Purpose
Tibial tubercle osteotomy (TTO) is a powerful tool for addressing malalignment in a variety of patellofemoral disorders. The use of a novel surgical system has created the opportunity to improve the modularity, precision, customization, and reproducibility of this surgery. This study aims to report early safety results from a cohort of TTO surgeries performed using the Multi-Direction Tibial Tubercle Transfer (MD3TTM) system (KINAMED INCORPORATED, USA). We hypothesized that the MD3TTM system would yield good safety outcomes and low complication rates at short to midterm follow-up.
Methods
This was a prospective study that took place at a single center between March 2020 and August 2022. The study included 39 consecutive TTO procedures performed using the MD3TTM system in skeletally mature patients. Electronic medical records were reviewed including demographic data, osteotomy type, other intra-operative findings, and complications including re-operation and revision. Results were statistically analyzed.
Results
A total of 39 knees in 36 patients (25 female, 11 male) were included, with three patients having bilateral TTO surgeries. The average participant age was 28.6 years (range 16 - 69). The patient chief complaints included pain (n = 12, 31%), instability (n = 11, 28%) or both (n = 16, 41%). The mean follow-up period was 14.7 months (range 0.25 - 33). TTO surgeries included isolated anteriorization (n = 4), combined anteromedialization (AMZ) (n = 22), medialization and distalization (n = 3), AMZ + distalization (n = 9), and AMZ + proximalization (n = 1). Within the study period, there were no revision surgeries due to fracture or non-union and no patients developed deep vein thrombosis (DVT). There were 5 cases (13%) of superficial wound erythema noted within two weeks of surgery which were treated with oral antibiotics for up to 7 days until complete resolution. No patient had a proven infection or required surgical intervention for wound complication or deep infection. There was one case (3%) of hardware removal combined with surgical lysis of adhesions due to stiffness at 7 months post-op.
Conclusion
Early surgical experience using the MD3TTM system for TTO surgery is encouraging. Regardless of the etiology or the type of translation performed, the preliminary results yield good safety outcomes and low complication rates at short and midterm follow-up.
KEYWORDS:
Tibial tubercle osteotomy (TTO), Tibial tubercle transfer, Fulkerson osteotomy, Anteromedialization, Complication