Return to Sports After Tibial Tubercle Osteotomy for Patellofemoral Pain and Osteoarthritis

Purpose: To determine the rate of return to sports and clinical outcomes after anteromedialization (AMZ) tibial tubercle osteotomy (TTO) for patients with patellofemoral pain and/or osteoarthritis. Methods: This study is a retrospective case series of consecutive patients who underwent unilateral or staged bilateral AMZ TTO for a primary diagnosis of patellofemoral pain or arthritis. Included were all patients with minimum 1-year follow-up. The indication for surgery was failure of at least 6 months of nonoperative treatment. Simultaneous tubercle distalization or proximal-medial soft-tissue procedures were excluded; however, prior patellar instability procedures did not prohibit inclusion if there was no recurrence. A diagnostic arthroscopy was performed to evaluate the cartilage surfaces; AMZ TTO was performed by use of a freehand technique and two 4.5-mm fully threaded screws for fixation. A gradual return to activities was permitted at 6 months; however, contact sports were prohibited until 9 months postoperatively. Patients were evaluated retrospectively for participation in sports using a questionnaire about the level of participation, return to sporting activities, and Kujala score. Statistical analysis included 1-way analysis of variance and χ² or Fisher exact and paired t tests. Results: Forty-eight patients played sports within 3 years before surgery. The majority were female patients (84.2%). The average age at surgery was 29.6 years, with an average follow-up period of 4.6 years. The average Kujala score improved from 51.2 to 82.6 (P <.0001); the average pain score improved from 4.1 to 1.8 (P <.001). Of the patients, 83.3% returned to at least 1 sport on average 7.8 months postoperatively. Of these, 77.5% believed they returned to sports at the same level or a higher level. Conclusions: Patients undergoing AMZ TTO for patellofemoral pain or arthritis had an 83.3% rate of return to 1 or more sporting activities at an average of 7.8 months after surgery, with many patients returning at the same level or a higher level of intensity compared with their preoperative state. Level of Evidence: Level IV, retrospective case series.