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Fracture of the tibial tubercle does not affect clinical outcomes in medial opening wedge high tibial osteotomy with distal tibial tubercle osteotomy

Archives of Orthopaedic and Trauma Surgery (2020)Cite this article

Abstract

Purpose

To investigate whether tibial tubercle fracture affected clinical outcomes and bony union in medial opening wedge high tibial osteotomy with distal tibial tubercle osteotomy (DTO) and to determine the anatomical risk factors for tibial tubercle fracture.

Materials and methods

All patients who underwent DTO were retrospectively reviewed, and 104 successive patients were included. The Knee Society Score and complications including tibial tubercle fracture were recorded. On radiographs and computed tomography scans, the length, thickness, width, height, and bony union of the osteotomized tibial tubercle and the posterior tibial slope were statistically analysed.

Results

Fracture of the tibial tubercle occurred intraoperatively in 11 patients (10.6%) and in the postoperative period in 1 (1.0%). The case of postoperative fracture showed non-union. There was no significant difference in the Knee Society Score between the non-fracture and fracture groups. There were significant differences in the posterior tibial slope and the height of the tibial tubercle between the groups (p < 0.0001 for each comparison). The logistic regression analysis showed that the height of the tibial tubercle was associated with a higher risk of the fracture of the tibial tubercle (p < 0.01; OR, 1.548; 95% CI, 1.149–2.085). However, there were no significant differences in the bony union rate of the tibial tubercle at 6 months after surgery between the groups.

Conclusions

Tibial tubercle fracture did not affect the clinical outcome and bony union in spite of the relatively high occurrence rate. Anatomical risk factors for the fractures was a lower tibial tubercle position.

Level of evidence

Level IV.

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Funding

No funding has been received for this study.

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Affiliations

  1. Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan

    Hiroyasu Ogawa & Masaya Sengoku

  2. Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan

    Hiroyasu Ogawa, Kazu Matsumoto, Hiroki Yoshioka & Haruhiko Akiyama

Authors
  1. Hiroyasu Ogawa
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  2. Kazu Matsumoto
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  3. Hiroki Yoshioka
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  4. Masaya Sengoku
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  5. Haruhiko Akiyama
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Correspondence to Kazu Matsumoto.

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Ogawa, H., Matsumoto, K., Yoshioka, H. et al. Fracture of the tibial tubercle does not affect clinical outcomes in medial opening wedge high tibial osteotomy with distal tibial tubercle osteotomy. Arch Orthop Trauma Surg (2020). https://doi.org/10.1007/s00402-020-03688-w

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  • DOI: https://doi.org/10.1007/s00402-020-03688-w

Keywords

  • Distal tibial tubercle osteotomy
  • High tibial osteotomy
  • Distal tuberosity osteotomy
  • Tibial tubercle fracture
  • Complication
  • Bony union