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. 2022 Apr;7(2):78-86.
doi: 10.1016/j.jisako.2021.10.002. Epub 2021 Nov 17.

Tibial tubercle osteotomy for patellofemoral malalignment and chondral disease provided good outcomes: A systematic review

Federica Rosso  1 , Roberto Rossi  2 , Umberto Cottino  3 , Davide E Bonasia  4
Affiliations
Free article

Tibial tubercle osteotomy for patellofemoral malalignment and chondral disease provided good outcomes: A systematic review

Federica Rosso et al. J ISAKOS. 2022 Apr.
Free article

Abstract

Importance: Tibial tubercle osteotomy (TTO) is indicated to treat patellofemoral (PF) malalignment and chondral disease refractory to conservative treatment. However, there are no systematic reviews describing TTO outcomes in chondral damages without instability.

Aim: The aims of this study were to (1) assess the quality of the published studies, (2) identify indication for TTO to treat PFP with chondral disease without instability, (3) evaluate the most common TTO techniques, (4) evaluate the clinical outcomes, and (5) evaluate TTO's complication and failure rates.

Evidence review: In December 2020, a literature search was performed applying the following criteria: (1) peer-reviewed Level 1-4 studies; (2) English language; (3) human subjects with clinical and/or radiological outcomes; (4) TTO alone or associated with minor cartilage procedure (only drilling, no instability); (5) minimum follow-up 12 months, minimum 10 patients; and (6) no more than 20% of drop-out rate. Data from studies were collected and described with weighted averages and standard deviations.

Findings: A total of 18 Level 4 studies were included. The average Coleman Methodology Score was 61.5 points (range 48-81). A total of 851 patients (892 knees) were included, with 64.8% of female patients. The weighted average follow-up was 49.1 months (range 12-128.5). Indication for TTOs was poorly described. The main technique used was anteromedialisation (60.4%). In 27.7% of the cases, TTO was associated with lateral release. Different scoring systems were used to evaluate outcomes, with significant improvements. The average rate of good/excellent results was 78.7% (range 57%-100%). Fifteen studies described the complication rate (9.9%), whereas only four reported the failure rate (6.2%).

Conclusion and relevance: TTOs performed to treat PF malalignment associated with chondral disease without instability provided good clinical outcomes, with acceptable complication/failure rates. However, high-level studies are necessary because of studies' heterogeneity regarding patellofemoral malalignment and chondral disease treatment.

Study design and level of evidence: Systematic review.

Level of the study: Level IV, systematic review of Level IV studies.

Keywords: Knee patella; Osteotomy; Patellofemoral chondral damage; Tibial Tubercle.

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Conflict of interest statement

Competing interests R.R. is a teaching consultant for Arthrex®, Zimmer Biomet®, Depuy Mitek®, Medacta®, Lima Corporate® and Smith and Nephew®. D.E.B. is a paid teaching consultant for Arthrex and Zimmer Biomet. He received editorial royalties for Elsevier and Springer, and he is in the editorial board “The Knee” journal, Elsevier. The other authors certify that they have no commercial associations that might pose a conflict of interest in connection with the submitted article. Conflict of interest is described in the appropriate uploaded document.

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