Treatment of patellofemoral chondropathy with the Bandi tibial tubercle osteotomy

Valenzuela, Luis Francisco Labé; Nemtala, Fernando; Orrego, Mario; Mardones, Rodrigo; Matas, Josep; Sudy, Hernán; Durruty, J.

doi:10.1016/j.knee.2010.03.007

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…13,16 For tibial tuberosity osteotomy (TTO), fractures of the proximal tibia, loss of tibial tuberosity fixation, nonunion of the tuberosity, and deep vein thrombosis 19 have been reported. 1,5,[10][11][12][13][14][15]22 The risk factors associated with these complications are incompletely understood; however, evidence suggests an increased risk of osseous complications with early weightbearing and with procedures involving complete detachment of the distal tuberosity, as required during distalization (Figures 1 and 2). 7,13,18 Our goals were to identify complications in patients who underwent TTO and to analyze patients who underwent concomitant distalization (TTO-d).…”

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confidence: 99%

Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization

Johnson

Wolfe

Mintz

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Tibial tuberosity osteotomy (TTO) is a versatile procedure commonly used to treat patellar instability as well as to unload cartilage lesions. TTO with concomitant distalization (TTO-d) may be performed in patients with patella alta to stabilize the patella by helping it to engage in the trochlea earlier during flexion.Purpose:To identify and compare perioperative complications in patients who underwent TTO and those who underwent TTO-d and to analyze risk factors associated with these complications.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively identified perioperative complications and associated factors from medical records for 240 patients who underwent TTO with or without distalization performed by 2 surgeons at 2 institutions between 2009 and 2015. A musculoskeletal radiologist at each institution determined osteotomy union using a published grading system. Significance was set at P < .01.Results:Of the 240 patients, 153 (122 TTO, 31 TTO-d) had clinical and radiographic follow-up of at least 90 days or evidence of osseous union. Eighty-eight complications were identified in 71 of 153 (46%) patients: delayed union (n = 35); painful hardware (n = 32); deep vein thrombosis (n = 4); clinical nonunion, delayed range of motion, sensory deficit, and wound breakdown (n = 3 each); and broken screw, fascial hernia, hematoma, quadriceps dysfunction, and tibial fracture (n = 1 each). Thirteen of 35 delayed unions occurred in the TTO-d group (P = .005). Painful hardware was more frequent in patients who received 4.5-mm screws (31/115) than in those who received 3.5-mm screws (1/38) (P = .001). A reoperation was required in 38 of 153 patients (37 patients using 4.5-mm screws vs 1 patient using 3.5-mm screws; P < .001), primarily for screw removal (32/38).Conclusion:Minor complications, including delayed union and painful hardware, were common, but major complications such as tibial fracture, deep vein thrombosis, and clinical nonunion were rare. Delayed union was more frequent in the TTO-d group. The 3.5-mm screws were less painful and less likely to need removal than the 4.5-mm screws.

