Tibial Tubercle Osteotomy May Not Provide Additional Benefit in Treating Patella Dislocation with Increased Tibial Tuberosity-Trochlear Groove Distance: A Systematic Review.

Abstract Purpose To examine the indications and outcomes of medial patellofemoral ligament (MPFL) reconstruction with or without tibial tubercle osteotomy (TTO) in treating recurrent or habitual patella dislocation with increased tibial tuberosity-trochlear groove (TT-TG) distance. Methods A literature search was performed on the established medical databases Cochrane central, PubMed/MEDLINE, EMBASE, Web of science. Inclusion criteria were as follow: skeletal mature patients with recurrent or habitual patella dislocation and increased TT-TG distance; treating with MPFL reconstruction combined with TTO procedure or isolated MPFL reconstruction; clinical outcomes and complications reported. Each study was assessed for quality and level of evidence. General characteristics, indications, surgical techniques, TT-TG distance, clinical results, imaging evaluation and complications of each study were recorded. Results Nine studies consisting of 288 knees met the inclusion criteria. Average of Coleman scores was 71.56 (ranged from 55 to 83). The threshold of increased TT-TG distance ranged from 16 to 20 mm of included studies. And similar good postoperative outcomes were reported in patients with increased TT-TG distance treating with MPFL reconstruction with or without TTO procedure. The mean postoperative Lysholm score ranged from 75.0 to 94.7 (I2=87.6%) in isolated MPFLR group, and from 85.0 to 87.6 (I2=16.3%) in TTO with MPFLR group. Similar postoperative congruence angle (CA) were reported in both groups as well. Postoperative redislocation rate ranged from 0 to 4.2% in TTO with MPFLR group and no redislocation was found in isolated MPFLR group. Postoperative apprehension sign was only reported in isolated MPFL reconstruction. Conclusion The outcomes of MPFL reconstruction with or without TTO treating recurrent or habitual patella dislocation with increased TT-TG distance appeared to be similar. However, this study was limited by the considerable heterogeneity, variety of techniques, variety of TT-TG distances, and the variability of patella alta and trochlear dysplasia among the included studies.