Return to Sports After Tibial Tubercle Osteotomy for Patellofemoral Pain and Osteoarthritis

Abstract

To determine the rate of return to sports and clinical outcomes after anteromedialization (AMZ) tibial tubercle osteotomy (TTO) for patients with patellofemoral pain and/or osteoarthritis. This study is a retrospective case series of consecutive patients who underwent unilateral or staged bilateral AMZ TTO for a primary diagnosis of patellofemoral pain or arthritis. Included were all patients with minimum 1-year follow-up. The indication for surgery was failure of at least 6months of nonoperative treatment. Simultaneous tubercle distalization or proximal-medial soft-tissue procedures were excluded; however, prior patellar instability procedures did not prohibit inclusion if there was no recurrence. A diagnostic arthroscopy was performed to evaluate the cartilage surfaces; AMZ TTO was performed by use of a freehand technique and two 4.5-mm fully threaded screws for fixation. A gradual return to activities was permitted at 6months; however, contact sports were prohibited until 9months postoperatively. Patients were evaluated retrospectively for participation in sports using a questionnaire about the level of participation, return to sporting activities, and Kujala score. Statistical analysis included 1-way analysis of variance and χ2 or Fisher exact and paired t tests. Forty-eight patients played sports within 3years before surgery. The majority were female patients (84.2%). The average age at surgery was 29.6years, with an average follow-up period of 4.6years. The average Kujala score improved from 51.2 to 82.6 (P < .0001); the average pain score improved from 4.1 to 1.8 (P < .001). Of the patients, 83.3% returned to at least 1 sport on average 7.8months postoperatively. Of these, 77.5% believed they returned to sports at the same level or a higher level. Patients undergoing AMZ TTO for patellofemoral pain or arthritis had an 83.3% rate of return to 1 or more sporting activities at an average of 7.8months after surgery, with many patients returning at the same level or a higher level of intensity compared with their preoperative state. Level IV, retrospective case series.