Why and Where to Move the Tibial Tubercle: Indications and Techniques for Tibial Tubercle Osteotomy

Background: Tibial Tubercle Osteotomy (TTO) is a surgical procedure designed to address disorders of the patellofemoral joint, including patellar instability, malignancy, and cartilage defects. The tibial tubercle, where the patellar tendon attaches to the tibia, plays a crucial role in maintaining the alignment and stability of the patella during knee movement. Abnormal positioning of the tibial tubercle can lead to increased lateral forces on the patella, resulting in dislocation and recurrent pain. Understanding the indications for TTO and the techniques involved is essential for orthopedic surgeons aiming to restore knee function and alleviate symptoms in patients with these conditions. Methods: This study reviews the current literature on tibial tubercle osteotomy, focusing on indications, surgical techniques, and outcomes. It synthesizes findings from studies conducted between ۲۰۱۰ and ۲۰۲۲, detailing anatomical considerations, patient selection criteria, and postoperative rehabilitation protocols. The review includes a description of various TTO techniques such as medialization, anteromedialization, and distalization, along with their respective benefits and potential complications. Additionally, this study discusses the demographics of patients who may benefit from TTO and evaluates the clinical outcomes related to these interventions. Results: Findings indicate that TTO is indicated for patients with significant patellar instability due to anatomical abnormalities, such as lateralization of the tibial tubercle or alta patella. The surgical techniques vary; for instance, anteromedialization involves repositioning the tibial tubercle medially and anteriorly to reduce lateral tension on the patella. Studies also show that TTO can significantly improve patient outcomes, with reported success rates ranging from ۷۰% to ۹۰% in reducing pain and preventing recurrences of dislocation. Moreover, complications may include delayed healing, residual instability, or over-correction leading to internal knee pain. Overall, TTO has been shown to effectively restore appropriate alignment of the patellar tendon and improve overall knee function. Conclusion: Consequently, tibial tubercle osteotomy is a valuable surgical option for managing patellofemoral joint disorders associated with misalignment and instability. By repositioning the tibial tubercle, surgeons can reduce excessive lateral forces on the patella, thereby improving stability and alleviating pain. Continued research to refine surgical techniques and identify optimal patient selection criteria is essential, and as the understanding of the biomechanical concepts related to tibial tubercle positioning evolves, strategies to address patellar instability will also advance.

کلیدواژه ها:

Tibial tubercle osteotomy (TTO) ، Patellar instability ، Patellofemoral joint ، Anteromedialization ، Surgical technique ، Knee alignment