A Systematic Review of 21 Tibial Tubercle Osteotomy Studies and More Than 1000 Knees: Indications, Clinical Outcomes, Complications, and Reoperations

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the literature for tibial tubercle osteotomy (TTO) studies and systematically reviewed them for indications, clinical outcomes, complications, and reoperations. Therapeutic clinical studies that reported TTO indications, operative findings, and outcomes were included. Quality of each study was assessed with the modified Coleman methodology score (MCMS). Twenty-one studies (976 patients, 1055 knees) were included in the analysis. Better quality studies had a mean (SD) MCMS of 19.8 (8.2), well under the 55-point cutoff. TTO was most commonly performed for isolated patellar instability in the presence of knee pain. The other pathologies addressed were patellofemoral osteoarthritis, patella alta, and patella baja with or without knee pain. TTO significantly improved knee pain and clinical outcome scores, though 21% of patients (>1 in 5) required reoperation for hardware removal. Young women with prior surgery on the affected knee were the primary patient population.