What to expect after a tibial tubercle osteotomy? A 10-year retrospective study of clinical and radiologic outcomes

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-05-22 DOI:10.1016/j.jor.2025.05.024

Joana Almeida , Ana Rita Senra , Maria Clara Correia , Maria João Leite , Paulo Oliveira , Francisco Serdoura , João Torres

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引用次数: 0

Abstract

Introduction

Patellofemoral instability (PFI) is a multifactorial entity that combines osseous and soft tissue abnormalities. Tibial tubercle osteotomy (TTO) addresses biomechanical malalignment but faces 50 % recurrence rates with TT-TG >20 mm. Long-term outcomes show 62.5 % success at 10–15 years post-TTO, though 16–21 % require reoperations. Current evidence lacks long-term data, underscoring the need for individualized surgical planning. This study evaluates 10-year outcomes via MRI and clinical outcomes to identify predictors of suboptimal results.

Methods

A retrospective observational study was designed. Demographic and clinical data, including age, gender, number of dislocations, and revision surgery, were collected. Radiologic measures were patellar height, tilt, displacement, maltracking, and trochlear dysplasia. They were assessed with computed tomography (CT) preoperatively and magnetic resonance imaging (MRI) postoperatively, with further identification of chondral lesions. Functional evaluation was based on the Kujala and Lysholm scores.

Results

Data from 36 knees were included. Recurrent dislocation occurred in 14 % (5 cases), primarily in younger females (median age 16) with residual malalignment. Symptomatic hardware removal (50 %) was the most common complication. Significant improvements were observed in the TT-TG distance (23 IQR 15.05–25.3 V S 15 IQR 10–18 mm, p = 0.002), patellar tilt and displacement with 0° of extension (patellar tilt: 28.5 IQR 17.75–34.25 V S 16.5 IQR 10–24.25°, p < 0.005; patellar displacement: 6.3 IQR 3.07–14.6 V S 2.5 IQR 0–8.25 mm, p = 0.01) and with active contraction only patellar tilt (34 IQR 24–42.5 V S 29 IQR 15-36° p = 0.014). Despite 54.8 % present with advanced chondropathy (Outerbridge III/IV), no correlation was found with age, alignment, or functional scores. The median Kujala score was 89.5 IQR 82.5–97.5, and the median Lysholm was 91 IQR 81.75–95.75.

Conclusion

TTO provides reliable long-term outcomes for patellofemoral instability. The risk of joint degeneration is non-negligible, especially in the setting of malalignment or older age on admission.

Level of evidence

III.

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胫骨结节截骨术后会发生什么？一项临床和放射预后的10年回顾性研究

髌股不稳定（PFI）是一个多因素的实体，结合骨和软组织异常。胫骨结节截骨术（TTO）解决了生物力学失调，但在TT-TG >； 20mm时面临50%的复发率。长期结果显示，tto后10-15年的成功率为62.5%，尽管16 - 21%需要再次手术。目前的证据缺乏长期数据，强调了个体化手术计划的必要性。本研究通过MRI和临床结果评估10年预后，以确定次优结果的预测因素。方法设计回顾性观察研究。收集了人口统计学和临床资料，包括年龄、性别、脱位数量和翻修手术。放射学测量是髌骨高度、倾斜、位移、跟踪不良和滑车发育不良。术前进行计算机断层扫描（CT），术后进行磁共振成像（MRI），进一步确定软骨病变。功能评估基于Kujala和Lysholm评分。结果纳入36个膝关节的数据。复发脱位发生率为14%（5例），主要发生在年轻女性（中位年龄16岁），并伴有残留的错位。症状性硬体取出（50%）是最常见的并发症。观察到有显著改善的ttg距离（23 IQR 15.05-25.3 V S 15 IQR 10-18 mm, p = 0.002），髌骨倾斜和移位0°延伸(髌骨倾斜：28.5 IQR 17.75-34.25 V S 16.5 IQR 10-24.25°，p <；0.005;髌骨移位：6.3 IQR 3.07-14.6 V S 2.5 IQR 0-8.25 mm, p = 0.01)，主动收缩时仅髌骨倾斜（34 IQR 24-42.5 V S 29 IQR 15-36°p = 0.014）。尽管54.8%的患者患有晚期软骨病变（Outerbridge III/IV），但与年龄、排列或功能评分没有相关性。Kujala评分中位数为89.5 IQR 82.5-97.5， Lysholm评分中位数为91 IQR 81.75-95.75。结论tto治疗髌股不稳具有可靠的远期疗效。关节退变的风险是不可忽视的，特别是在入院时出现错位或年龄较大的情况下。证据水平ii。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.