tibial tubercle osteotomy complications

I had shoulder cuff repair, involving 2 ligaments & bone spurs, only 6 weeks ago. This article does not contain any studies with human participants or animals performed by any of the authors. Columbia University's Center for Shoulder, Elbow and Sports Medicine. Medialization TTT is the most common type of procedure and involves transfer of the tibial tubercle to a more medial position on the tibia. Screw breakage occurred only once, which was discovered 6months after the surgery, but with the consolidation of the osteotomy and a Caton index of 1.1, no further action was needed. EFOST surgical techniques in sports medicineknee surgery, vol 2. If they do, they can be removed after the bone has healed in its new position. The results of trochleoplasty have been described more recently, and the . A Guide to Orthopedic Care, Pediatric & Adolescent Sports Medicine Injuries, Get the Perfect Grip on Your Next Game: Adaptive Golf Gloves, Healthcare Journal of Baton Rouge Mentions Dr. Burnham Performing New Surgery to Repair Torn ACL, Sports Medicine Near Me: Finding the Right Doctor for You, When to See a Doctor for Knee Pain When Bending: The Complete Guide, 11 Benefits of Exercise: It Can Change Your Life, Knee Bursitis: Causes, Symptoms, and Treatment Options, Your Childs Knocked Knees: Everything You Need to Know, BioUni OATS Procedure Cartilage Replacement for the Knee, Capsulorraphy Shoulder Stabilization Procedure. My 14 year old son originally went in to see Dr. Burnham very scared (he hadn't had an injury before) and he was instantly made to feel at ease. Luhmann SJ, Fuhrhop S, ODonnell JC, Gordon JE. A Chi-square test was performed to look at the differences in the male-to-female ratio, and an unpaired T test to look at the differences in the age between the groups with and without complications. sharing sensitive information, make sure youre on a federal Tibial tubercle osteotomy and transfer is done through an incision made in the front of your leg just below the patella. DOI: 10.1016/j.jisako.2022.11.005 Corpus ID: 253899986; High Incidence of Complication Following Tibial Tubercle Surgery". The goal of the surgery is to improve patellar tracking and stability, alleviate pain, and take pressure off of the cartilage. The .gov means its official. He made my daughter feel comfortable and made sure to listen to both of our concerns prior to his diagnosis. Revisiting Fulkersons original technique for tibial tubercle transfer: easing technical demand and improving versatility. Epub 2018 Jan 23. Both fractures were stabilized with a locking compression plate. The goals of this operation are to: wedge Improve knee alignment graft Shift weight from the arthritic part of the knee onto a healthier part of the knee Level IV, systematic review of Level IV studies. Removal of the screws because of irritation or pain was seen in 22 cases (8.2%). 2016 Jun;32(6):1185-95. doi: 10.1016/j.arthro.2015.11.039. Most commonly, osteotomies about the knee are cuts in the top of the shin or "tibia" bone. One hundred and four knees (52%) underwent elective hardware removal because of soft tissue discomfort. An overview of complications is displayed in Table Table2.2. In their review, the complication rate lies between 3.3 and 10.7%. there would be low rates of serious complications after medial opening wedge high tibial osteotomy utilizing an internal locking plate xator. Epub 2016 Feb 13. 2001;29(4):4039. concluded that the risk of complications is related to the employed technique [6]. sharing sensitive information, make sure youre on a federal There were two cases in which there was a problem with the part of bone removed from the distal side that was pressed into the proximal part of the osteotomy. Accessibility 2022. There was no significant difference in the age between patients with and without complications (p=0.80), but the amount of women in the group with complications was higher compared to the group without complications (Chi-square= 4.5765, p=0.03). Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature. Anteromedial tibial tubercle transfer without bone graft. @article{Lundeen2022HighIO, title={High Incidence of Complication Following Tibial Tubercle Surgery". 1997;25:5337. Dr Burnham is so personable. Secondly, the tibial fractures were only seen in 0.76%, again less than reported by Payne et al. 2022 Jun 30;4(4):e1397-e1402. It has since become a commonly-performed orthopedic procedure, with several different techniques being developed over the years. There are several different types of TTT, which vary based on the specific location of the tibial tubercle transfer. Kanamiya T, Naito M, Ikari N, Hara M. The effect of surgical dissections on blood flow to the tibial tubercle. a The red dashed line reflects the cut for complete detachment of the tibial tubercle. However, every patient experiences pain differently, and some may experience more discomfort than others. A, The area for a tibial tubercle osteotomy of 8 to 10 cm is outlined. And I feel my rode to recovery will be wonderful. The https:// ensures that you are connecting to the It is important to ensure that the patellar tendon remains attached to the tibial tubercle during this process. Kanamiya T, Naito M, Hara M, et al . With stability issues caught early, the probability of arthritis or further issues decreases. National Library of Medicine My daughter injured her ankle in cross country practice and we were able to get in the next day to see Dr. Burnham. It may be 4-6 months before the bone heals enough to withstand the substantial stress that accompanies high impact activities, heavy lifting, and running. The other three complications occurred only once (0.38%): a superficial wound infection with a S. aureus for which a patient got antibiotics for 6weeks, a deep flexion contracture of 90 which was restored without further surgery after 5months to 130, and a delayed union. Distal tibial tubercle transfer for patellar instability. 2018 Jan;34(1):189-197. doi: 10.1016/j.arthro.2017.07.020. Tibial tubercle osteotomy and transfer is done through an incision made in the front of your leg just below the patella. A review of the literature. TTO was most commonly performed for isolated patellar instability in the presence of knee pain. Background:Patellofemoral (PF) dysplasia is common in patients with recurrent patellar instability. It is a surgical procedure to improve alignment of the patella. Morris E, Gillings SL, Jessen CR, Lipowitz AJ. With the help of an oscillating saw, a cut is made medial to the tuberosity and a distal cut is also made. Tibial tubercle osteotomy is a surgical procedure which is performed along with other procedures to treat patellar instability, patellofemoral pain, and osteoarthritis. From our data, we cannot confirm this theoretical concept in practice. I would highly recommend him. Copyright 2015 Arthroscopy Association of North America. 