Computational simulation of medial versus anteromedial tibial tuberosity transfer for patellar instability

John J. Elias, Kerwyn C. Jones, Andrew J. Copa, Andrew J. Cosgarea

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


The study utilizes dynamic simulation of knee function to determine how tibial tuberosity medialization and anteromedialization influence patellar tracking and contact pressures for knees with patellar instability. Dual limb squatting was simulated with six multibody dynamic simulation models representing knees being treated for patellar instability. Each knee exhibited lateral patellar maltracking in the pre-operative condition based on the bisect offset index. The patellar tendon attachment points on the tibia were medialized by 10 mm to represent tibial tuberosity medialization, with an additional 5 mm of anteriorization applied for anteromedialization. The patellofemoral contact pressure distribution was quantified using discrete element analysis. Data were analyzed with repeated measures analysis of variance with post-hoc tests and linear regressions. Tibial tuberosity medialization and anteromedialization significantly (p < 0.05) decreased the bisect offset index for nearly all flexion angles up to 80°, with the largest changes near full extension. Both procedures significantly decreased the maximum lateral pressure at 55°, but increased the maximum medial pressure from 30 to 80°. The pre-operative to post-operative increase in the maximum contact pressure was significantly correlated with the maximum pre-operative bisect offset index for tuberosity medialization (r2 = 0.84), but not for anteromedialization. Statement of Clinical Significance: The results indicate tibial tuberosity medialization decreases patellar lateral maltracking and lateral patellofemoral contact pressures, but increases medial contact pressures. When pre-operative patellar maltracking is relatively low, tibial tuberosity medialization is likely to increase maximum contact pressures. Tibial tuberosity anteromedialization lowers the risk of elevated post-operative contact pressures compared to medialization.

Original languageEnglish (US)
Pages (from-to)3231-3238
Number of pages8
JournalJournal of Orthopaedic Research
Issue number12
StatePublished - Dec 2018


  • cartilage pressure
  • patellar instability
  • patellar tracking
  • tibial tuberosity anteromedialization
  • tibial tuberosity medialization

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


Dive into the research topics of 'Computational simulation of medial versus anteromedial tibial tuberosity transfer for patellar instability'. Together they form a unique fingerprint.

Cite this