Tibial Tubercle Osteotomies Performed in an Outpatient Setting Have a Low Rate of Early Complications

Abstract

PurposeThe purpose of this study was to characterize the early postoperative complications following outpatient Tibial Tubercle Osteotomy (TTO) to determine its safety in this setting. MethodsPatients undergoing TTO by a single surgeon between July 2017 and August 2022 for patellar instability or patellofemoral chondromalacia and achieving minimum 3 months of clinical and radiographic follow-up were evaluated for inclusion. Although an inclusion criterion was minimum follow-up of 3 months, if evidence of a healed osteotomy was observed sooner, final follow up was accepted at 2 months. Patient demographics, perioperative risk factors, and incidence of complications were collected retrospectively. Categorical data was analyzed using chi-squared and Fisher exact tests. Continuous data was analyzed using two-tailed t-tests and Mann-Whitney U data for parametric and nonparametric data, respectively. ResultsA total of 195 knees in 167 patients met inclusion criteria, with a mean age of 24.7 ± 9.2 years and mean follow-up time of 10.9 months (range: 2 - 69 months).51 early postoperative complications occurred in 47 (24.1%) knees in 42 (25.1%) patients. 10 major and 41 minor complications occurred. Major complications were associated with older age (p = 0.015), smoking (p = 0.038), and smaller preoperative patellar tendon-lateral trochlear ridge distance (p = 0.012). 44 reoperations occurred in 42 (21.5%) knees in 37 (22.2%) patients. The most common reasons for reoperation included removal of symptomatic hardware (31 knees; 15.9%) and arthrofibrosis requiring lysis of adhesions and manipulation under anesthesia (8 knees; 4.1%). The mean time to reoperation was 13.0 months (range: 1 – 42 months). Smaller body mass index was associated with increased risk of reoperation (p = 0.002). ConclusionOutpatient TTO is safe when performed with the described technique, however the later development of minor complications is not infrequent following surgery. Patients should be counseled regarding a relatively high incidence of hardware irritation, arthrofibrosis, and eventual reoperation.