Anterior tibial tubercle osteotomy in adolescents and young adults: functional results and complications

Abstract

Introduction: Tibial tubercle osteotomy (TTO) is a surgical approach that allows for the restoration of distal patellar alignment in skeletally mature patients. The objectives of this study were to evaluate functional results and to analyze the risk factors associated with complications. Methods: We carried out a retrospective analysis of patients subjected to a TTO between 2008 and 2016 and documented demographic and clinical data. Results were evaluated according to the Kujala Anterior Knee Pain Scale and the Tegner-Lysholm Knee Scoring Scale. Complications were evaluated with a modified Clavien-Dindo Classification of Surgical Complications. Results: We evaluated 33 TTOs in 29 patients (17 women) with a median age of 18 years (IQR 2, range: 14-39) and a median follow-up time of 49 months (IQR 2, range: 12-115). The Kujala and the Tegner-Lysholm scoring improved from 61 and 61.5 to 94 and 92.3, respectively (p=0.001). Union was achieved at a median of 8 weeks. There were 9 complications (27%): a grade II complication (superficial infection) and 8 grade III complications (arthrofibrosis, tibial fractures, and anterior tibial tubercle fractures). Osteotomies in which the tibial tubercle was completely detached had a significantly higher rate of complications (51.5% vs. 11.1%, p=0.029). Conclusions: TTO represents an effective approach for the treatment of several conditions of the patellofemoral joint in adolescents and young adults. In our series, a high percentage of the procedures presented complications, although they did not affect the final result. Osteotomies that involve complete detachment of the tubercle and those associated with ligament reconstruction have an increased risk of complications.

Keywords

• Patelofemoral
• inestabilidad
• dolor
• osteotomía
• adolescentes
• adultos jóvenes
• Patellofemoral instability
• pain
• osteotomy
• adolescents
• young adults.