2015 Sep;31(9):1819-25. doi: 10.1016/j.arthro.2015.03.028. An official website of the United States government. Adding anteriorization to a standard medialization procedure allows unloading of the cartilage and can help improve knee pain and less cartilage contact pressures. Tibial tubercle osteotomy (TTO) is one of the many proce-dures utilized in the treatment of recurrent patellar insta- . Google Scholar. }, author={Anna Lundeen and Jeffrey A Macalena and Julie Agel and Elizabeth A. Arendt}, journal={Journal of ISAKOS : joint disorders \& orthopaedic sports medicine}, year . Dr. Burnham took his time and answered all my questions with explanations. Very professional! Accessibility The other remarkable finding was the lower number of screw removals in this case series. CrossRef 1b). PMC The procedure is typically performed through an incision on the front of the knee. and transmitted securely. 24.6 ), following tibial tubercle osteotomies, can occur from perpetuation of the osteotomy cut through the proximal tibia since the anterior cortex of the proximal tibia is disrupted with any osteotomy. The average cost of Fulkerson osteotomy is about 4500$. Dr. Burnham and his remarkable staff have been a godsend for our son. * Patella alta when the patella is positioned too high on the femur on patients with recurrent patellar instability, * Patellofemoral cartilage loss with or without cartilage restoration procedure, * Trochlear dysplasia when the groove that the kneecap glides in is too shallow. 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). Imaging studies, such as x-rays, lower extremity alignment films, CT scan, and MRI, may also be ordered to further evaluate the patellar instability or patellofemoral pain. eCollection 2022 Aug. Sanchis-Alfonso V, Domenech-Fernandez J, Ferras-Tarrago J, Rosello-Aon A, Teitge RA. and transmitted securely. Bethesda, MD 20894, Web Policies omy cut for tibial tubercle osteotomy within appropriately placed cutting jig. They explain things very well. Highly recommended! Painful screws requiring removal occur in 3% to 77% of cases. Both my children have seen Dr. Burnham with great results. Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment. Two patients (0.76%) sustained a tibial shaft fracture at the side of the step-cut performed during the transfer surgery: the first patient while jumping on one leg during rehabilitation 2.5months after the surgery, and the other after 6.5months after a fall. This typically resolves on its own within a few weeks, but may require physical therapy or other interventions. He and his staff could not have been more helpful and professional. The .gov means its official. . Proximalisation of the tubercle without screw breakage was seen in three patients (1.14%), and this was recognized after 10days, 3weeks, and 3months, respectively; all three patients had the screws revised after which the osteotomy fully consolidated. Severe complications such as compartment syndrome and pulmonary embolism are rare. An official website of the United States government. QueryAlthough both the tibial fractures were seen after first 6 weeks, we think that protecting the tibia in the first stadium of bone healing will give less excessive stress on the damaged cortex at the distal cut, which is perpendicular to the shaft, and so prevents the tibial shaft fractures. Very positive experience at Bone and Joint Clinic in Baton Rouge. Recovery times vary from individual to individual, but most patients are kept non-weight bearing for 6 weeks. In osteotomy procedure, a periosteal incision of 8-10 cm length is made at 1cm medial to the tibial tubercle. van de Groes SAW. In case of recurrent patellar instability, surgical management results in a lower risk of recurrent dislocation than conservative management [1]. Rare complications include potential risk of blood clot, infection and fracture or delayed bone healing. They concluded that when adequate exposure cannot be obtained, step-cut TTO is a safe and reproducible procedure if strict attention is paid to technique and fixation. Running and other high-impact activities will take longer, sometimes up to a year. Learn more My daughter recovered fully from a total knee reconstruction and now she able to return to sports. They walked me through the process from beginning to end. Most often 2-3 screws are placed from the anterior aspect of the tibial tuberosity into the posterior tibial cortex. Dr. Jeremy Burnham is an orthopedic surgeon in Louisiana who is specialty-trained in complex knee surgeries to address patellofemoral instability, such as transfers and osteotomies of the tibial tubercle. Sports Med Arthrosc Rev. Tibial tubercle osteotomy is a technique gaining popularity in knee revision surgery which allows exposure and access to the medullary canal of the tibia, with reduced risk of extensor lag compared to techniques involving the quadriceps [ 1 ]. 0.5% for wound complications, 0.8% for tibial tubercle fractures, and 1.9% for proximal tibia fractures. Early weight-bearing and complete detachment of the distal tuberosity may increase these risks. Pain medication can be used to help manage any pain that does occur. https://doi.org/10.1007/978-3-662-61097-8_24, DOI: https://doi.org/10.1007/978-3-662-61097-8_24, Publisher Name: Springer, Berlin, Heidelberg. Ridley TJ, Baer M, Macalena JA. TTT was first described in the early 1900s as a treatment for patellar instability. Log In or Register to continue You may also need Factors associated with early tibial tuberosity fracture after tibial plateau leveling osteotomy. Methods: Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. FOIA Tibial tubercle osteotomy is a complex surgical procedure with significant risk of complications. The risk of subsequent hardware removal was also quantified. Dr. Burnham and Jerrica did a great job taking care of all my orthopedic needs. 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. Painful screws requiring removal occur in 3% to 77% of cases. Knee Surg Sports Traumatol Arthrosc. This is a quite safe procedure and provides excellent access and surgical exposure during a difficult primary or revision total knee arthroplasty. It is important to understand potential complications of tibial tuberosity osteotomies (TTOs) and how to avoid them. sharing sensitive information, make sure youre on a federal Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). Tibial tubercle osteotomy is a surgical procedure that is performed along with other procedures to treat patellar instability, patellofemoral pain, and osteoarthritis. If you're an athlete needing a doctor that understands; this is the guy. The site is secure. Tibial tubercle osteotomy is a complex surgical procedure with a significant risk of complications. Federal government websites often end in .gov or .mil. It has been recommended that these screws should be at least 2mm longer than the measured bi-cortical distance to ensure adequate bite [13]. [6]. A systematic review of multiple databases was performed to identify studies that reported complications of TTO. government site. Lateralization of the tibial tubercle is most often measured using the tibial tubercle-trochlear groove distance (TTTG). Recurrent instability occurs in 5% of cases at 5 years. Great shoulder doc. According to a study, fibular fractures occurred in 5.4 percent of TPLO procedures. The goal of this review was to quantify the risk of perioperative and early postoperative complications of tibial tubercle osteotomy (TTO) with different techniques. 