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Revision Tibial Tubercle Osteotomy for Nonhealing: A Single-center Case Series
William ElNemer1, Julia S Retzky2, Kathryn Barth2
1The Johns Hopkins University School of Medicine, Department of Orthopedics, Maryland, United States, Baltimore.
The Journal of Knee Surgery
|July 21, 2026
Summary
Revision tibial tubercle osteotomy (TTO) effectively addresses nonunion and fractures, with 65% achieving union. Strategies like bone marrow aspirate concentrate and managing vitamin D deficiency improve outcomes in revision TTO surgery.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- Tibial tubercle osteotomy (TTO) is a key procedure for patellofemoral issues.
- Complications like nonunion, fracture, and instability often necessitate revision TTO.
- Effective management strategies for revision TTO are crucial for patient outcomes.
Purpose of the Study:
- To evaluate the management and outcomes of revision TTO procedures.
- To identify factors influencing union rates and healing times in revision TTO.
- To report the efficacy of biological augmentation in revision TTO cases.
Main Methods:
- Retrospective review of 20 patients undergoing revision TTO for nonunion, delayed union, or fracture.
- Data collection included demographics, surgical details, biological adjuncts, and fixation methods.
- Outcomes assessed were union rates, time to healing, and need for further revision.
Main Results:
- 65% of revision TTOs achieved union at a mean of 14.6 weeks; 15% had delayed union.
- Delayed union was associated with older age and vitamin D deficiency (p=0.049).
- 80% of revisions utilized biological augmentation, such as bone marrow aspirate concentrate (BMAC).
Conclusions:
- Revision TTO is effective for addressing complications of primary TTO, with a high success rate.
- Robust fixation, biological augmentation (BMAC), and managing comorbidities like vitamin D deficiency are vital.
- Further research is needed to optimize protocols for high-risk revision TTO populations.