Triple positioning of tibial tubercle osteotomy for patellofemoral disorders

Background and purposePatellofemoral disorders are often associated with patellofemoral malalignment. Tibial tubercle transfer is an effective method to correct the patellofemoral malalignment. This study evaluated the long-term results of triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders with 10-year follow-up.Patients and MethodsFifty-six patients with 62 knees underwent triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders. All patients received standard rehabilitation protocol postoperatively. The average length of follow-up was 128.5 ± 9.8 months (range 116 to 149). The evaluations included pain score, Kujala patellofemoral score, Lysholm score and radiograph of the knee.ResultsThe overall clinical results were excellent in 41.9%, good in 37%, fair in 12.9% and poor in 5% at 1 year; and 29% excellent, 41% good, 18.3% fair and 9.3% poor at 10 years. Satisfactory results were 78.9% and 70.9%, and unsatisfactory results 21.1% and 29.1% at 1 year and 10 years respectively. There was no correlation of clinical outcomes with age, sex, body weight and height and preoperative pain score. However, there was a positive correlation of clinical outcomes with the improvement of the congruence angle on postoperative X-rays of the knee, and a negative correlation of clinical outcome with the severity of articular cartilage damage assessed in arthroscopy. The complications included 1 non-union and 1 infection with non-union.ConclusionTriple positioning of tibial tubercle osteotomy is effective and long lasting in patients with patellofemoral disorders with 70.9% satisfactory results at 10-year follow-up.Level of evidenceIV (refer to instructions for detailed description on the level of evidence).