8600 Rockville Pike http://creativecommons.org/licenses/by/4.0/. A fibrous layer on the V-shaped fragment was excised and a third screw was placed to increase stability, and this resulted in consolidation after 5months. Wolfe EL, Mintz DN, et al. Once the tibial tubercle is in its new position, it is typically secured with screws and/or a plate and screws. doi: 10.1016/j.asmr.2022.04.028. For some patients who have knee arthritis, this surgery can delay or prevent the need for a partial or total knee replacement by preserving damaged joint . eCollection 2022 Sep. Doran M, Essilfie AA, Hurley ET, Bloom DA, Manjunath AK, Jazrawi LM, Strauss EJ, Alaia MJ. Several surgical techniques are described. How do I prepare for TTO? Operative versus non-operative management of patellar dislocation. Recommend highly. A V-shaped TTO is a safe procedure. The bones must heal before they can bear weight after tibial tubercle transfer. Published by Elsevier Inc. All rights reserved. The attachment parts are permanent unless they cause pain. His staff is very friendly and upbeat, knowledgeable and thorough. In: Klos B, Jones H, editors. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Values higher than 1.2 indicate increased patellar height that may contribute to patellar instability and patella dislocation. Risks following tibial tubercle osteotomy surgery are rare but may . Amazing doctor, amazing family mantreats patients with the highest level of care, compassion, and quality! Figure 7. In young and active patients, closing-wedge high tibial osteotomies are reliable procedures in the treatment of osteoarthritis of the medial compartment of the knee. Caton JH, Dejour D. TTO Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. In the end he offered the best treatment for me.This is the first time in months that I have felt myself. 2021 Dec 20;11(1):e7-e12. The infection rate was 0.76% with one septic arthritis and one superficial wound infection, comparable to the findings of Payne et al. 10.2 Literature Review of Complications. Very reassuring, showed me X-rays and explained the healing process very clearly. Online ahead of print. [6] in their systematic review, the incidence in our group (0.38%) is even lower. Median follow-up was 4months (range 3120months), because standard follow-up was only up to 4months if uncomplicated. Tibial tubercle transfer (TTT), also known as tibial tubercle osteotomy (TTO), or Fulkerson osteotomy, is a surgical procedure that is performed to correct lateral displacement of the tibial tubercle. Magnetic Resonance Imaging Validation of Tibial Tubercle Transfer Distance in the Fulkerson Osteotomy: A Clinical and Cadaveric Study. Before The healing phase is long, but he does A+ work. . Keywords: tibial tuberosity osteotomy; patellofemoral; knee; surgical management; biomechanics; instability; tibial . Physical therapy and other holistic methods may be used to help with the pain. Dr. Burnham performed my hip pin surgery and it all went extremely well. This study, however, points out that in experienced hands, this type of TTO is a relatively safe technique. Conclusions: Methods This study included 169 consecutive patients (200 knees) who underwent MOWHTO with a Tomox locking plate at a single center, completing a minimum 2-year follow-up. A long tibial stem, cemented or press-fit, that cannot be removed via access to only the tibial plateau-baseplate interface but instead requires access to the tibial stem in the medullary canal to break up the ingrowth and/or cement fixation. Dr. Burnham was very thorough with his examination and diagnosis. Kakazu R, Luczak SB, Grimm NL, Fitzsimmons KP, Andrish JT, Farrow LD, Pace JL. Help with .mp4 files. Risks and complications. The surgical technique involves transfer of the tibial tubercle from its original location to a new site on the tibia, depending on the specific pathology that is being treated. Dr. Jeremy Burnham is an orthopedic surgeon in Louisiana who is specialty-trained in complex knee surgeries. The sum of forces acting on the medial and lateral patellar facet and . 2016 May;32(5):929-43. doi: 10.1016/j.arthro.2015.10.019. Thanks to his staff for being so helpful. Most people can put weight on their operated leg 4 to 6 weeks after surgery but wont have full range of motion for 3 to 4 months. Lubowitz JH. In three cases, the tibial tubercle proximalised without breakage of the screws. 2006. Joint preservation surgery to repair damage to articular cartilage inflicted by osteoarthritis and malalignment. When considering surgery, your orthopedic surgeon will obtain a detailed history of your symptoms and previous treatments. Knee Surg Sports Traumatol Arthrosc. It can take up to a year for the MPFL graft to fully attach to the bone. Most studies maintain percentages up to 50% of the hardware removal in TTO. Previous studies emphasize that detaching osteotomies results in devascularisation, which can lead to non-union and tibial shaft fractures. official website and that any information you provide is encrypted How is Tibial Tubercle Osteotomy Performed, Tibial tubercle transfer (TTT), also known as tibial tubercle osteotomy (TTO), between 60-77.5% of patients are able to return to the same level of sports activity after surgery. . This bone block was placed in the gap on the proximal side to enhance stability and to provide a more stable situation of the tuberosity (Fig. Stable compression was obtained. The https:// ensures that you are connecting to the A A triplanar osteotomy (6.5 cm in height with a width of 1.5 cm) was created on the medial cortex of the proximal tibia along the 3 sides (proximal, distal, and lateral) of the rectangle; the medial margin of the tibia was used as the medial side of the rectangle.B-D 2 curved skin incisions were made. Federal government websites often end in .gov or .mil. Risks following Tibial Tubercle Osteotomy surgery are rare but may include compartment syndrome, deep vein thrombosis, infections and delayed bone healing Background: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Complications after tibial tuberosity