Tibial Tubercle Osteotomy With Distalization for the Treatment of Patella Alta

Palhares, Guilherme; Hinkley, Paige; Rizy, Morgan; Fletcher, Connor; Gomoll, Andreas H.; Strickland, Sabrina M.

doi:10.1016/j.eats.2022.12.015

Cited by 3 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23,30,39 Additionally, elevating the periosteum from the tibia at the distal cut site facilitates coverage of the distal portion of the transferred tubercle, in an attempt to reestablish an environment conducive to healing. 30 Last, using a proximal bone block and maintaining a distal screw trajectory enhances the mechanical stability of the osteotomy, as evidenced by a recent biomechanical study demonstrating a markedly higher mean load to failure (P \ .001) and a lower mean maximum tibial tubercle displacement during cyclic loading (P \ .001) with use of a proximal bone block. 48 Past literature reports the rate of TTO arthrofibrosis as between 2.8% and 22%.…”

Section: Discussionmentioning

confidence: 99%

“…24 The surgical approach for TTO-D, employing a wedge-shaped tibial tubercle shingle without a step cut, may improve bone healing by maximizing the contact area after the transfer of the distal hinge. 23,30,39 Additionally, elevating the periosteum from the tibia at the distal cut site facilitates coverage of the distal portion of the transferred tubercle, in an attempt to reestablish an environment conducive to healing. 30 Last, using a proximal bone block and maintaining a distal screw trajectory enhances the mechanical stability of the osteotomy, as evidenced by a recent biomechanical study demonstrating a markedly higher mean load to failure ( P < .001) and a lower mean maximum tibial tubercle displacement during cyclic loading ( P < .001) with use of a proximal bone block.…”

Section: Discussionmentioning

confidence: 99%

“…Excess bone from the distal aspect of the shingle was removed and used as an autograft to anteriorize the shingle. 22,30 For distalization, the periosteum was repaired over the distal aspect of the osteotomy. The tubercle was secured with fully threaded cortical screws via lag technique through the tubercle aiming roughly 15° distally to achieve compression across the osteotomy and aid in resisting proximal migration of the fragment 48 (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…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%

mentioning

confidence: 99%

See 4 more Smart Citations

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

Shah,

Uppstrom,

Rizy

et al. 2024

Am J Sports Med

View full text Add to dashboard Cite

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.

show abstract