Advertisement

Plate and screw fixation of arthroscopically assisted tibial tuberosity osteotomy: technique and results

  • Jarrad M. StevensEmail author
  • Simon B. Barton
  • Matthew Alexander
  • Jonathan D. Eldridge
  • Damian Clark
Original Article • KNEE - ARTHROPLASTY
  • 60 Downloads

Abstract

Introduction

We describe a fixation technique for tibial tuberosity osteotomies (TTO) utilising a plate and screw construct which adheres to established principles of bone healing. We record and discuss the complication profile and benefits of this technique.

Method

The technique is outlined, and thirty consecutive case of TTO fixed with this combination of plate and screws were analysed during a study period from January 2018 to October 2018. All patients were followed up clinically to 3 months post-operation for the purpose of identifying early complications of surgery. Radiographic series were reviewed at 2, 6 and 12 weeks post-operation for evidence of fracture, loss of position, hardware failure and union.

Results

All cases went on to clinical and radiographic union by 12 weeks. We identified one case of hardware failure, one case of superficial infection and one case of stiffness requiring manipulation.

Conclusion

We have found this technique of plate and screw construct to be effective in arthroscopically assisted TTO fixation leading to consistent union without loss of position with a low complication profile.

Keywords

Tibial tuberosity osteotomy Arthroscopy Fixation Plate Screw Knee 

Notes

Funding

No funds were obtained for this paper.

Compliance with ethical standards

Conflict of interest

No conflict of interest is declared.

References

  1. 1.
    Hauser EDW (1938) Total tendon transplant for slipping patella: new operation for recurrent dislocation of the patella. Surg Gynecol Obstet 66:199–214Google Scholar
  2. 2.
    Stetson WB, Friedman MJ, Fulkerson JP, Cheng M, Buuck D (1997) Fracture of the proximal tibia with immediate weightbearing after a Fulkerson osteotomy. Am J Sports Med 25:570–574CrossRefGoogle Scholar
  3. 3.
    Fulkerson JP (1999) Fracture of the proximal tibia after Fulkerson anteromedial tibial tubercle transfer: a report of four cases. Am J Sports Med 27:265CrossRefGoogle Scholar
  4. 4.
    Bellemans J, Cauwenberghs F, Brys P, Victor J, Fabry G (1998) Fracture of the proximal tibia after Fulkerson anteromedial tibial tubercle transfer: a report of four cases. Am J Sports Med 26:300–302CrossRefGoogle Scholar
  5. 5.
    Wolff AM, Hungerford DS, Krackow KA, Jacobs MA (1989) Osteotomy of the tibial tubercle during total knee replacement: a report of twenty-six cases. J Bone Joint Surg 71A:848–852CrossRefGoogle Scholar
  6. 6.
    Cosgarea AJ, Freedman JA, McFarland EG (2001) Nonunion of the tibial tubercle shingle following Fulkerson osteotomy. Am J Knee Surg 14:51–54PubMedGoogle Scholar
  7. 7.
    Ritter MA, Carr K, Keating EM, Faris PM, Meding JB (1996) Tibial shaft fracture following tibial tubercle osteotomy. J Arthroplasty 11:117–119CrossRefGoogle Scholar
  8. 8.
    Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 177:176–181Google Scholar
  9. 9.
    Pemmaraju G, Raad A, Kotecha A, Chugh S, Mughal E (2015) Modified technique of tibial tuberosity transfer. Arthrosc Tech 4(4):349–352CrossRefGoogle Scholar
  10. 10.
    Clark D, Walmsley K, Schranz P, Mandalia V (2017) Tibial tuberosity transfer in combination with medial patellofemoral ligament reconstruction: surgical technique. Arthrosc Tech 6(3):591–597CrossRefGoogle Scholar
  11. 11.
    Whiteside LA, Ohl MD (1990) Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 260:6–9CrossRefGoogle Scholar
  12. 12.
    Mendes MW, Caldwell PE, Jiranek JA (2004) The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 19:167–174CrossRefGoogle Scholar
  13. 13.
    Warner BT, Kamath GV, Spang JT, Weinhold PS, Creighton RA (2013) Comparison of fixation methods after anteromedialization osteotomy of the tibial tubercle for patellar instability. Arthroscopy 29:1628–1634CrossRefGoogle Scholar
  14. 14.
    Johnson AA, Wolfe EL, Mintz DN, Demehri S, Shubin Stein BE, Cosgarea AJ (2018) Complications after tibial tuberosity osteotomy: association with screw size and concomitant distalization. Orthop J Sports Med 6(10):2325967118803614.  https://doi.org/10.1177/2325967118803614 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Davis K, Caldwell PE, Wayne J, Jiranek WA (2000) Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. Clin Orthop 380:241–249CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Avon Orthopaedic CentreSouthmead HospitalBristolUK
  2. 2.Knox Orthopaedic GroupKnox Private Hospital MelbourneMelbourneAustralia
  3. 3.Aintree University Teaching HospitalLiverpoolUK

Personalised recommendations