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How the Elmslie-Trillat procedure has been used in Europe or US?
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Pavlov (1990) reported 84% good results
declining to 70% after 30 months with an
anteromedialisation of the tuberosity with a
correlation with the cartilage status. Conti
et al.
(1992) found 87% good subjective results after
the ET procedure. Aglietti
et al.
(1994) reported
good results with tuberosity transfer with and
without soft tissue correction. Koskinen found
better results after an ET procedure compared
to a Roux-Goldwaith (1998). Kruger
et al.
(1999) found 70% good results after the ET
procedure.
Kumar
et al.
(2000) reported 61% good results
with better outcome for instability patients.
Diks
et al.
(2003) found 85% good results with
CT guided tuberosity transfer, patients with an
objective lateral tracking patella had better pain
relief. Marcacci
et al.
(2004) reported about a
variant with a medial slip of the patellar tendon
tenodesed on the anteromedial side of the tibia
inadjunct to the normal ET procedure in cases
where a simple ET operation does not restore
patella tracking. Kataraglis
et al.
(2006) found
in the 73% good results in patients with anterior
knee pain or instability with better results for
the instability group. Koeter
et al.
(2007) found
the good results in a prospective study with a
self-aligning tuberosity technique in flexion of
the knee for correct positioning of the tuberosity.
The average pain reduction was 5 points on a
10 points pain score. Endres and Wilke (2011)
round excellent results in 16 of 18 patients after
10 years an reported no progressive arthritic
changes at follow-up interestingly.
The US approach around the tuberosity started
with Goldtwaith (1904) who developed a
technique with medialisation of a lateral slip of
the patellar tendon sutured to the medial capsule
but this technique became not very popular.
Later a lot of enthusiasm for the Hauser
operation came up but MacNab et al reported in
1954 arthritic changes after this procedure.
Hughston (1979) reported about his subtle
tuberosity medialisation similar to the Elmslie-
Trillat of around 5mm in combination with a
medial soft tissue procedure and found over a
25 year period 70% good results. Brown in
1984 81% good results with an average of
10 mm medialisation at 42 months of follow-
up, they found a correlation with the q-angle
and undercorrection resulted in less good
results. Fulkerson in 1983 reported a variant of
the ET procedure with an anteromedialisation
of the tuberosity with an oblique osteotomy
simulating the effects of both the ET procedure
and the Maquet operation with ventralisation
of the patellar tendon.
Despite these developments the proximal
realignment remained relatively more popular
in the US. Later in 1994 Shelbourne reported
the ET procedure being effective in treating
patella instability and maltracking by reducing
the abnormal patellar congruence angle.
Crosby and Insall in 1976 also reported arthritic
changes after tuberosity transfer and found 20%
recurrent instability and the arthritic changes
were not seen after soft tissue procedures.
Carney
et al.
(2005) reported a 26 year follow-
up after ET procedures and found 7% recurrent
dislocation rate and a decline from 73% good
results after 3 years to 54% good results after
26 years. Barber
et al.
(2008) found a 91%
succesrate in eliminating instability and a
satisfaction rate of 8 out of 10 points after an
average of 8 years follow-up.
Cosgarea
et al.
(1999) found in biomechanical
analysis failure to fracture at a lower load in the
Fulkerson osteotomy techniques and recom
mend protected weight bearing after surgery.
Ramappa
et al.
(2006) found in lab tests similar
effects of both techniques on correction of
abnormal patella tracking and pressures but the
medialisation was more effective in reducing
lateral facet pressures.
In recent review paper from Amis (2007) the
strong biomechanical effect of the ET procedure
has well been described and the operation should
be performed with care not to overmedialise
since this can easily cause too high medial
pressures. However the medial soft tissues also
play in concert with the lateral side an important
role in guiding the patella in the trochlea in
combination with the muscles. Future
development of a comprehensive approach to
analyse all the pathology of the patellofemoral