Introduction

Patients with recurrent patella dislocations with trochlea dysplasia are commonly treated surgically with an osteotomy of the tibia tubercle. Traditionally, the recovery and rehabilitation is slow and protected out of concern for fixation failure but at the cost of stiffness, muscle atrophy and extended return to ADLs. A more aggressive rehabilitation protocol would improve patient outcomes so long as complications are not increased.

Purpose

To evaluate the safety and effectiveness of an aggressive weightbearing and early strength introduction post-operative rehabilitation program for tibial tubercle osteotomies (TTO).

Methods

This study is a retrospective case series of consecutive patients who underwent unilateral or staged bilateral TTO’s performed by a single surgeon from August 2013 to February 2018. Included were all patients with minimum 1-year follow-up. Surgical indication was for recurrent patella instability, lateral patella facet overload or anterior knee pain with elevated TTTG, all patients failed conservative measures. A diagnostic arthroscopy was performed to evaluate the cartilage surfaces, patella tracking followed by a TTO performed by use of a freehand technique and two 3.5-mm fully threaded screws for fixation. Aggressive post-operative rehabilitation was implemented allowing patients to be immediate full weightbearing with an unlocked hinged knee brace as soon as acceptable quadriceps function was observed postoperatively. Lower extremity strengthening was implemented at 4 wks. Return to sport at 3-4 Months. Patients were evaluated retrospectively using a questionnaire and chart review to determine rate of complication, outcomes scores including the Kujala and Knee Injury and Osteoarthritis Outcome Score (KOOS) and range of motion were obtained at least 6 months from the date of surgery. Demographic data including age, BMI, sex, laterality, surgical indications, concomitant surgeries.

Results

A total of 59 knees in 55 patients (40 female; 15 male) with an average age of 29.9±12.3 years (range 14-56) were analyzed. Outcomes from post-operative questionnaires were as follows: SANE: 86.11 ± 11.40, Kujala: 73.8±20.5 and KOOS: 74.1±18.4. There was no statistically significant difference in the pre -and postoperative average range of motion (121.8±28.3 vs 130.4±8.8 degrees, p =.06). Complications included; 5/59 recurrent instability symptoms, 1 tibia fractures, 0 non-unions, 1 DVT/PE, 6 Patients with arthrofibrosis requiring surgery. One patient required conversion to PFA, 4 patients required removal of symptomatic hardware.

Conclusion

Aggressive postoperative rehabilitation in TTO patients has demonstrated to be a safe and effective means of treatment with good subjective and objective outcomes and complications lower than traditional rehabilitation protocols.