Tibial Tuberosity

Surgical access to cancellous bone in the proximal base of the tibia can be obtained from the lateral surface of the bone with vertical skin incision running along the medial edge of anterior tibialis muscle below the tibial tuberosity [11] and via medial access through a skin incision running 2 cm below and 2 cm medially from tibial tuberosity [5]. The author of this chapter prefers medial access due to a lower number of described complications of this procedure. The medial surface of the tibia is located in this area directly under the skin. Access to the bone is obtained by an incision... 

Fig. 15.1 Locations of the three portals and landmarks on the right knee joint for ACL reconstruction using the far anteromedial portal technique. AL anterolateral portal, AM anteromedial portal, FAM far anteromedial portal, FT patellar tendon, IFF inferior pole of the patella, UL lateral joint line, MJL medial joint line, 7T tibial tuberosity...

On the tibial side, we make a small incision 1 cm medial of the tibial tuberosity. In the joint, the tip of a drill guide is placed just behind the Parsons knob, slightly medial from the center of the ACL footprint. This position corresponds to the anatomical AMB in adults. A guide wire of approximately 2.4 mm in diameter is introduced through the physis. The appropriate positioning of the guide wire should... 

Fig. 2.5a,b. AP knee. Centre Midway between the femoral condyles the child s finger s width helow the inferior aspect of the patella. Area imaged The full width of the joint, including the whole of the patella and the proximal portion of the tibial tuberosity... 

The area imaged should include the whole of the patella and the proximal portion of the tibial tuberosity. 

Fig. 7.37a,b. Variation in appearance of the tibial tuberosity in two normal 11-year-old boys... 

Ogden JA (1984) Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skeletal Radiol 11 246-257... 

Tibial tuberosity 7-15 years 7-15 years 19 years 19 years ... 

The quadriceps muscle attaches to the patella via the quadriceps tendon and the retinaculum medially and laterally. They are attached to the tibial tuberosity distally via the patella tendon. They are therefore integral to the stability of the patellofemoral joint. 

Fig. 14.9. Classification of tibial tuberosity avulsion injuries 1A,1B, separation of the distal portion of the physis 2A,2By the separation involves the ossification centres of the tibial tubercles and tibial epiphysis 3A,3B, fracture/separation of the entire tubercle. In addition, there may be fracturing through the avulsed fragment (type B)...

Fig. 14.10. Radiographs showing a type 3A tibial tuberosity fracture...

The knee should be palpated and landmarks identified. Swelling may be palpated medial, inferior, or lateral to the patella or in the popliteal fossa. Tenderness detected during palpation may indicate the location of the source of pain, such as over the tibial tuberosity in the case of Os-good-Schlatter disease. 

The patient was directed by a family member to attempt osteopathic manipulative treatment There was weakness of two out of five of the extensor hallucis muscles of both feel, and the left leg was dusky and had a +2 pilling edema extending to ihe tibial tuberosity. The patient had lost all of ihe hair from his legs below ihe patellae. Pulses were difficult to appreciate at times. 

Electrode placement was preceded by palpation and visual inspection of each of the muscles. The positions of the electrodes are as given in Table 1. A ground electrode was placed on the tibial tuberosity. Electrode placement at a particular site was verified to be proper by inspection of the EEG signal output when a subject was asked to voluntarily moved the respective muscle. 

From the anatomic point of view, the subcutaneous prepatellar bursa is located anterior to the lower half of the patella and the proximal patellar tendon, just deep to the skin. More caudally, the superficial infrapatellar bursa is located between the tibial tuberosity and the skin. The deep infrapatellar bursa lies between the deep boundary of the distal patellar tendon and the anterior aspect of the tibia. The anserine bursa intervenes between the superficial... 

Fig. 19.22a-c. Osgood-Schlatter disease, a Extended field-of-view longitudinal 12-5 MHz US image of the patellar tendon (arrowheads) in a 15-year-old adolescent with focal tenderness and chronic pain over the tibial tuberosity reveals a swollen and hypoechoic distal patellar tendon (asterisks) associated with bony irregularities and fragmentation (arrows) of the anterior tibial surface. P, patella. b,c Correlative color Doppler 12-5 MHz US images reveal a hypervascular pattern (arrows) within the intratendinous focal hypoechoic areas of the distal patellar tendon... 

Fig. 19.28a-c. Minimally displaced fracture the double cortical sign , a Longitudinal 12-5 MHz US image with b schematic drawing correlation in a 14-year-old sprinter with a recent acute traction trauma and pain over the tibial tuberosity shows a thickened patellar tendon (arrowheads) associated with elevation and fragmentation of the cortical bone of the tibial tuberosity forming two hyperechoic layers (arrows) instead of one. This appearance indicates minimally displaced cortical avulsion. Note the cartilage layer (asterisks) interposed between the tendon and the bone, c Normal contralateral side for comparison... 

Four fingerbreadths below the tibial tuberosity (TT) and one finger-breadth lateral to the tibial crest. 

One handbreadth distal to the tibial tuberosity (TT) and one finger-breadth off the medial edge of the tibia. The electrode is directed obliquely through the soleus and flexor digitorum longus, just posterior to the tibia. 

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