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Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy

BACKGROUND: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation p...

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Autores principales: Morgan, Courtney, Bell, Ryan M., Burland, Julie P., Kriscenski, Danielle, Ilinski, Adrian, Cote, Mark P., Edgar, Cory M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720819/
https://www.ncbi.nlm.nih.gov/pubmed/36479459
http://dx.doi.org/10.1177/23259671221133105
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author Morgan, Courtney
Bell, Ryan M.
Burland, Julie P.
Kriscenski, Danielle
Ilinski, Adrian
Cote, Mark P.
Edgar, Cory M.
author_facet Morgan, Courtney
Bell, Ryan M.
Burland, Julie P.
Kriscenski, Danielle
Ilinski, Adrian
Cote, Mark P.
Edgar, Cory M.
author_sort Morgan, Courtney
collection PubMed
description BACKGROUND: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. PURPOSE: To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with ≥6 months of follow-up. The surgical indication was primarily for patients with recurrent patellar instability. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS(5)]). RESULTS: A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 ± 12.57 years were included in the final analysis. Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67° ± 32.65° vs 131.12° ± 9.02°, respectively; P = .022). Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. The mean postoperative AKPS and KOOS(5) scores were 72.98 ± 21.51 and 75.05 ± 16.02, respectively. CONCLUSION: Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols.
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spelling pubmed-97208192022-12-06 Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy Morgan, Courtney Bell, Ryan M. Burland, Julie P. Kriscenski, Danielle Ilinski, Adrian Cote, Mark P. Edgar, Cory M. Orthop J Sports Med Article BACKGROUND: Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased. PURPOSE: To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with ≥6 months of follow-up. The surgical indication was primarily for patients with recurrent patellar instability. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS(5)]). RESULTS: A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 ± 12.57 years were included in the final analysis. Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67° ± 32.65° vs 131.12° ± 9.02°, respectively; P = .022). Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. The mean postoperative AKPS and KOOS(5) scores were 72.98 ± 21.51 and 75.05 ± 16.02, respectively. CONCLUSION: Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols. SAGE Publications 2022-11-29 /pmc/articles/PMC9720819/ /pubmed/36479459 http://dx.doi.org/10.1177/23259671221133105 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Morgan, Courtney
Bell, Ryan M.
Burland, Julie P.
Kriscenski, Danielle
Ilinski, Adrian
Cote, Mark P.
Edgar, Cory M.
Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
title Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
title_full Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
title_fullStr Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
title_full_unstemmed Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
title_short Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
title_sort effectiveness of an accelerated rehabilitation protocol after tibial tubercle osteotomy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9720819/
https://www.ncbi.nlm.nih.gov/pubmed/36479459
http://dx.doi.org/10.1177/23259671221133105
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