To characterize the early postoperative complications following outpatient tibial tubercle osteotomy (TTO) to determine its safety in this setting.
Patients undergoing TTO by a single surgeon between July 2017 and August 2022 for patellar instability or patellofemoral chondromalacia and achieving a minimum of 3 months of clinical and radiographic follow-up were evaluated for inclusion. Although an inclusion criterion was a minimum follow-up of 3 months, if evidence of a healed osteotomy was observed sooner, final follow-up was accepted at 2 months. Patient demographics, perioperative risk factors, and incidence of complications were collected retrospectively. Categorical data were analyzed using χ2 and Fisher exact tests. Continuous data were analyzed using 2-tailed t tests and Mann-Whitney U data for parametric and nonparametric data, respectively.
A total of 195 knees in 167 patients met inclusion criteria, with a mean age of 24.7 ± 9.2 years and mean follow-up time of 10.9 months (range, 2-69 months). Fifty-one early postoperative complications occurred in 47 (24.1%) knees in 42 (25.1%) patients. Ten major and 41 minor complications occurred. Major complications were associated with older age (P = .015), smoking (P = .038), and smaller preoperative patellar tendon–lateral trochlear ridge distance (P = .012). Forty-four reoperations occurred in 42 (21.5%) knees in 37 (22.2%) patients. The most common reasons for reoperation included removal of symptomatic hardware (31 knees; 15.9%) and arthrofibrosis requiring lysis of adhesions and manipulation under anesthesia (8 knees; 4.1%). The mean time to reoperation was 13.0 months (range, 1-42 months). Smaller body mass index was associated with increased risk of reoperation (P = .002).
Outpatient TTO is safe when performed with the described technique, but the later development of minor complications is not infrequent following surgery. Patients should be counseled regarding a relatively high incidence of hardware irritation, arthrofibrosis, and eventual reoperation.
Level IV, case series.
To investigate the efficacy of platelet-rich plasma (PRP) as an augmentation in meniscus repair.
A comprehensive search of PubMed, Medline (via EBSCO), ProQuest, and ScienceDirect from January to February 2023 was conducted using the terms “meniscus repair,” “PRP,” and “meniscus tear.” Meta-analyses that investigated the rate of failure after meniscus repair were included. Studies before 2003, not in English, associated procedures during surgery, and animal studies were excluded. The included studies underwent quality appraisal and risk of bias assessment. Data were extracted from each study‘s text, figures, tables, and associated supplementary files and then analyzed qualitatively.
The failure rate is lower in the PRP augmentation group compared with the group without augmentation, with a mean difference of 0.42, 0.50, and 0.43. Visual analog scale score was also found to be significantly lower in the treatment group, with a mean difference of 0.40, 0.76, and 6.69. However, only mean differences in Lysholm score in one of the included studies were found significant regarding functional outcomes, which can be found in the Xie et al. study with a mean difference of 3.06.
In this study, we found that meniscal repairs augmented with PRP have a lower failure rate.
Level IV, systematic review of Level III-IV studies.