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. 2024 May 1;6(4):100948.
doi: 10.1016/j.asmr.2024.100948. eCollection 2024 Aug.

Tibial Tubercle Osteotomies Performed in an Outpatient Setting Have a Low Rate of Early Complications

Thomas E Moran  1 , Adam J Tagliero  1 , Richard E Campbell  1 , G Bradley Reahl  1 , Elizabeth K Driskill  1 , Alexander J Wahl  1 , David R Diduch  1
Affiliations

Tibial Tubercle Osteotomies Performed in an Outpatient Setting Have a Low Rate of Early Complications

Thomas E Moran et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To characterize the early postoperative complications following outpatient tibial tubercle osteotomy (TTO) to determine its safety in this setting.

Methods: Patients undergoing TTO by a single surgeon between July 2017 and August 2022 for patellar instability or patellofemoral chondromalacia and achieving a minimum of 3 months of clinical and radiographic follow-up were evaluated for inclusion. Although an inclusion criterion was a minimum follow-up of 3 months, if evidence of a healed osteotomy was observed sooner, final follow-up was accepted at 2 months. Patient demographics, perioperative risk factors, and incidence of complications were collected retrospectively. Categorical data were analyzed using χ2 and Fisher exact tests. Continuous data were analyzed using 2-tailed t tests and Mann-Whitney U data for parametric and nonparametric data, respectively.

Results: A total of 195 knees in 167 patients met inclusion criteria, with a mean age of 24.7 ± 9.2 years and mean follow-up time of 10.9 months (range, 2-69 months). Fifty-one early postoperative complications occurred in 47 (24.1%) knees in 42 (25.1%) patients. Ten major and 41 minor complications occurred. Major complications were associated with older age (P = .015), smoking (P = .038), and smaller preoperative patellar tendon-lateral trochlear ridge distance (P = .012). Forty-four reoperations occurred in 42 (21.5%) knees in 37 (22.2%) patients. The most common reasons for reoperation included removal of symptomatic hardware (31 knees; 15.9%) and arthrofibrosis requiring lysis of adhesions and manipulation under anesthesia (8 knees; 4.1%). The mean time to reoperation was 13.0 months (range, 1-42 months). Smaller body mass index was associated with increased risk of reoperation (P = .002).

Conclusions: Outpatient TTO is safe when performed with the described technique, but the later development of minor complications is not infrequent following surgery. Patients should be counseled regarding a relatively high incidence of hardware irritation, arthrofibrosis, and eventual reoperation.

Level of evidence: Level IV, case series.

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Conflict of interest statement

The authors report the following potential conflicts of interest or sources of funding: D.R.D. reports receiving research support from Aesculap/B.Braun, DJ Orthopaedics, and Moximed; is a committee member in the American Orthopaedic Society for Sports Medicine; is a paid consultant for Mitek and Osteocentric; and receives IP royalties from Smith & Nephew. All other authors (T.E.M., A.J.T., R.E.C., G.B.R., E.K.D., A.J.W.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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