Low Complication Rate Following Contemporary Pure Anteriorization Tibial Tubercle Osteotomy for Patellofemoral Chondral Wear in Patients Aged Less Than 50 Years

PURPOSE: To assess the safety of a contemporary pure anteriorization tibial tubercle osteotomy (aTTO) technique for patellofemoral chondral wear. METHODS: Consecutive patients undergoing a modern aTTO technique for patellofemoral chondral wear from 2016 to 2024 with minimum 6-month follow-up were evaluated. Indications included symptomatic patellofemoral chondral wear in young (age < 50 years) active patients, among patients with normal coronal (i.e., tibial tubercle-trochlear groove < 15) and axial (i.e., Caton-Deschamps Index < 1.3) plane alignment. The primary outcome was overall complication rate, including wound complications, nonunion, and fracture, among others. Removal of hardware was offered to all our patients and not considered a complication. Categorical comparisons were made with Fisher exact tests. RESULTS: There were 57 patients with a mean follow-up of 2.4 years. The mean (standard deviation) age was 30.5 (7.2) years and 54.4% of patients were women. Thirty-nine (68.4%) patients underwent concomitant cartilage restoration. Mean operative anteriorization was 11.2 (2.2) mm. The overall complication rate was 5.3% (3 patients), including 2 (3.5%) manipulations under anesthesia for arthrofibrosis and 1 (1.8%) superficial cellulitis successfully managed with oral antibiotics alone. There was no difference in complication rates patients between patients who underwent aTTO alone and aTTO with concomitant cartilage restoration procedures within the numbers available (5.6% vs 5.1%, P > .99). There were no episodes (0%) of wound dehiscence, deep surgical site infection, nonunion, or fracture. Eighteen (31.6%) patients underwent elective removal of hardware. CONCLUSIONS: Contemporary pure aTTO can be performed safely for isolated patellofemoral chondral wear, with no instances of wound breakdown or nonunion/fracture encountered in this series. Given the growing recognition of the importance of sagittal plane alignment on patellofemoral cartilage health, these findings suggest that contemporary aTTO may be considered as a treatment option for patients with patellofemoral chondral wear who may not be ideal candidates for traditional TTO techniques. LEVEL OF EVIDENCE: Level IV, retrospective case series.