Reasons for and Complications Following Revision Tibial Tubercle Osteotomy

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.

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

Case series; Level of evidence, 4.

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.

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.

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.