Anterior Tibial Tuberosity Osteotomy in Patellar Instability: There are No Differences in Functional Clinical Outcomes or Bone Healing between Fixation with One 6.5-mm Screw and Two 4-mm Screws

Abstract

Introduction Anterior tibial tubercle (ATT) osteotomies can be fixed with one or more screws. Nevertheless, limited evidence is available regarding the optimal number of screws.

Objective To compare the functional and radiographic outcomes and complications of patients who underwent ATT osteotomy fixed with one 6.5-mm or two 4-mm screws. Our hypothesis is that fixation of the ATT with two 4mm screws yields better functional and radiological outcomes and fewer complications.

Materials and Methods We conducted a retrospective, multicentric study including 30 patients who underwent ATT osteotomy fixation with one 6.5-mm cancellous screw (group 1; n = 15) or two 4-mm cancellous screws (group 2; n = 15) with a minimum follow-up of 2 years. We excluded patients who underwent medial patellofemoral ligament reconstruction and those with inflammatory or severe degenerative knee disease. Clinical and radiological data, as well as complications, were recorded. The functional outcomes were assessed through Lysholm and Kujala scales and bone healing, through the Cornu scale. In the statistical analysis, values of p < 0.05 were deemed significant, and grade 1 on the Cornu scale was considered the parameter for bone healing.

Results As for the functional results, on the Lysholm scale, group 1 presented a median score of 78 (range: 23–95) points, and group 2, a median of 81 (range: 25–100) points (p = 0.632); On the Kujala scale, group 1 presented a median score of 79 (range: 38–97) points, and group 2, a median of 80 (range: 39–100) points (p = 0.819). The median time until bone healing was of 2 months in both groups (p = 0.694). Regarding complications, one case of delayed union and one case of symptomatic hardware removal were observed in each group.

Conclusion No clinical and radiographical differences were observed between the fixation of ATT osteotomies with one 6.5-mm or two 4-mm screws.

Level of evidence IV.

Keywords

patellofemoral instability - anterior tibial tubercle osteotomy - fixation - screws - bone healing

Publikationsverlauf

Eingereicht: 18. April 2023

Angenommen: 29. Mai 2024

Artikel online veröffentlicht:
25. September 2024

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