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Tibial Tubercle

Published in N°012 - July / August 2021
Article viewed 56 times

Tibial Tubercle "Crest" Osteotomy (TCO) a modification of the classical Tibial Tubercle Osteotomy allows safe and easy extensile knee exposure

By Umar BJ Yousuf & Rhidian L Morgan-Jones in category UPDATE
Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, United Kingdom / [email protected]

There is an increasing demand for revision total knee arthroplasty. Exposure is a critical operative step and can be difficult; struggling for exposure impacts the workflow of the surgery and may lead to prolonged operating time.

Introduction

There is an increasing demand for revision total knee arthroplasty [1]. Exposure is a critical operative step and can be difficult; struggling for exposure impacts the workflow of the surgery and may lead to prolonged operating time. Faced with these challenges of rising demand and complexity of revision surgery, the arthroplasty surgeon must be equipped with the necessary knowledge and skill to employ safe and reproducible techniques in order to achieve satisfactory patient outcomes. We describe the method of tibial tubercle ‘crest’ osteotomy (TCO) as developed and used in our institution routinely by the senior author in revision knee arthroplasty. The TCO represents a modification of the classical TTO described by Whiteside long time ago [8].

The ideal extensile approach should ensure the integrity of the extensor mechanism, safe explantation/ implantation, simple postoperative protocol and speedy recovery [2]. Adequate exposure can be achieved through either proximal soft tissue or distal boney procedures. Soft tissue procedures are associated with patella tendon avulsion and marked extensor lag [3]. We believe that proximal soft tissue procedures are a poor choice with significant implications for healing, function and outcome and we find the distally based...

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