osteotomy: association with screw size and concomitant distalization. Current estimates of TTO complications in the literature vary widely; with complication rates reaching 59 percent. When performing a V-shaped TTO, the tibial tubercle with periosteum is completely detached from the tibia and a step-cut osteotomy is used [7]. BACKGROUND: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Tibial fractures after tibial tubercle osteotomies for patellar instability: a comparison of three osteotomy configurations. Avoiding Complications in Cervical Disc Arthroplasty 34:54. Revision lateralization osteotomy of the tibial tubercle has excellent outcomes in patients suffering from previous medial tibial tubercle overcorrection. This site needs JavaScript to work properly. I am a coach, and I have two boys playing sports, the best thing I can say is that my sons will go see Dr. Burnham in the event they are injured, and I will always recommend him to my athletes. eCollection 2022 Jan. Editorial Commentary: Tibial Tubercle Osteotomy Complications Are Most Common With Complete Detachment of the Distal Periosteal Hinge. All patients were followed up until at least 4months, so wound problems or non-unions would have been detected. TTO is indicated in patients with recurrent patellar dislocations due to patella alta or an increased tibial tubercletrochlear groove (TTTG) distance. osteotomy site Osteotomy means cutting the bone. If the bone has not healed in the anticipated mount of time typically four to six months, it is called a delayed union. Out of the 263 knees, 144 (54.8%) had at least one additional procedure to the TTO. Schematic drawing of the V-shaped tibial TTO tubercle osteotomy for transfer. The best surgeon is Baton Rouge that actually care about his patients!!! Risks following tibial tubercle osteotomy surgery are rare but may . The type of TTO used in this study is an osteotomy in three planes. In osteotomy procedure, a periosteal incision of 8-10 cm length is made at a distance of 1cm medial to the tibial tubercle. Only small sample size studies have been performed on this subject to the best of our knowledge [5, 11]. Tibial Tubercle Osteotomy is a surgical procedure which is performed along with other procedures to treat kneecap (patellar) instability, pain and osteoarthritis. This variability is due, in part, to inconsistent definitions of complication between studies. In patients with medial compartment osteoarthritis (OA) and varus malalignment, high tibial osteotomy (HTO) is a well-established joint preserving treatment option , , , which aims to realign the mechanical axis, offload the medial compartment with the overall goal of reducing pain, improving joint function and delaying the progression of end stage osteoarthritis. This systematic review aims to investigate whether one technique is superior to the other. Incisional complications, tibial tuberosity fractures, and implant failure were the most commonly reported complications after . Secondly, it is very important to make the distal cut carefully and not too far into the cortex of the tibia. Thirteen knees (4.9%) had a major complication. MeSH Part of Springer Nature. Orthopaedic surgeons assess the entire picture and dont make surgical decisions on just one parameter. Ill def refer friends and family! Careers. It is important to understand potential complications of tibial tuberosity osteotomies (TTOs) and how to avoid them. A review of the literature. He is walking without a limb and is on schedule with his progress. Dr. Jeremy Burnham did a reconstruction of my ACL on April 19th. He is amazing and a blessing to have in the medical industry. A Tibial Tubercle Osteotomy works by correcting the malalignment of the patella in the trochlear groove. Tibial tubercle osteotomy (TTO) is most commonly performed for isolated patellar instability in the presence of knee pain. The retrospective case series comprised a large cohort of 263 knees with patella alta in 203 patients who underwent a V-shaped TTO, with or without additional realignment procedures, between March 2004 and October 2017. Patellar instability occurs when the patella is not properly aligned with the femur, or thighbone. I never met a doctor and his team that showed some much compassion about their patient. Revision lateralization osteotomy of the tibial tubercle has excellent outcomes in patients suffering from previous medial tibial tubercle overcorrection. From along term standpoint, knee pain typically improves dramatically. Beer P, Bockstahler B, Schnabl-Feichter E. Tibial plateau leveling osteotomy and tibial tuberosity advancement - a systematic review. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). This is quite a safe procedure and provides excellent access and surgical exposure during a difficult primary or revision total knee arthroplasty. Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. Springer, Berlin, Heidelberg. Arthroscopy. Disclaimer, National Library of Medicine Orthop J Sports Med. 2022 Oct;30(10):3515-3525. doi: 10.1007/s00167-022-06964-x. The .gov means its official. This helps to realign the patella and improve joint function. Those factors include the location, anesthesia used, aftercare, and most importantly, the expertise of the concerned surgeon. Dr. Burnham & his staff are very personable & caring. These include, but are not limited to:InfectionBleedingNerve injuryBlood clotsJoint stiffnessLoosening or breakage of implantsFailure of the bone to heal properly. Tibial tubercle osteotomy (TTO) is performed with goals of correcting patellar maltracking and redistributing contact forces across the PF joint. I have been very pleased with him at each visit. Orthop J Sports Med. My daughter journey was very trying and hard but we made it through with all of their help. The incidence of complications of tibial tubercle osteotomy: a systematic review. We had a wonderful experience and I highly recommend him. A piece of bone from the tibia is removed to correct the CatonDeschamps index to 1 as planned preoperatively. Takes his time with you and doesn't hurry to rush out of the room if you have questions. Dr. Burnham clearly cares about his patients and their follow up care. It can be used to change the position/load between the patella and the trochlear sulcus by moving the tubercle in different directions including distal, medial, anterior, or a combination of these. He was outstanding. Abstract. Smith TO, Song F, Donell ST, Hing CB. Knows his stuff. Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Level of evidence: Level IV, systematic review of Level IV studies. Treatment may be nonoperative or operative depending on location of the fracture, degree of displacement, and any associated injuries. It does not compromise the functional results of TKA. