Effect of medial displacement of the tibial tubercle on patellar position after rotational malposition of the femoral component in total knee arthroplasty

A large Q angle induced by technical error such as an internally related femoral component causes patellar failure after total knee arthroplasty. The effect of medial displacement of the tibial tubercle to decrease the Q angle for patellar tracking was studied by evaluating the patellar position relative to the patellar groove on the femoral component in cadaver specimens. A 5 degrees internally related femoral component caused the patella to shift medially about 5 mm and also caused the tibia to rotate internally about 3 degrees at full extension. With a 5 degrees externally rotated femoral component, normal patellar tracking occurred. The distance of medial displacement was determined so that the patellar tendon was parallel to the longitudinal axis of the tibia al full extension. This allowed the quadriceps tendon, the patella, and the patellar tendon to form a straight line. The average distance of medial transposition of the tibial tubercle was 9.32 mm. Medialization of the tibial tubercle caused the patella to shift about 2 mm medially from the patellar groove. The transfer also caused an external rotation of the tibia (2 degrees-5 degrees). Medial transfer of the tibial tubercle changes patellar kinematics and corrects the tendency toward lateral patellar dislocation caused by internally rotating the femoral component; however, it also creates minor patellar and tibial kinematic changes that may have a clinical effect.