Distal realignment procedures are those surgical procedures performed below the kneecap in an attempt to better align it with the groove of the underlying femur bone.
Page updated April 2024 by Dr Sheila Strover (Clinical Editor)
For what problems is distal realignment indicated?
Distal realignment may be performed for recurrent patellar instability, such as recurrent subluxation or dislocation.
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Quote from peer-reviewed paper:
"....distomedial...tibial tubercle transfer....led to clinically relevant functional improvement and pain reduction in patients with patellar maltracking and patella alta without instability...."
Citation: Bayoumi T, van Duijvenbode DC, Benner JL, Boerma-Argelo KDS, Stavenuiter MHJ, van der List JP. Clinical Improvement Is Achieved Following Tibial Tubercle Distomedialization for Patellar Maltracking and Patella Alta Without Instability. Arthrosc Sports Med Rehabil. 2021 Jun 15;3(3):e845-e853. doi: 10.1016/j.asmr.2021.01.027. PMID: 34195653; PMCID: PMC8220615.
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Quote from peer-reviewed paper:
"....regardless of the type of medialization procedure employed, over- and undercorrection must be avoided...."
Citation: Lavery M, Bell J, Rickelman T, Boezaart A, Albright JP. Patellofemoral realignment: dynamic intraoperative assessment. Iowa Orthop J. 2005;25:160-3. PMID: 16089091; PMCID: PMC1888761.
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Quote from peer-reviewed paper:
"....However, the....[removal of hardware]....rate was high (72%)"
Citation: Bayoumi T, van Duijvenbode DC, Benner JL, Boerma-Argelo KDS, Stavenuiter MHJ, van der List JP. Clinical Improvement Is Achieved Following Tibial Tubercle Distomedialization for Patellar Maltracking and Patella Alta Without Instability. Arthrosc Sports Med Rehabil. 2021 Jun 15;3(3):e845-e853. doi: 10.1016/j.asmr.2021.01.027. PMID: 34195653; PMCID: PMC8220615.
What are the various distal realignment procedures?
The various procedures have evolved over the years and include -
Relevance of the TT-TG distance
To assess how far the tibial tubercle and the trochlear groove are out of alignment, the surgeon will use scan pictures to calculate the TT-TG distance, and use this as a guide for correction.