Tibial tubercle transfer associated with low complication risk with, without distalization
Key takeaways:
- Tibial tubercle osteotomy with vs. without distalization yielded low rates of postoperative complications.
- Both techniques yielded similar rates of arthrofibrosis, nonunion and reoperation.
Results published in the American Journal of Sports Medicine showed tibial tubercle osteotomy with vs. without distalization yielded similar postoperative outcomes for patients with patellofemoral instability, malalignment and patella alta.
According to the study, the techniques yielded statistically similar rates of postoperative arthrofibrosis, nonunions and reoperations.
“Tibial tubercle osteotomy (TTO) is a well-established surgical treatment for patients with patellofemoral pain or instability,” Aakash K. Shah, BA, lead author and research fellow at Hospital for Special Surgery, told Healio. “Our study found that TTO is a safe procedure with a low complication rate. Additionally, no increased risk of complications was observed when performing TTO with distalization.”
Shah and colleagues from the department of sports medicine at Hospital for Special Surgery performed a retrospective cohort study of data for skeletally mature patients who underwent primary TTO with (n = 117) vs. without (n = 134) distalization between September 2014 and May 2023. Patients had a minimum follow-up of 6 months. The most common indication for surgery was patellofemoral instability (61% of patients).
Overall, six patients (5%) who received TTO with distalization and nine patients (7%) who received TTO without distalization had at least one postoperative complication.
Among the distalization group, Shah and colleagues found three cases (3%) of arthrofibrosis, three cases (3%) of clinical nonunion and three cases (3%) of reoperation. Among the non-distalization group, Shah and colleagues found seven cases (5%) of arthrofibrosis, one case (1%) of clinical nonunion and one case (1%) of reoperation. They noted the differences in these rates between the cohorts were not clinically significant.
Shah and colleagues found no cases of nonunion for patients with either concomitant high tibial osteotomy (HTO) or concomitant distal femoral osteotomy (DFO). However, they noted the one patient who had combined concomitant HTO and DFO had clinical nonunion.
After univariate analysis, Shah and colleagues found concomitant intra-articular procedures were significantly associated with risk of complications among the distalization group, while increased tourniquet time was significantly associated with risk of complications among the non-distalization group.
“TTO, with or without distalization, can be confidently performed to manage patellofemoral pain or instability without heightened concern for complications,” Shah said.
Perspective
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There is discrepancy in the literature regarding outcomes of TTO. It has become clear with this research from Aakash K. Shah, BA, Sabrina M. Strickland, MD, and colleagues that technical precision is the key to success. I hasten to point out that Sercan Yalcin, MD, and Lutul D. Farrow, MD, at the Cleveland Clinic have recently published a separate study showing favorable results with low complication rates after TTO.
In short, anteromedial or medial TTO is remarkably safe and free of complications when properly done with flat osteotomy and tibial notching is avoided.
Reference:
Yalcin S, et al. Orthop J Sports Med. 2024;doi: 10.1177/23259671241278722.
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