Tibial Tubercle Anteriorization and Distalization Using the Multi-Directional Tibial Tubercle Transfer (MD3T) System

作者：Ran Atzmon, Adam Wadsworth, Anna Bartsch, Kinsley Pierre, Begum Topkarci, Aimee Steen, Monica S. Vel, Seth L. Sherman · 发表于：Video Journal of Sports Medicine · 年份：2025 · DOI：10.1177/26350254251342812 · 被引用次数：3 · 研究领域：Lower Extremity Biomechanics and Pathologies、Total Knee Arthroplasty Outcomes、Osteoarthritis Treatment and Mechanisms

Background: Tibial tubercle osteotomy (TTO) is a well-established procedure that improves patella-trochlea contact area and reduces aberrant forces causing maltracking or compression of the patellofemoral joint (PFJ). Contemporary TTO surgery often involves anteriorization, medialization, distalization, or combinations like anteromedialization (AMZ). The classic Fulkerson AMZ is a time-tested standard, but the technique does not allow for isolated planar adjustments such as straight anteriorization and may not be viable for subsets of patients with medial patellofemoral cartilage lesions due to the resultant medial shift of contact forces. The Multi-Directional Tibial Tubercle Transfer (MD3T) system enhances TTO precision and modularity, enabling customizable realignments. Indications: Anteriorization-type TTO reduces PFJ compression and addresses pathologies such as focal chondral defects, patellofemoral pain, maltracking, and instability. Distalization-type TTO corrects patella alta in patients with a Caton-Deschamps Index ≥1.2. However, distal displacement of the tubercle can increase compressive forces in the PFJ; thus, care must be taken to avoid overcorrection and resultant overloading of the articulating surfaces. The MD3T system supports both anteriorization and distalization, ensuring controlled corrections. Technique Description: The MD3T employs a proprietary wedge system for precise uniplanar or multiplanar corrections during TTO. For uniplanar adjustments, a sing...