Tibial Tubercle Osteotomies Performed in an Outpatient Setting Have a Low Rate of Early Complications

Thomas E Moran; Adam J Tagliero; Richard E Campbell; G Bradley Reahl; Elizabeth K Driskill; Alexander J Wahl; David R Diduch

doi:10.1016/j.asmr.2024.100948

Tibial Tubercle Osteotomies Performed in an Outpatient Setting Have a Low Rate of Early Complications

Arthrosc Sports Med Rehabil. 2024 May 1;6(4):100948. doi: 10.1016/j.asmr.2024.100948. eCollection 2024 Aug.

Authors

Thomas E Moran¹, Adam J Tagliero¹, Richard E Campbell¹, G Bradley Reahl¹, Elizabeth K Driskill¹, Alexander J Wahl¹, David R Diduch¹

Affiliation

¹ Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.

Abstract

Purpose: To characterize the early postoperative complications following outpatient tibial tubercle osteotomy (TTO) to determine its safety in this setting.

Methods: Patients undergoing TTO by a single surgeon between July 2017 and August 2022 for patellar instability or patellofemoral chondromalacia and achieving a minimum of 3 months of clinical and radiographic follow-up were evaluated for inclusion. Although an inclusion criterion was a minimum follow-up of 3 months, if evidence of a healed osteotomy was observed sooner, final follow-up was accepted at 2 months. Patient demographics, perioperative risk factors, and incidence of complications were collected retrospectively. Categorical data were analyzed using χ² and Fisher exact tests. Continuous data were analyzed using 2-tailed t tests and Mann-Whitney U data for parametric and nonparametric data, respectively.

Results: A total of 195 knees in 167 patients met inclusion criteria, with a mean age of 24.7 ± 9.2 years and mean follow-up time of 10.9 months (range, 2-69 months). Fifty-one early postoperative complications occurred in 47 (24.1%) knees in 42 (25.1%) patients. Ten major and 41 minor complications occurred. Major complications were associated with older age (P = .015), smoking (P = .038), and smaller preoperative patellar tendon-lateral trochlear ridge distance (P = .012). Forty-four reoperations occurred in 42 (21.5%) knees in 37 (22.2%) patients. The most common reasons for reoperation included removal of symptomatic hardware (31 knees; 15.9%) and arthrofibrosis requiring lysis of adhesions and manipulation under anesthesia (8 knees; 4.1%). The mean time to reoperation was 13.0 months (range, 1-42 months). Smaller body mass index was associated with increased risk of reoperation (P = .002).

Conclusions: Outpatient TTO is safe when performed with the described technique, but the later development of minor complications is not infrequent following surgery. Patients should be counseled regarding a relatively high incidence of hardware irritation, arthrofibrosis, and eventual reoperation.

Level of evidence: Level IV, case series.