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. Careers, Archives of Orthopaedic and Trauma Surgery, MPFL, Patellofemoral instability, Tibial tubercle, TTO. Dr. Burnham was very thorough and took the time to explain what he thought my root problem may be, why, and how he suggested we proceed with my care. A self-centring osteotomy of the tibial tubercle for patellar maltracking or instability: results with ten-years' follow-up. Many delayed unions go on to heal; limited non-weight bearing may be required to resolve this. Would you like email updates of new search results? Bethesda, MD 20894, Web Policies The tibial tubercle is then moved to a new position and secured with screws or a plate and screws. Normal TTTG values range from 10-12mm, while anything higher than 20mm is considered for TTT. 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). Since then, many different surgeons have developed additional variations of techniques for performing the surgery. If this happens, this will be the weak spot for stress rising. MeSH Bethesda, MD 20894, Web Policies Minor complications include events that are unlikely to have influenced the functional outcome or caused no permanent harm to the patient. By moving the bone (tibial tubercle), it can correct the malalignment of the patella in the groove (trochlea) of the femur (thigh bone) and eliminate symptoms of instability and decrease the symptoms of arthritis. The complications which we had in this series were not only in the beginning of the study, but spread during the years investigated. It is important to understand potential complications of tibial tuberosity osteotomies (TTOs) and how to avoid them. Risks and complications. Tibial tubercle osteotomy is a surgical procedure which is performed along with other procedures to treat patellar instability, patellofemoral pain, and osteoarthritis. government site. For instance, making the distal cut very carefully is crucial. This usually starts improving after the first week. Data were obtained from available patient files. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. Early weight-bearing and complete detachment of the distal tuberosity may increase these risks. Frame M, Hauck O, Newman M, Cirtautas A, Wijdicks C. Orthop J Sports Med. This can result in pain, instability, and dislocation of the patella. Your surgeon will line your knee cap up with your thigh and shin. and transmitted securely. The most common indications for tibial tubercle transfer are recurrent patellar dislocation or subluxation, chronic patellofemoral pain, and patellar instability secondary to a lateralized tibial tubercle. Fulkerson Osteotomy Cost. 2017 Jan/Feb;46(1):E23-E27. 2018 Oct 19;6(10):2325967118803614. doi: 10.1177/2325967118803614. The risk of deep infection is <1%. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. Disclaimer, National Library of Medicine The bone was healed, but during the growth, the screws were pulled oblique, so the tubercle proximalised again. Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR. Am J Sports Med. 24. Most patients report excellent pain relief and functional improvement after tibial tubercle transfer. The risk of deep-vein thrombosis (4%) after TTO is higher than that associated with other sports surgeries (1% to 2%). I recommend him, as well as his staff, to anyone requiring such services. Koh, C. Stewart Patellar instability It is very unlikely that tibial fractures were treated in another clinic. A new distractor with angle-scale for proximal tibia medial opening wedge osteotomy. Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J, Bach BR, Cole BJ. Appreciate the attention and time spent during office visits. Arthroscopy. 2018 Jun;26(2):86. doi: 10.1097/JSA.0000000000000196. Suture Tape Augmentation of Screw Fixation Reduces Fragment Migration in Tibial Tubercle Osteotomy: A Biomechanical Study. Dr Burnhams bedside manner was exceptional. 8600 Rockville Pike Arthroscopy. The presumed higher risk for tibial fractures or pseudo-arthrosis could not be confirmed. The tibial tubercle osteotomy is most commonly needed in cases of arthrofibrosis or patella baja. Physical therapy that focuses on knee movement is critical to avoiding stiffness and reducing scar tissue, as well as moving the knee without early after surgery. Most frequent reasons for longer follow-up were: recurrent dislocations, postoperative complications, consultation for contralateral knee issues, and request for TTO hardware removal. Tibial tubercle osteotomy complications can be classified as major and minor. Most patients report moderate to severe pain after TTTO surgery. A systematic review by Payne et al. He did a great job of explaining both the progress of my injury and the way ahead as it applied to recovery. Mid Cervical Osteotomy Techniques 15:24. You might use a continuous passive motion machine at home for several hours each day, or your physiotherapist may help perform this movement for you. Also, the theory of creating a tibial stress fracture when using a step-cut osteotomy lives among surgeons [10]. Blood clots can be very dangerous, and can even be life-threatening if they travel to the lungs. Bleeding is also a potential complication. He had knee surgery a few months ago and is recovering remarkably well. A V-shaped TTO is a (relatively) safe procedure with a low complication rate. Objectives: Tibial tubercle osteotomy (TTO) is a common procedure that is frequently used in the treatment of recurrent patellar instability and/or patellar chondrosis. Patellofemoral instability is a common problem in adolescents (231:100,000). In one patient, the malunion was seen after 4years after a recurrent patellar dislocation. Correspondence to Distalization is a less common type of TTT, which involves transfer of the tibial tubercle to a more distal position on the tibia. Arthrosc Sports Med Rehabil. PubMed Central The tibial tubercle-trochlear groove distance was only improved after DDFO from 17.0 2.3 mm to 15.1 2.0 mm (P = 0.001). Review, CrossRef I have see all three orthopedic doctors at the Grove and Jerrica is the one I see the most and the latest she's absolutely wonderful. Editorial commentary: tibial tubercle osteotomy complications are most common with complete detachment of the distal periosteal hinge. Federal government websites often end in .gov or .mil. It acts as an attachment for the patellar tendon and serves as a fulcrum for knee extension. Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. The site is secure. In one patient, the bone block became a loose body that was removed arthroscopically. In only one case, the piece of bone that was transpositioned from distal to proximal became loose. (4,8,9, 11, 15) We did not experience any complications relating to the tibial tubercle osteotomy and all patients had healed by the six month follow up. Fulkerson JP, Becker GJ, Meaney JA, Miranda M, Folcik MA. Epub 2014 Mar 14. Columbia University's Center for Shoulder, Elbow and Sports Medicine. His main office is located in Baton Rouge and he treats patients in the Gonzales, Prairieville, St. Amant, Walker, Denham Springs, Livingston, Hammond, Brusly, Port Allen, Plaquemine, New Roads, Zachary, St. Francisville, and Lafayette areas. PMID: 26882966. When a delayed union goes on to have unsatisfactory Tibial tubercle osteotomy and transfer is done through an incision made in the front of your leg just below the patella. On completion of the reconstructive procedure, fixation of the osteotomy fragment is performed. Am J Orthop (Belle Mead NJ). 5 stars! Tibial Tubercle Osteotomy Complication Rates between Intra-versus Extra-articular Procedure. C, The osteotomy is reduced and fixed with multiple fixation wires. Tibial tubercle anteromedialization (AMZ) is another type of TTT, which involves transfer of the tibial tubercle to a more anterior and medial position on the tibia. Patellar Tendon Imbrication for the Treatment of Patella Alta in Skeletally Immature Patients. However, in actuality, it may vary depending upon the above-mentioned factors . 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Return to Sport after Tibial Tubercle Osteotomy for Patellofemoral Pain and Osteoarthritis, What Does an Orthopedist Do? Thank you Dr. Burnham for being so amazing! The most common complication was knee arthrofibrosis in seventeen knees (10.4%). Only gold members can continue reading. Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization Alex A. Johnson, MD, Elizabeth L. Wolfe, BS, Douglas N. Mintz, MD, Shadpour Demehri, MD, Beth E. Shubin Stein, MD, and Andrew J. Cosgarea, MD Orthopaedic Journal of Sports Medicine 2018 6: 10 A saw is then used to make an osteotomy (bone cut) along the guide pins. (2020). doi: 10.1016/j.eats.2022.05.002. A meta-analysis. Research studies have shown the rate of complications to be less than 15%. The insertion of the patellar tendon onto the tibia is exposed. The TTTO procedure involves making small incisions in the knee joint and using special instruments to detach the tibial tubercle from its current attachment site. Epub 2005 Jun 15. Painful screws requiring removal occur in 3% to 77% of cases. The patella, or kneecap, is a small bone at the front of the knee that helps in the movement and function of the joint. I had a traumatic knee injury that he performed surgery on. Thanks to Dr. Burnham and his staff. No cases of persisting disability in the range of motion were seen. In the context of patellar instability or patellar dislocation, the tibial tubercle is often positioned too far lateral (toward the outside of the knee). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Knee Osteotomies Can Be Performed Safely In An Ambulatory Setting. The risks on non-union and tibial fractures are particularly low despite the complete detachment of the periosteum and usage of step-cut osteotomy. The overall complication risk was 4.6%. The The incidence of complications of tibial tubercle osteotomy: a systematic review. The first description of a tibial tubercle osteotomy was by Fulkerson in 1909, who used the procedure to treat patellar instability. The patient with a non-union was re-operated after 9months. Three-dimensional schematic imaging of the TTO technique before (a), during (b), and after (c) the V-shaped osteotomy. Liu JN, Mintz DN, Nguyen JT, Brady JM, Strickland SM, Shubin Stein BE. Complications of tibial tuberosity osteotomy include fracture, nonunion, painful hardware and deep venous thrombosis. Patellar Tendon Imbrication for Patella Alta. I highly recommend him. Once in place, the bone is reattached to the tibia with a metal plate, wires or screws. Descriptive statistics are displayed in Table Table1.1. The aim of this study was to report the complication rates directly related to the surgical technique of a V-shaped TTO, where the tubercle is completely released from its periosteum using a step-cut osteotomy. This is done in order to increase patellar contact with the femoral trochlea, and decrease lateral patellar tracking. This procedure is typically performed in patients with patellar instability secondary to a high-riding patella, also known as patella alta. Thirteen major complications were registered (4.9%) including two tibial fractures (0.75%) and one non-union (0.37%). Tibial Tubercle Osteotomy & Arthroscopic Lateral Release Recovery after knee surgery entails controlling swelling and discomfort, healing, return of range-of-motion of the knee joint, regaining strength in the muscles around the knee joint, and a gradual return to activities. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve . Patellofemoral instability is a very complex condition and occurs when the patella slides off the lateral aspect of the femur. Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. This is a quite safe procedure and provides excellent access and surgical exposure during a difficult primary or revision total knee arthroplasty. Arthrosc Tech. Epub 2022 Apr 16. 2014 May;42(5):1118-26. doi: 10.1177/0363546514525929. A distinct advantage of this study is its large sample size and the uniform technique that was used. FOIA Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA. improvement in Kujala pain scores from 51.2 to 82.6 postoperatively. One study demonstrated an improvement in Kujala pain scores from 51.2 to 82.6 postoperatively. Minor complications include events that are unlikely to have influenced the functional outcome or caused no permanent harm to the patient. 1.Introduction. Arthroscopy. Statistical analysis Compared to the non-union rate of 0.8% in the 787 TTOs published by Payne et al. doi: 10.1016/j.eats.2021.08.029. Next, guide pins are used to mark out the planned bone cuts (osteotomy). The new PMC design is here! Also, I had to make numerous visits to the Ochsner Clinic due to my injury and Dr. Burnham's team and the staff at Ochsner were always very professional and courteous. 2007;15(2):617. 