Stress Fracture after Tibial Tuberosity Osteotomy - Analyzing the Contributing Factors

Tibial tubercle osteotomy (TTO) is an appropriate surgical procedure for patellar instability and chronic patellofemoral pain; however, complications such as proximal tibial fracture occur in 1-1.8% of cases.

A 19-year-old non-professional dancer underwent TTO with medialization for patellofemoral pain. Postoperatively, rehabilitation followed a structured protocol. At 3 months, radiographs revealed an onset of stress fracture below the TTO site, progressing and involving two-thirds of the tibial diameter on the last follow-up. Surgical fixation with a lateral tibial locking plate was performed to prevent propagation. Ten months after plating, the fracture had fully consolidated, while a Knee Injury and Osteoarthritis Outcome score was 90.5, and the hardware was removed without complications.

Proximal tibial stress fractures post-TTO are rare but require early recognition and intervention. This case highlights the caution required in rehabilitation and the necessity of surgical intervention as a viable treatment to ensure proper fracture healing and successful recovery.