9mm medialization + 0,5mm
anteriorization
 GROUP B: Dejour Osteotomy – 10mm distalization + 0,7mm distalization
 Lateral release always associated
 Standardized rehab program
 Assessment of demographic, clinical, and functional data
 Statistical analysis:
 Wilcoxon test
 Parametric t-test
Min follow up : 6 years

8. RESULTS
 42 reviewed patients
 Group A:
 16 patient (6M, 10F)
 Age: 36 yo
 9 experienced dislocations
 Group B:
 26 patient (5M, 21F)
 Age: 33 yo
 22 experienced dislocations

9. RESULTS
0
10
20
30
40
50
60
70
80
90
Pre grpA Follow Up grpA Pre grpB Follow Up grpB
NRS Kujala Tegner

10. RESULTS
GROUP A PRE-OP FOLLOW-
UP
NRS 7,1 (sd 0,69) 2,9 (sd 2,3)
KUJALA 46,3 (sd 7,8) 91,1 (sd 3,8)
TEGNER 4,1 (sd 1,6) 3 (sd 1)
P<0.001
GROUP A PRE-OP FOLLOW-
UP
NRS 7,4 (sd 1,74) 2,5 (sd1,9)
KUJALA 50,5 (sd
21,5)
74,2 (sd
23,4)
TEGNER 4,4 (sd 1,6) 2,4 (sd 0,88)
GROUP B PRE-OP FOLLOW-
UP
NRS 5,75 (sd 2,6) 3,75 (sd 3,1)
KUJALA 60,5 (sd
17,5)
78 (sd 13,2)
TEGNER 4,2 (sd 0,5) 3,75 (sd
1,76)
GROUP B PRE-OP FOLLOW-
UP
NRS 7,6 (sd 1,74) 1,9 (sd2,9)
KUJALA 55,8 (sd
14,1)
89,7 (sd
9,44)
TEGNER 4,8 (sd 2,2) 4,6 (sd 0,88)
PATIENTS WITH INSTABILITY PATIENTS W/O INSTABILITY

11. CONCLUSIONS
 Outcome overlapping for anteromedialization and
distomedialization
 Patients with stable PFJ have a limited effect from a distalization
surgerie. It should be associated to other surgical concomitant
procedures
 The lack of significant differences between group A and B, despite
the good outcomes obtained at the final follow up, can be
explained by the unloading of the articular cartilage
 The «perfect transposition» requires an extensive pre-op planning,
and should be tailored on the individual patient

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