Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewThe Incidence of Complications of Tibial Tubercle Osteotomy: A Systematic Review
Section snippets
Methods
In October 2014, a literature search of Scopus and PubMed was undertaken. The search terms that were used included “Elmslie” or “Elmslie-trillat” or “Fulkerson” or “Tibial Tubercle Osteotomy” or “TTO” or “Distalization” or “Anteromedialization” or “Medialization” and “Dislocation” or “Subluxation” or “Instability,” with the search limited to human studies in English. The search yielded 576 proposed articles, 104 of which were duplicates. The review process of the remaining 472 articles involved
Results
The 19 studies included a total of 787 TTOs. There were 472 direct medialization procedures (Elmslie-Trillat technique) in 11 studies,10, 11, 12, 14, 15, 17, 19, 22, 23, 24, 26 193 anteromedialization procedures (Fulkerson technique) in 5 studies,9, 13, 20, 25, 27 and 102 procedures in 3 studies16, 18, 21 in which the tibial tubercle was completely detached for medialization, distalization, or a combination.
The mean patient age varied across the studies from 20 to 31 years. Seventeen of the
Discussion
The major finding of this review is that the risk of complications is higher when the osteotomy involves completely detaching the tibial tubercle (10.7%) than when attempts are made to preserve a distal cortical hinge, as with the Elmslie-Trillat (3.3%) and Fulkerson (3.7%) osteotomies.
Among the most devastating complications associated with TTO is nonunion of the osteotomy site. Six patients (0.8%) in this series had nonunion of the osteotomy site, 5 of whom required revision surgery. The risk
Conclusions
Tibial tubercle osteotomy is a complex surgical procedure with significant risk of complications. Osteotomies that involve complete detachment of the tubercle have an increased risk of complications compared with those in which a distal cortical hinge is maintained.
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See commentary on page 1826
The authors report the following potential conflict of interest or source of funding: D.F. receives support from Vericel, DePuy Mitek, and Smith & Nephew.