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Tibial Tubercle Osteotomies: Indications and Results

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Patellofemoral Pain, Instability, and Arthritis

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Abstract

Tibial tubercle osteotomy (TTO) can be used in the management of recurrent patellar instability (recurrent lateral patellar dislocation) and in the management of pain thought to be due to damage to the patellofemoral articular surfaces. In the former, the aim is to restore normal patellar tracking in the trochlear groove and in the latter, to unload the damaged articular surface(s). In some situations, both problems are being addressed together.

There has been a changing paradigm in the management of patellofemoral instability, such that medial patellofemoral ligament (MPFL) reconstruction has for many surgeons become the mainstay of surgical intervention, with TTO taking on an adjuvant role. When used, TTO is increasingly used to distalise rather than to medialise the tibial tubercle. In the management of patellofemoral chondral lesions, direct anteriorisation is now rarely performed, and even anteromedialisation appears to be less frequently performed.

Biomechanical studies have shown how powerful TTO can be in modifying patellar tracking and patellofemoral contact forces. TTO therefore needs to be used judiciously with careful preoperative planning and surgical implementation. However, radiological measurements require refinement and validation, particularly when the same measurements are made using different modalities such as plain radiographs, CT scans and MRI. Furthermore, the thresholds for interventions, particularly TTO, still require significant clarification, as an isolated MPFL reconstruction appears to provide satisfactory outcomes in an increasing number of scenarios. In the treatment of patellofemoral chondral lesions, the situation is even less clear with a variety of interventions used with little sound evidence for their efficacy and indications. The role of TTO appears to be waning, despite reports of satisfactory outcomes.

Complications are relatively uncommon after TTO but can be devastating. Of the more significant complications, tibial fracture and non-union remain the most frequent but can generally be prevented by careful surgical technique. These complications appear to be more frequent when the tibial tubercle is completely detached.

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  1. OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia

    Julian A. Feller

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Editors and Affiliations

  1. Lyon-Ortho-Clinic, Lyon, France

    David Dejour

  2. Istituti Ortopedico Rizzoli Clinica, Ortopedica Traumatologica III, Bologna, Italy

    Stefano Zaffagnini

  3. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth A. Arendt

  4. Department of Paediatric Surgery, University of Tampere, Tampere, Finland

    Petri Sillanpää

  5. Clinic Diakonissen LinzOrthopädie & Sportchirurgie Linz, Puchenau, Austria

    Florian Dirisamer

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Feller, J.A. (2020). Tibial Tubercle Osteotomies: Indications and Results. In: Dejour, D., Zaffagnini, S., Arendt, E., Sillanpää, P., Dirisamer, F. (eds) Patellofemoral Pain, Instability, and Arthritis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61097-8_20

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