2022 Springer Nature Switzerland AG. Great doctor. This chapter discusses the various complications that can occur and provides suggestions to minimize the risk of complications following tibial tubercle osteotomy. This is a preview of subscription content, access via your institution. Longo UG, Rizzello G, Ciuffreda M, Loppini M, Baldari A, Maffulli N, Denaro V. Arthroscopy. Osteotomized tibial tubercle bone block being trans-lated in the appropriate direction to address patellofemoral Occurrence and demographics of complications in TTO. Tigchelaar S, van Essen P, Bnard M, Koter S, Wymenga A. A tibial tubercle transfer is a procedure in which the tibial tubercle, a small bony prominence below the kneecap, is moved to a new position. Follow-up was obtained in 6weeks and 4months postoperatively, in case of fusion without further complications. Descriptive statistics were used to analyse the frequency of complications as a percentage of the total. In the second case, this bone block was malpositioned directly underneath the patellar tendon and caused tendinopathy, and was surgically removed. The Incidence of Complications of Tibial Tubercle Osteotomy: A Systematic Review. This is a quite safe procedure and provides excellent access and surgical exposure during a difficult primary or revision total knee arthroplasty. Before Major complications were defined as tibial fractures, non-union, neurovascular complications, infection, and wound complications that required surgical intervention. Most patients were female (73.8%). Tibial Tubercle Osteotomy for Revision Total Knee Arthroplasty Feat. Dr. Burnham and his staff were/are amazing. He spent a great amount of time explaining everything to me in a way that I understood everything. Burnham JM, Howard JS, Hayes CB, Lattermann C. Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Transfer: A Systematic Review of Outcomes and Complications. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve . Figure 8. Tibial tubercle bone block being drilled and fixated in translated position with two 4.5-mm countersunk cortical screws. Jerrica, Dr. Burnham, and the therapy staff (Luke and Joey )were awesome. Swelling, bruising, and seroma formation may occur in the short or intermediate time period after surgery. Full recovery from any type of surgery takes time and includes regaining strength and flexibility as well as addressing any residual pain. Bookshelf The site is secure. . suggested that when a complete detachment of the tibial tubercle is performed and the medial, lateral, and distal periosteum is transected, it leads to a complete arrest of the blood flow and a higher chance of non-union [8]. This might have caused a lack of stability, which could be the reason for the tibial shaft broke. In osteotomy procedure, a periosteal incision of 8-10 cm length is made at a distance of 1cm medial to the tibial tubercle. Some authors suggest that maintaining the medial and/or distal periosteum at the tubercle when performing an osteotomy is crucial for preserving the vascularisation and osteotomy union [8, 9]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Divano S, Camera A, Biggi S, Tornago S, Formica M, Felli L. Tibial tubercle osteotomy (TTO) in total knee arthroplasty, is it worth it? Tibial tubercle osteotomies are used to treat patients who suffer from patellofemoral instability (PFI) or painful patellar maltracking. I felt very informed and well cared for. Dr. Burnham and Jerrica are AMAZING! It is important to understand potential complications of tibial tuberosity osteotomies (TTOs) and how to avoid them. The overall complication rate for tibial tubercle osteotomy was 29.5%: major complication rate 21.5%, minor complication rate 8.0% ( Table 3 ). Use of small (3.5- mm diameter), countersunk screws reduces this risk. Two hundred and sixty-three (263) knees in two hundred and three (203) patients were included. Rantanen J, Paananen M. Modified hauser operation for patellar instability. Tibial tubercle transfer (TTT), also known as tibial tubercle osteotomy (TTO), or Fulkerson osteotomy, is a surgical procedure that is performed to correct lateral displacement of the tibial tubercle. The tibial tubercle is completely detached on three sides with an oscillating saw and osteotome to perform a distal transfer. This video demonstrates a patellofemoral replacement with a tibial tubercle osteotomy. In both cases, the piece of bone that was resected was not placed back proximally, because it did not fit. In retrospect, this was not the case in two out of three situations. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. However, because the osteotomy is performed in an open procedure, the cuts can be perfectly visualised which makes it less complex. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. The authors declare that they have no conflict of interest. Dr Jeremy Burnham has a great way of interacting with his patients. This can cause the knee cap to dislocate outside the lateral edge of the trochlea. The tibial tubercle is the bony prominence on the anterior medial aspect of the tibia (shin bone). Moreover, all patients got instructed that the hardware is only removed in case of specific complaints of the screws. [6] (2.4% when using a detached TTO) or Luhmann et al. Fulkerson JP. The present study analyzes the long-term results of 217 patients after an average of 9 years and compares them to the results in the literature. This may relieve pain and improve movement of your leg. Immediate mobilization of 35 knees, a 58 year follow-up study. All patients operated between March 2004 and October 2017 in the Radboud University Medical Centre, Nijmegen, using a V-shaped TTO were included. Accessibility Careers. Am J Sports Med. Knee Surg Sports Traumatol Arthrosc. 57.5 ). Some may experience minor discomfort and swelling for a prolonged period of several months. Tibial Tubrical Osteotomy FAQ 1. Really a national leader in sports medicine! b Situation after distalization of the tubercle with the bone part from distal put back proximally. An official website of the United States government. The patient is in a supine position. He has a great rapport with teenagers. Tibial tubercle osteotomy is a surgical procedure which is performed along with other procedures to treat patellar instability, patellofemoral pain, and osteoarthritis. In five knees (1.9%), minor complications occurred (Table (Table2).2). In: Dejour, D., Zaffagnini, S., Arendt, E., Sillanp, P., Dirisamer, F. (eds) Patellofemoral Pain, Instability, and Arthritis. HHS Vulnerability Disclosure, Help If there were no complications after 6 weeks, full weight bearing and full range of motion were allowed. 2006 May;14(5):443-6. doi: 10.1007/s00167-005-0671-4. The cost of this surgery method varies with several factors. 1Department of Orthopaedics, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6500 HB Nijmegen, The Netherlands, 2Department of Orthopaedics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. Vet Surg. Knee Surg Sports Traumatol Arthrosc. Most patients are able to return to full activity within 3-4 months. Everyone I was in contact with, from support staff to Dr. Burnham, was kind, friendly, competent, and generous with time and information. Their results showed that the use of a TTO in total knee arthroplasty did not influence the knee scoring and function, with a union rate close to 100%. He listens and address every concern with appropriate solutions. Risks and complications. 