The Effect of a Tibial-Tubercle Transplant in Children on the Growth of the Upper Tibial Epiphysis

¹ St. Luke's Hospital, New York, and The House of St. Giles the Cripple, Brooklyn

Distal and medial transplantation of the tibial tubercle was performed twenty-four times in fifteen children who were in their eleventh year or younger.

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A follow-up study two to eleven years after operation revealed the following data:

The distally displaced patella, with but minor variations, tended to remain in the same position relative to the knee joint as growth continued; the articular surface of the transplanted patella showed some evidence of being remodeled to conform to the shape of the articular surfaces of the underlying femur and tibia;

The tibial tubercle failed to develop in either the normal or transplanted positions;

The attachment of the patellar tendon remained in its normal position as growth continued, migrating upward as the tibia increased in length; there was no evidence that the patellar tendon lengthened, except to the extent expected with normal growth;

With growth in length of the tibia, the epiphysis and metaphysis moved away from the plate and screws that had been used to fix the transplanted tibial tubercle. As a result, the plate and screws were found to be located on the diaphysis at follow-up;

With the technique employed, disturbance of growth of the proximal end of the tibia occurred in only one case—that in which a recurvatum deformity of sufficient severity developed to require corrective osteotomy;

The growth and development of the proximal tibial epiphysis and knee joint were not affected in any of the patients in these cases.

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