How tibial tubercle torsion impacts patellar stability: A biomechanics study.

Abstract Introduction A new factor for patellofemoral instability–external torsion of the tibial tubercle–has recently been described. The primary aim of this biomechanics study was to analyze the consequences of internal torsion tibial tubercle osteotomy (TTO) on an experimentally unstable patella. We hypothesized that internal TTO can stabilize an experimental patellar instability. Materials and Methods This in vitro study was conducted on six fresh anatomical specimens. The knees were flexed to 25°. The patella was destabilized by transecting the patellar retinaculae and the vastus medialis tendon and by applying continuous oblique traction on the quadriceps tendon. A 3D stereovision system was used to record patellar displacement and tilt and to determine whether patellar dislocation occurred. The measurements were done before the osteotomy then repeated on the same knee after a triangular internal torsion 30° TTO was completed, without medialization. Results There was a significant difference in the patellar displacement and tilt before and after the osteotomy (p  Discussion Internal torsion of the tibial tubercle improves patellar stability, confirming our hypothesis. These findings confirm the stabilizing effect of placing the tibial tuberosity in internal torsion. Although a knee without instability factors is not the perfect model for patellar instability, our findings suggest that tibial tubercle torsion influences patellar stability. Internal TTO may be justified as a surgical treatment of patellofemoral instability.