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.
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References
Hauser EDW (1938) Total tendon transplant for slipping patella: new operation for recurrent dislocation of the patella. Surg Gynecol Obstet 66:199–214
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 25:570–574
Fulkerson JP (1999) Fracture of the proximal tibia after Fulkerson anteromedial tibial tubercle transfer: a report of four cases. Am J Sports Med 27:265
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 26:300–302
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:848–852
Cosgarea AJ, Freedman JA, McFarland EG (2001) Nonunion of the tibial tubercle shingle following Fulkerson osteotomy. Am J Knee Surg 14:51–54
Ritter MA, Carr K, Keating EM, Faris PM, Meding JB (1996) Tibial shaft fracture following tibial tubercle osteotomy. J Arthroplasty 11:117–119
Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 177:176–181
Pemmaraju G, Raad A, Kotecha A, Chugh S, Mughal E (2015) Modified technique of tibial tuberosity transfer. Arthrosc Tech 4(4):349–352
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):591–597
Whiteside LA, Ohl MD (1990) Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 260:6–9
Mendes MW, Caldwell PE, Jiranek JA (2004) The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 19:167–174
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 29:1628–1634
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
Davis K, Caldwell PE, Wayne J, Jiranek WA (2000) Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. Clin Orthop 380:241–249
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Stevens, J.M., Barton, S.B., Alexander, M. et al. Plate and screw fixation of arthroscopically assisted tibial tuberosity osteotomy: technique and results. Eur J Orthop Surg Traumatol 30, 139–145 (2020). https://doi.org/10.1007/s00590-019-02536-x
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DOI: https://doi.org/10.1007/s00590-019-02536-x