title: The Incidence of Complications of Tibial Tubercle Osteotomy: A Systematic Review.
abstract: OBJECTIVE
  The goal of this review was to quantify the risk of perioperative and early postoperative complications of tibial tubercle osteotomy (TTO) with different techniques.
  
  
  METHODS
  A systematic review of multiple databases was performed to identify studies that reported complications of TTO. Complications were defined as any adverse outcome, including osteotomy site nonunion, fracture, infection, wound complications, neurovascular complications, deep vein thrombosis (DVT), and pulmonary embolism (PE). Major complications were defined as nonunion, fracture, infections/wound complications requiring return to the operating room, and DVT or PE. The risk of subsequent hardware removal was also quantified.
  
  
  RESULTS
  The 19 identified studies included a total of 787 TTOs: 472 direct medialization procedures (Elmslie-Trillat technique), 193 anteromedialization procedures (Fulkerson technique), and 102 procedures in which the tibial tubercle was completely detached for medialization or distalization, or a combination. The overall complication risk was 4.6%. The risk of complications was higher when the tibial tubercle was completely detached (10.7%) than with Elmslie-Trillat (3.3%) or Fulkerson (3.7%) procedures (P = .004). The overall risk of major complications was 3.0%. Hardware removal was performed in 36.7% of osteotomies and was less frequent with the Elmslie-Trillat technique (26.8%) than with the Fulkerson technique (49.0%) or complete tubercle detachment (48.3%) (P < .001).
  
  
  CONCLUSIONS
  Tibial tubercle osteotomy is a complex surgical procedure with a significant risk of complications. Osteotomies that involve complete detachment of the tubercle have an increased risk of complications compared with those in which a distal cortical hinge is maintained.
  
  
  METHODS
  Level IV, systematic review of Level IV studies.
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Joshua
authors.initials: J
authors.lastname: Payne
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Nathan
authors.initials: N
authors.lastname: Rimmke
authors.affiliation: School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Schmitt
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
authors.affiliation: Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.. Electronic address: robert.magnussen@gmail.com.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Magnussen
mesh_terms: D016208:Databases, Factual; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome