TITLE:
Long-Term Clinical Outcome of the Tibial Tuberosity Osteotomy in Patients with Patellar Instability
AUTHORS:
Mads Hoelgaard Christensen, Christina Emborg, Sinan Said, Carsten M. Mølgaard
KEYWORDS:
Knee, Tibial Osteotomy, Patella instability, Luxation, Knee Pain
JOURNAL NAME:
Open Access Library Journal,
Vol.11 No.6,
June
7,
2024
ABSTRACT: Background: Surgical management of patellofemoral instability involves various procedures, including tibial tubercle osteotomy (TTO), aimed at improving patellar tracking and reducing stress on the patellar articular cartilage. This study focuses on the long-term outcomes and patient satisfaction following TTO, particularly the Trillat procedure, performed as a standalone surgical intervention for patellofemoral instability. Methods: A retrospective analysis was conducted on patients who underwent the Trillat procedure between 2000 and 2012 at Aalborg University Hospital. Clinical evaluations were performed, including range of motion assessment, stability tests, and functional scoring using the Kujala Anterior Knee Pain Scale, International Knee Documentation Committee score, and Lysholm Knee Scoring Scale. Additionally, patients reported subjective satisfaction and perceived sensations of recurrent patellar dislocation or subluxation. Results: Fifty-three patients (54% of the initial cohort) with a mean follow-up of 9.8 years were included. The average subjective satisfaction score (SANE) was 6.5 out of 10, with over 60% reporting a score above 5 and expressing willingness to undergo the procedure again. Functional scores indicated fair outcomes, with a mean Kujala score of 66.8 and a mean Lysholm score of 67%. However, 36% of patients reported sensations of recurrent patellar subluxation or dislocation postoperatively. Clinical signs of cartilage defects were observed in 43% of knees, with associated tenderness and crepitus in some cases. Conclusion: TTO, specifically the Trillat procedure, demonstrates mixed outcomes in the long term for patellofemoral instability. While it can prevent most cases of recurrent dislocations, its effectiveness as a standalone surgical treatment is limited. Careful consideration should be given to patient selection, and TTO should be reserved for cases where patellar stability cannot be ensured by alternative procedures such as MPFL reconstruction.