High incidence of complication following tibial tubercle surgery

Objectives: Tibial tubercle osteotomy (TTO) is a common procedure that is frequently used in the treatment of recurrent patellar instability and/or patellar chondrosis. Current estimates of TTO complications in the literature vary widely, with complication rates reaching 59 percent. This variability is due, in part, to inconsistent definitions of complication between studies. The purpose of this study was to identify our complication rate following TTO procedures, with sub-analysis of whether the complication rate was affected by: 1. An intra-articular component defined as an additional procedure that altered post-operative rehabilitation and 2. A distalization of the tubercle translation. Methods: All patients between May 2009 and May 2015 who underwent a TTO were retrospectively identified. Complications were defined as major (fracture of the tibia, deep infection, non-union, delayed union, arthrofibrosis, deep vein thrombosis (DVT) and loss of screw fixation) versus minor (superficial wound infection, disturbance of cutaneous sensation and delay in wound healing). Subgroup analysis of distalization versus no distalization and intra-versus extra-articular concomitant procedures were also analysed. Results: One hundred and sixty-three TTOs in 150 patients were included in the final cohort with a mean follow-up of 21.3 months. The overall complication rate was 35 major complications (21.5%) and 13 minor complications (8.0%), with a total complication rate of 29.5 percent. TTO distalization did not increase the rate of complications. DVT was only seen in the intra-articular procedure cohort (n = 3/1.8%). Arthrofibrosis was the most common complication, occurring in 17 knees. Conclusion: The overall complication rate of TTOs was 29.5%, with arthrofibrosis (10.4%) as the largest complication. DVT increased with concomitant intra-articular procedure. Distalization of the tubercle compared to no distalization had no significant effect on complications. Level of evidence: Retrospective Cohort study, level III.