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confidence: 99%

Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization

Johnson

Wolfe

Mintz

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Otherwise, the proportion lost to follow-up should not exceed the proportion experiencing the major end point 8. Prospective calculation of the study size: information of the size of detectable diference of interest with a calculation of 95% CI, according to the expected incidence of the outcome event, and information about the level for statistical Based on MINORs criteria studies were classiied high quality (met > 75% of criteria), moderate quality (met 50-74% of criteria), low quality (met 25-49% of criteria) or very low quality (met < 25% of criteria) [42] Authors Years Evidence Study design 1 2 3 5 6 7 8 Total Quality Al-Sayyad et al [2] 2002 II Prospective 2 2 2 0 2 2 0 12 High Bellemans et al [4] 1997 III Prospective 2 2 2 0 2 2 0 12 High Buda et al [5] 2019 III Retrospective 2 2 1 0 2 2 0 11 Moderate Caroino et al [7] 2008 III Retrospective 2 2 1 0 2 1 0 10 Moderate Diks et al [9] 2003 IV Case series 2 1 1 0 2 2 0 10 Moderate Enea et al [11] 2018 III Retrospective 2 2 1 0 2 2 0 11 Moderate Farr [13] 1997 IV Case series 0 0 1 0 2 2 0 6 Low Fisher et al [14] 2016 III Retrospective 2 2 1 0 2 2 0 11 Moderate Fulkerson et al [16] 1990 IV Case series 2 1 2 0 2 2 0 11 Moderate Gigante et al [17] 2009 III Prospective 2 2 2 1 2 2 0 13 High Gillogly et al [18] 2014 IV Case series 2 2 1 0 2 2 0 11 Moderate Henderson et al [22] 2005 III Retrospective 1 1 2 0 2 2 0 9 Moderate Kanamiya et al [30] 2006 IV Case series 2 1 2 0 2 2 0 11 Moderate Kanazawa et al [31] 2017 IV Case series 2 2 2 0 2 2 0 12 High Karamehmetoǧlu et al [32] 2007 IV Case series 2 1 2 0 2 2 0 11 Moderate Karataglis et al [33] 2006 III Retrospective 2 2 1 0 2 1 0 10 Moderate Klinge et al [34] 2019 III Retrospective 2 2 1 0 2 2 0 10 Moderate Koëter et al [35] 2007 III Prospective 2 2 2 0 2 1 2 13 High Morshuis et al [41] 1990 III Retrospective 2 1 2 0 2 1 0 9 Moderate Radin et al [46] 1993 III Retrospective 2 0 1 0 2 2 0 9 Moderate Rosso et al [49] 2017 IV Case series 2 2 2 0 2 1 0 11 Moderate Steimer et al [54] 2007 IV Case series 0 1 2 0 2 2 0 9 Moderate Thomas et al [57] 1999 IV Case series 2 1 2 0 2 2 0 10 Moderate Valenzuela et al [61] 2011 III Retrospective 2 2 2 0 2 2 0 12 High Wang et al [63] ...…”

Section: Discussionmentioning

confidence: 99%

“…In one study [35], mean Lysholm score increased pre-to post-operatively from 62 (57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67) to 92 (88-96), respectively. Kujala increased from 62 (57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67) pre-operatively to 90 (86-94) post-operatively (Table 3).…”

Section: Medial Transfermentioning

confidence: 96%

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Tibial tubercle transfer leads to clinically relevant improvement in patients with patellar maltracking without instability: a systematic review and meta-analysis

Bayoumi

Benner

Stavenuiter

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To assess the diferent surgical techniques and their outcomes following tibial tubercle transfer (TTT) in patients with patellar maltracking. Methods A systematic search of the literature was performed in PubMed, EMBASE and Cochrane Library. Studies reporting patient-reported outcome measures (PROMs) or clinical outcome following: TTT in patients with patellar maltracking were included. Collected PROMs were Lysholm, Kujala, IKDC score, and VAS pain. Clinical outcome included reported clinical success, patient satisfaction, complications and removal of hardware (ROH). Overall pre-, post-operative and change scores were estimated using random-efects meta-analysis models. Results were reported as overall mean and per transfer direction. Results A total of 26 studies and 761 patients (818 knees, mean age 35 years, mean follow-up 5.0 years) were included. In 73% of the studies, surgery was performed after failed conservative treatment. Transfer direction was anteromedial in 76% of all procedures. Overall Lysholm score improved from 61 to 91, Kujala from 52 to 85, IKDC from 53 to 81, and VAS from 6.2 to 2.5, respectively. Clinical success was reported in 79% of patients, and 80% of patients reported to have satisfactory results. Rates of complications and ROH were 13% and 29%, respectively. Conclusions TTT for management of patellar maltracking can lead to good results with clinically meaningful improvement, an overall clinical success of 79% and overall patient satisfaction of 80% when appreciating the underlying anatomic condition and using appropriate technique. The level of evidence was low, and large-scale prospective, comparative cohort studies with uniform outcome scales are needed to conirm these indings. Level of evidence IV.

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Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation

Sobhy

Mahran

Kamel

2012

Eur J Orthop Surg Traumatol

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Treatment of patellofemoral chondropathy with the Bandi tibial tubercle osteotomy

Cited by 6 publications

References 15 publications

Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization

Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization

Tibial tubercle transfer leads to clinically relevant improvement in patients with patellar maltracking without instability: a systematic review and meta-analysis

Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation

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