Early Postoperative Complications and Associated Variables After Tibial Tubercle Osteotomy: A 15-Year Experience From a Single Academic Institution

Alexander N Berk; Kennedy K Gachigi; David P Trofa; Dana P Piasecki; James E Fleischli; Bryan M Saltzman

doi:10.1177/23259671231194367

Early Postoperative Complications and Associated Variables After Tibial Tubercle Osteotomy: A 15-Year Experience From a Single Academic Institution

Orthop J Sports Med. 2023 Oct 18;11(10):23259671231194367. doi: 10.1177/23259671231194367. eCollection 2023 Oct.

Authors

Alexander N Berk^{1

2

3}, Kennedy K Gachigi^{1

2}, David P Trofa⁴, Dana P Piasecki^{1

2

3}, James E Fleischli^{1

2

3}, Bryan M Saltzman^{1

2

3}

Affiliations

¹ OrthoCarolina-Sports Medicine Center, Charlotte, North Carolina, USA.
² OrthoCarolina Research Institute, Charlotte, North Carolina, USA.
³ Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, North Carolina, USA.
⁴ Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA.

Abstract

Background: Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patients with patellofemoral disorders.

Purpose: To determine the rate of early (≤90 day) postoperative complications after TTO and variables related to postoperative complications.

Study design: Case series; Level of evidence, 4.

Methods: Patients who underwent TTO at a single academic institution within a 15-year period (2008-2022) were identified. All patients with a minimum 90-day follow-up were considered for study inclusion. Exclusion criteria were age younger than 14 years and revision surgery. Patient characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications.

Results: A total of 344 knees in 313 patients met eligibility criteria and were included in the final analysis. One intraoperative complication (0.3%), a premature closure of the incision before repair of the vastus medialis, was identified. There were 141 postoperative complications (138 surgical, 3 medical) in 118 patients for a complication rate of 34.3%. The most common complications were stiffness requiring a nonstandard-of-care intervention (16.3%), superficial wound infection/wound dehiscence (8.1%), and hemarthrosis/effusion requiring aspiration (5.8%). Patients experiencing postoperative complications were older (mean difference, 3.49 years; 95% CI, 1.26-5.73 years; P = .002), had a higher mean Charlson Comorbidity Index (mean difference, 0.26; 95% CI, 0.08-0.45; P = .006), and were more likely to be current smokers (P = .015) compared with patients with no complications. Inpatient surgery (defined as surgery in a hospital setting with at least 1 overnight stay) was associated with postoperative complications (odds ratio [OR], 2.29; 95% CI, 1.39-3.77; P = .001); this association remained significant generation of a multivariate model (OR, 2.07; 95% CI, 1.19-3.58; P = .010). Previous surgery on the ipsilateral knee (P < .001) and concomitant autologous chondrocyte implantation (P = .046) were also associated with postoperative complications.

Conclusion: The study findings indicated a low intraoperative complication rate (0.3%) and a relatively high early postoperative (≤90 day) complication rate (34.3%) after TTO. Variables associated with postoperative complications included greater age, higher Charlson Comorbidity Index, surgery in an inpatient setting, previous surgery on the ipsilateral knee, and concomitant autologous chondrocyte implantation.

Keywords: adverse events; complications; patellar instability; patellar maltracking; patellofemoral pain; tibial tubercle osteotomy.