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. 2025 Feb 6;13(2):23259671241312232.
doi: 10.1177/23259671241312232. eCollection 2025 Feb.

Reasons for and Complications Following Revision Tibial Tubercle Osteotomy

Nathan H Varady  1 , Tyler J Uppstrom  1 , Aakash Shah  1 , Morgan Rizy  1 , Ava G Neijna  1 , Andreas H Gomoll  1 , Sabrina M Strickland  1
Affiliations

Reasons for and Complications Following Revision Tibial Tubercle Osteotomy

Nathan H Varady et al. Orthop J Sports Med. .

Abstract

Background: While tibial tubercle osteotomy (TTO) is a highly effective treatment for patellofemoral malalignment, some patients may have recurrent symptoms after surgery. To date, there are little data on revision TTO (rTTO) and its outcomes.

Purpose: To evaluate the (1) reasons for and (2) complications following rTTO.

Study design: Case series; Level of evidence, 4.

Methods: This was a retrospective review of patients who underwent rTTO from a single high-volume patellofemoral surgeon between 2016 and 2023. All included patients had a minimum of 3 months of follow-up data. Demographic characteristics, indications for primary and revision surgery, operative characteristics, concomitant procedures, range of motion at 6 and 12 weeks postoperatively, radiographic data, and complications were collected.

Results: There were 16 knees (14 patients) that underwent rTTO, including 10 (63%) for persistent malignment (all of which had chondral damage requiring concomitant intervention) and 6 (38%) for fracture/nonunion. The knees undergoing rTTO for malalignment were 90% female, compared with 33% female for fracture/nonunion (P = .04). For persistent malalignment rTTO, the only complication (10% [1/10]) was arthrofibrosis (0°-65° at 6 weeks postoperatively), requiring arthroscopic lysis of adhesions (0°-140° at 12 weeks postoperatively). Within the follow-up available (median, 2.2 years; range, 9 months-5.3 years), there were no cases of new or recurrent patellar instability after rTTO. Similarly, at a median follow-up of 1.2 years (range, 4 months-3.0 years), all 6 knees that underwent rTTO for fracture/nonunion achieved union, with delayed union requiring percutaneous bone marrow grafting at 4 months postoperatively being the only complication in this cohort.

Conclusion: Patients who underwent rTTO demonstrated low complication rates and high union rates in this study. There was a high prevalence of chondral damage requiring concomitant intervention among patients undergoing rTTO for persistent malalignment. While rTTO is a relatively rare procedure, these data suggest that it can be a safe and effective option for patients with recurrent symptoms or fracture/nonunion after primary TTO.

Keywords: cartilage; malalignment; patellofemoral; revision; tibial tubercle osteotomy.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.H.G. has received research support from Cartiheal, JRF Ortho, Moximed, Organogenesis, and Vericel; consulting fees from Bioventus, Flexion Therapeutics, JRF Ortho, Moximed, Smith & Nephew, and Vericel; nonconsulting fees from Bioventus, Flexion Therapeutics, Moximed, Organogenesis, Smith & Nephew, Linvatec, Pacira Pharmaceuticals, and Vericel; honoraria from JRF Ortho and Fidia Pharma USA; royalties from Organogenesis; and has stock/stock options in Engage, Smith & Nephew, and Stryker. S.M.S. has received research support from Miach and Vericel; consulting fees from Flexion Therapeutics, Miach, Smith & Nephew, and Vericel; nonconsulting fees from Miach and Smith & Nephew; honoraria from JRF Ortho and Vericel; and stock/stock options in Engage and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the Hospital for Special Surgery (reference No. 2020-2123).

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