Abstract：
Tibial tubercle osteotomy (TTO) is indicated to treat patellofemoral (PF) malalignment and chondral disease refractory to conservative treatment. However, there are no systematic reviews describing TTO outcomes in chondral damages without instability.
The aims of this study were to (1) assess the quality of the published studies, (2) identify indication for TTO to treat PFP with chondral disease without instability, (3) evaluate the most common TTO techniques, (4) evaluate the clinical outcomes, and (5) evaluate TTO\'s complication and failure rates.
In December 2020, a literature search was performed applying the following criteria: (1) peer-reviewed Level 1-4 studies; (2) English language; (3) human subjects with clinical and/or radiological outcomes; (4) TTO alone or associated with minor cartilage procedure (only drilling, no instability); (5) minimum follow-up 12 months, minimum 10 patients; and (6) no more than 20% of drop-out rate. Data from studies were collected and described with weighted averages and standard deviations.
A total of 18 Level 4 studies were included. The average Coleman Methodology Score was 61.5 points (range 48-81). A total of 851 patients (892 knees) were included, with 64.8% of female patients. The weighted average follow-up was 49.1 months (range 12-128.5). Indication for TTOs was poorly described. The main technique used was anteromedialisation (60.4%). In 27.7% of the cases, TTO was associated with lateral release. Different scoring systems were used to evaluate outcomes, with significant improvements. The average rate of good/excellent results was 78.7% (range 57%-100%). Fifteen studies described the complication rate (9.9%), whereas only four reported the failure rate (6.2%).
TTOs performed to treat PF malalignment associated with chondral disease without instability provided good clinical outcomes, with acceptable complication/failure rates. However, high-level studies are necessary because of studies\' heterogeneity regarding patellofemoral malalignment and chondral disease treatment.
Systematic review.
Level IV, systematic review of Level IV studies.
The aims of this study were to (1) assess the quality of the published studies, (2) identify indication for TTO to treat PFP with chondral disease without instability, (3) evaluate the most common TTO techniques, (4) evaluate the clinical outcomes, and (5) evaluate TTO\'s complication and failure rates.
In December 2020, a literature search was performed applying the following criteria: (1) peer-reviewed Level 1-4 studies; (2) English language; (3) human subjects with clinical and/or radiological outcomes; (4) TTO alone or associated with minor cartilage procedure (only drilling, no instability); (5) minimum follow-up 12 months, minimum 10 patients; and (6) no more than 20% of drop-out rate. Data from studies were collected and described with weighted averages and standard deviations.
A total of 18 Level 4 studies were included. The average Coleman Methodology Score was 61.5 points (range 48-81). A total of 851 patients (892 knees) were included, with 64.8% of female patients. The weighted average follow-up was 49.1 months (range 12-128.5). Indication for TTOs was poorly described. The main technique used was anteromedialisation (60.4%). In 27.7% of the cases, TTO was associated with lateral release. Different scoring systems were used to evaluate outcomes, with significant improvements. The average rate of good/excellent results was 78.7% (range 57%-100%). Fifteen studies described the complication rate (9.9%), whereas only four reported the failure rate (6.2%).
TTOs performed to treat PF malalignment associated with chondral disease without instability provided good clinical outcomes, with acceptable complication/failure rates. However, high-level studies are necessary because of studies\' heterogeneity regarding patellofemoral malalignment and chondral disease treatment.
Systematic review.
Level IV, systematic review of Level IV studies.
摘要：
胫骨结节截骨术（TTO）用于治疗保守治疗难治性的髌股（PF）排列不良和软骨疾病。然而,没有系统评价描述TTO在无不稳定性的软骨损伤中的结局.
这项研究的目的是（1）评估已发表研究的质量，（2）确定TTO治疗PFP伴软骨疾病无不稳定性的适应症，（3）评估最常见的TTO技术，(4)临床疗效评价,（5）评估TTO的并发症和故障率。
2020年12月，采用以下标准进行了文献检索：（1）同行评审的1-4级研究；（2）英语；（3）具有临床和/或放射学结果的人类受试者；（4）TTO单独或与小软骨手术相关（仅钻孔，无不稳定性)；(5)至少随访12个月，最少10名患者；和（6）不超过20%的辍学率。收集来自研究的数据并用加权平均值和标准偏差描述。
共纳入18项4级研究。平均Coleman方法评分为61.5分(范围48-81)。共纳入851例患者（892膝），64.8%的女性患者。加权平均随访时间为49.1个月（范围12-128.5）。TTO的适应症描述不佳。使用的主要技术是前内化（60.4％）。在27.7%的病例中，TTO与侧向释放有关。使用不同的评分系统来评估结果，有重大改进。良好/优异结果的平均率为78.7%(范围57%-100%)。15项研究描述了并发症发生率（9.9％），而只有4人报告了失败率(6.2%)。
用于治疗与软骨疾病相关的PF排列不良而没有不稳定的TTO提供了良好的临床结果。并发症/失败率可接受。然而,高水平的研究是必要的，因为关于髌股排列不良和软骨疾病治疗的研究的异质性。
系统评价。
IV级,四级研究的系统评价。
这项研究的目的是（1）评估已发表研究的质量，（2）确定TTO治疗PFP伴软骨疾病无不稳定性的适应症，（3）评估最常见的TTO技术，(4)临床疗效评价,（5）评估TTO的并发症和故障率。
2020年12月，采用以下标准进行了文献检索：（1）同行评审的1-4级研究；（2）英语；（3）具有临床和/或放射学结果的人类受试者；（4）TTO单独或与小软骨手术相关（仅钻孔，无不稳定性)；(5)至少随访12个月，最少10名患者；和（6）不超过20%的辍学率。收集来自研究的数据并用加权平均值和标准偏差描述。
共纳入18项4级研究。平均Coleman方法评分为61.5分(范围48-81)。共纳入851例患者（892膝），64.8%的女性患者。加权平均随访时间为49.1个月（范围12-128.5）。TTO的适应症描述不佳。使用的主要技术是前内化（60.4％）。在27.7%的病例中，TTO与侧向释放有关。使用不同的评分系统来评估结果，有重大改进。良好/优异结果的平均率为78.7%(范围57%-100%)。15项研究描述了并发症发生率（9.9％），而只有4人报告了失败率(6.2%)。
用于治疗与软骨疾病相关的PF排列不良而没有不稳定的TTO提供了良好的临床结果。并发症/失败率可接受。然而,高水平的研究是必要的，因为关于髌股排列不良和软骨疾病治疗的研究的异质性。
系统评价。
IV级,四级研究的系统评价。
