A detaching, V-shaped tibial tubercle osteotomy is a safe procedure with a low complication rate

Akkie Rood,Sander Koëter,Jordy Van Sambeeck,Sebastiaan A W Van De Groes,Albert Van Kampen

doi:10.1007/s00402-020-03375-w

Abstract

IntroductionIn patients with recurrent patellar dislocations, a tibial tubercle osteotomy (TTO) can be indicated to correct patella alta or an increased trochlear groove–tibial tubercle distance. Several surgical techniques are described. Previous studies emphasize that detaching osteotomies results in devascularisation, which can lead to non-union and tibial shaft fractures. The aim of this study was to report the complication rates directly related to the surgical technique of a V-shaped TTO, where the tubercle is completely released from its periosteum using a step-cut osteotomy.MethodsThe retrospective case series comprised a large cohort of 263 knees with patella alta in 203 patients who underwent a V-shaped TTO, with or without additional realignment procedures, between March 2004 and October 2017. Data were obtained from available patient files. Complications were defined as minor or major.ResultsThirteen major complications were registered (4.9%) including two tibial fractures (0.75%) and one non-union (0.37%). Five complications (1.9%) were defined as minor. Removal of the screws because of irritation or pain was seen in 22 cases (8.2%).ConclusionA V-shaped TTO is a safe procedure. The presumed higher risk for tibial fractures or pseudo-arthrosis could not be confirmed.

Highlights

In patients with recurrent patellar dislocations, a tibial tubercle osteotomy (TTO) can be indicated to correct patella alta or an increased trochlear groove–tibial tubercle distance
TTO is indicated in patients with recurrent patellar dislocations due to patella alta or an increased tibial tubercle–trochlear groove (TT–TG) distance
The hypothesized advantages of the V-shaped TTO are that the risk on non-union is low due to the triangular shape of the bone block with a twice as big bone contact area of the trabecular bone, and the intrinsically stable nature of the shape of the osteotomy in comparison to a sliding flat osteotomy

Summary

Introduction

In patients with recurrent patellar dislocations, a tibial tubercle osteotomy (TTO) can be indicated to correct patella alta or an increased trochlear groove–tibial tubercle distance. Previous studies emphasize that detaching osteotomies results in devascularisation, which can lead to non-union and tibial shaft fractures. The aim of this study was to report the complication rates directly related to the surgical technique of a V-shaped TTO, where the tubercle is completely released from its periosteum using a step-cut osteotomy. Results Thirteen major complications were registered (4.9%) including two tibial fractures (0.75%) and one non-union (0.37%). In case of recurrent patellar instability, surgical management results in a lower risk of recurrent dislocation than conservative management [1]. TTO is indicated in patients with recurrent patellar dislocations due to patella alta or an increased tibial tubercle–trochlear groove (TT–TG) distance. Small sample size studies have been performed on this subject to the best of our

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