1a), as earlier described by Caton and van de Groes [7, 12]. This is a quite safe procedure and provides excellent access and surgical exposure during a difficult primary or revision total knee arthroplasty. and an AMZ tubercle. I wont ever go anywhere else. Purpose: University of Minnesota, Minneapolis, MN, USA, TRIA Orthopedic Center, Bloomington, MN, USA, You can also search for this author in Major complications were defined as tibial fractures, non-union, neurovascular complications, infection, and wound complications that required surgical intervention. Please enable it to take advantage of the complete set of features! Carlson VR, Boden BP, Sheehan FT. Patellofemoral kinematics and tibial tuberosity-trochlear groove distances in female adolescents with patellofemoral pain. Arthroscopy. I was worried for my future with my legs letting me walk but she put me at ease letting me know she will do everything in her power to fix me or send me to whatever specialist I need to see to make sure I have a good chance walking in my future, and they all truly fantastic doctors. Arthrosc Tech. Complications After Tibial Tuberosity Osteotomy: Association With Screw Size and Concomitant Distalization. Complications were defined as minor or major. The surgical procedure of triplanar osteotomy and transverse distraction. 8600 Rockville Pike Patellofemoral Pain, Instability, and Arthritis pp 295302Cite as. However, the hypothesized advantages of the V-shaped TTO are that the risk on non-union is low due to the triangular shape of the bone block with a twice as big bone contact area of the trabecular bone, and the intrinsically stable nature of the shape of the osteotomy in comparison to a sliding flat osteotomy. The median age of operation was 19years (range 1249years). The new attachment site for the patellar tendon is usually placed just medial, and somewhat anterior, to the original location. Level of evidence: TTO specifics depend on anatomy, radiographic alignment characteristics, and presence of chondral defects. Am J Sports Med. In osteotomy procedure, a periosteal incision of 8-10 cm length is made at 1cm medial to the tibial tubercle. He answered all my questions satisfactorily and his entire staff were polite and professional. TIBIAL TUBERCLE OSTEOTOMY PHASE I: ~0-2 Weeks Postoperative GOALS: WBAT with crutches/brace Monitor wound healing Full extension DRESSING: - POD 1: Debulk dressing, TED Hose in place - POD 2: Change dressing, keep wound covered, continue TED Hose - POD 7-10: Sutures out, D/C TED Hose when effusion resolved 2014;42(8):200617. Tibial tubercle osteotomy (TTTO) is an open procedure used to treat patellofemoral instability. Bookshelf 2022 Nov 23. doi: 10.1007/s00402-022-04700-1. Payne et al. A Tibial tubercle osteotomy is generally considered a higher level/ salvage type procedure. Large studies reporting the complication rates of a V-shaped TTO are missing, but necessary, to give a clearer view on this and can help to determine the optimal technique. Anteriorizing Tibial Tubercle Osteotomy for Patellofemoral Cartilage Lesions Abstract Patellofemoral chondral lesions are common and can lead to significant pain. These procedures include knee arthroscopy, lateral release, MPFL reconstruction, and cartilage restoration procedures such as MACI. Research studies have shown that approximately 83% of patients are able to return to sports, and somewhere between 60-77.5% of patients are able to return to the same level of sports activity after surgery. By far the best orthopedic team I have ever met. The most common indications for TTT nowadays are recurrent patellar dislocation or subluxation, chronic patellofemoral pain, and patellar instability secondary to a lateralized tibial tubercle. The risk of wound complications is 1% and can be reduced with meticulous handling of soft tissues and avoidance of large medial incisions. eCollection 2021 Oct. Schmidt S, Mengis N, Rippke JN, Zimmermann F, Milinkovic DD, Balcarek P. Arch Orthop Trauma Surg. Am J Sports Med. 2017;45(5):11029. Amazing Doctor and wonderful staff!! Unable to load your collection due to an error, Unable to load your delegates due to an error. One study described a tibial tuberosity fracture that was remedied by modifying the plate size and position [15]. Through an anteromedial approach, the patellar tendon is identified and the periosteum is released. The tibial tubercle transfer was performed making a V-shaped osteotomy of the attachment of the patellar tendon on the tibial tubercle using a saw and osteotome (Fig. The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active young patients: a systematic review with meta-analysis. Google Scholar. Patellar height is measured by using the Caton-Descamps Index or the Insall-Salvati ratio. Besides correction of . With the help of an oscillating saw, a cut is made medial to the tuberosity and a distal cut is also made. Tibial tubercle osteotomy and transfer is done through an incision made in the front of your leg just below the patella. GREAT DOCTOR VERY CARING AND KNOWLEDGEABLE!! official website and that any information you provide is encrypted Epub 2021 Mar 17. Early weight-bearing and complete detachment of the distal tuberosity may increase these risks. No brace was used, but all patients were instructed to bend the knee up to 70. Online ahead of print. We are so grateful and thankful. No re-dislocation or major complications occurred. The osteotomy was fixed using two small fragment lag screws. The basic principles remain the same, however, and involve transfer of the tibial tubercle to a new location on the tibia. Really cares for his patients! Table 3. Research studies have shown the rate of complications to be less than 15%. https://doi.org/10.1007/978-3-662-61097-8_24, Patellofemoral Pain, Instability, and Arthritis, Shipping restrictions may apply, check to see if you are impacted, Tax calculation will be finalised during checkout. Complications, as well as clinical pearls to avoid these complications, are also included. This is more common in patients who are smokers or have diabetes. From 2014 to present, no cast is used. Johnson AA, Wolfe EL, Mintz DN, Demehri S, Shubin Stein BE, Cosgarea AJ. The tibial tubercle is the secondary ossification center of the proximal tibia. The blue dashed line marks the small bone block that is transferred from distal to proximal. In osteotomy procedure, a periosteal incision of 8-10 cm length is made at a distance of 1cm medial to the tibial tubercle. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. The specific surgical technique that is used will depend on the underlying causes of patellar maltracking and dislocation, as well as the surgeons preference. Proximal tibial fractures (Fig. 2015 Sep;31(9):1826. doi: 10.1016/j.arthro.2015.06.045. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 1983;177:17681. What is a tibial tubercle osteotomy? You may need x-rays or a CT scan. There were no early tibial fractures. With an injury like this you want the best, and Dr. Burnham is the best. 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