Elevation of the patellar tendon by means of displacement of the tibial
tubercle has been advocated by Maquet, Ficat and Hungerford, and Murray as
an alternative to patellectomy for the treatment of patellofemoral
arthralgias. Although tubercle elevation certainly reduces the over-all
patellofemoral contact force, its effects on the complex local patterns of
contact stress are of more direct significance. In a laboratory series
using fresh amputation material, arrays of six miniature contact stress
sensors were embedded in the retropatellar cartilage of knees subjected to
isometric quadriceps-extension forces. The experimental data revealed that
elevation of the patellar tendon generally afforded relief of local contact
stress regardless of the joint configuration (zero degrees, 45 degrees, or
90 degrees of flexion), but that its effects were most pronounced at 90
degrees of flexion. Progressive increase in the tendon elevation caused
progressive reduction in the contact stress. Most of the contact stress
relief was achieved, however, with the first one-half inch of tendon
elevation; further elevations to one and one and one-half inches were only
marginally useful. In view of the increased superior patellar pole contact
associated with distal pole flotation, the results indicate that under most
circumstances the optimum amount of elevation of the tibial tubercle is
about one-half inch.