High incidence of complication following tibial tubercle surgery

Lundeen, Anna; Macalena, Jeffrey A.; Agel, Julie; Arendt, Elizabeth A.

doi:10.1016/j.jisako.2022.11.005

Cited by 13 publications

(15 citation statements)

References 36 publications

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“…The results of this study highlight the safety of TTO-D and differ from the findings in previous literature, which have shown that TTO-D had a complication rate ranging from 15% to 58%, and a complication rate ranging from 7% to 36% when excluding hardware removal as a complication. 18,24,32,39 The findings in this study regarding the safety of distalization relative to TTO-ND are similar to those in a recent study that found no significant differences between TTO-ND and TTO-D. 24 Similar to the study by Lundeen et al, 24 the postoperative management was conservative with a slow progression to weightbearing.…”

Section: Discussionsupporting

confidence: 88%

“…Past literature reports the rate of TTO arthrofibrosis as between 2.8% and 22%. 24,27,35,40 This study has a rate of arthrofibrosis of 4.2%. No difference was observed for arthrofibrosis between TTO-D and TTO-ND cohorts ( P = .452).…”

Section: Discussionmentioning

confidence: 94%

“…This may be related to the necessity of fully detaching the shingle during TTO-D, potentially leading to compromised local vascularity and periosteum, and increased mechanical stress at the attachment site of the transferred tubercle. 18,19,24,30,32,39 The purpose of this study was to (1) compare complication rates after TTO and TTO-D with the complication rates previously reported in the literature and (2) identify patient and surgical characteristics and risk factors associated with postoperative complications.…”

mentioning

confidence: 99%

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Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization

Shah,

Uppstrom,

Rizy

et al. 2024

Am J Sports Med

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Background: Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patellofemoral instability and pain. TTO with distalization (TTO-D) is indicated for patients with patellofemoral instability, patellar malalignment, and patella alta. The current literature demonstrates several complications that may be associated with TTO, with reportedly higher rates of complications associated with TTO-D. Purpose: To analyze and compare complication rates after TTO without distalization (TTO-ND) and TTO-D and assess risk factors associated with complications. Study Design: Cohort study; Level of evidence, 3. Methods: All skeletally mature patients who underwent TTO with or without distalization by a single surgeon between September 2014 and May 2023 with a minimum of 6 months of clinical follow-up were retrospectively reviewed. Patient factors, surgical indications, perioperative data, and complications were collected via a retrospective review of electronic medical records. Concomitant procedures were categorized as intra-articular, extra-articular, and osteotomies. Results: A total of 251 TTOs (117 TTO-D, 134 TTO-ND) were included in the study group. Postoperative complications were observed in 15 operations (6%), with arthrofibrosis as the most common complication (10 operations [4%]). TTO-D and TTO-ND had similar rates of complication (5% vs 7%; P = .793). Clinical nonunion was observed in 3 operations (3%) in the TTO-D cohort and 1 operation (1%) in the TTO-ND cohort. In the TTO-D cohort, concomitant intra-articular procedures were significantly associated with an increased likelihood of complications in a univariate model. In the TTO-ND cohort, an increased tourniquet time was significantly associated with an increased likelihood of complications in a univariate model. For all TTOs as well as the TTO-D and TTO-ND cohorts, there were no significant associations between patient or surgical variables in a multivariate model. Conclusion: TTO with and without distalization is a safe procedure with low rates of complication. TTO-D was not associated with a higher rate of complications compared with TTO-ND. There was no association between complications and surgical variables for TTO procedures.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization

Shah,

Uppstrom,

Rizy

et al. 2024

Am J Sports Med

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“…6 A recent publication from Dr. Arendt evaluating 150 patients undergoing ATT osteotomy reported major complications in 21.5% of cases and minor complications in 8%. 7 It is worth mentioning that these percentages are highly variable in the literature because of the lack of a clear objective definition of complications in ATT OTTs.…”

Section: Introductionmentioning

confidence: 99%

Fractura tibial secundaria a osteotomía de la tuberosidad anterior de la tibia: Reporte de tres casos y revisión de la literatura

Figueroa,

Isla,

Ithriago

et al. 2023

Revista Chilena de Ortopedia y Traumatología

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ResumenExisten múltiples opciones de tratamiento al momento de enfrentarnos al amplio espectro de la patología patelofemoral. Dentro de las patologías más frecuentemente encontradas están la inestabilidad y artrosis patelofemoral. Se han descrito distintos tipos de tratamiento, siendo especialmente relevantes los procedimientos de realineamiento distal. Estas técnicas son efectivas en la mayoría de los casos, pero no están exentas de complicaciones, reportándose en hasta un tercio de los casos.A continuación presentamos tres casos donde se realizó una osteotomía de la tuberosidad anterior de la tibia como herramienta terapéutica para 2 patologías distintas, en todos los casos se reportó una fractura tibial a nivel de la osteotomía, complicación infrecuente pero que puede tener graves consecuencias en el pronóstico de nuestros pacientes.

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“…Although distalization TTO has been associated with improvements in radiographic parameters and patient reported outcomes, concerns regarding increased rate of complications have been reported [10, 14–16, 19–21, 23]. Importantly, distalization TTO, unlike other TTOs, requires complete detachment of the osteotomy fragment for mobilization, disrupting the distal hinge, which has been postulated as a rationale for higher rates of bony complications [10, 19].…”

Section: Introductionmentioning

confidence: 99%

Proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy

Uppstrom

Cash

Jahandar

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The purpose of this study was to quantify diferences in mechanical stability of a wedge-shaped distalization tibial tubercle osteotomy (TTO) with a standard technique, versus a modiied technique with use of a proximal bone block and distally angled screw trajectory. Methods Ten fresh-frozen cadaver lower extremity specimens (ive matched pairs) were utilized. Within each specimen pair, one specimen was randomly assigned to undergo a standard distalization osteotomy ixed with two bicortical 4.5-mm screws oriented perpendicular to the long axis of the tibia, and the other to undergo a distalization osteotomy with modiied ixation utilizing a proximal bone block and distally angled screw trajectory. Each specimen's patella and tibia were mounted on a servo-hydraulic load frame using custom ixtures (MTS Instron). The patellar tendon was dynamically loaded to 400 N at a rate of 200 N/second for 500 cycles. Following the cyclic loading, loading to failure was done at 25 mm/min. ResultsThe modiied distalization TTO technique demonstrated signiicantly higher average load to failure compared to the standard distalization TTO technique (1339 N vs. 844.1 N, p < 0.001). Average maximum tibial tubercle displacement during cyclic loading was signiicantly smaller in the modiied TTO technique group compared to the standard TTO technique (1.1 mm vs. 4.7 mm, p < 0.001). Conclusion This study demonstrates that distalization TTO utilizing a modiied technique with a proximal bone block and distally aimed screws is biomechanically superior to standard distalization TTO without proximal bone block and screw trajectory perpendicular to the long axis of the tibia. This increased stability may aid in reducing the reported higher complication rates (including loss of ixation, delayed union and nonunion) following distalization TTO, although future clinical outcome studies are warranted.

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High incidence of complication following tibial tubercle surgery

Cited by 13 publications

References 36 publications

Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization

Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization

Fractura tibial secundaria a osteotomía de la tuberosidad anterior de la tibia: Reporte de tres casos y revisión de la literatura

Proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy

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