Abstract
Introduction Anterior tibial tubercle (ATT) osteotomies can be fixed with one or more screws.
Nevertheless, limited evidence is available regarding the optimal number of screws.
Objective To compare the functional and radiographic outcomes and complications of patients
who underwent ATT osteotomy fixed with one 6.5-mm or two 4-mm screws. Our hypothesis
is that fixation of the ATT with two 4mm screws yields better functional and radiological
outcomes and fewer complications.
Materials and Methods We conducted a retrospective, multicentric study including 30 patients who underwent
ATT osteotomy fixation with one 6.5-mm cancellous screw (group 1; n = 15) or two 4-mm
cancellous screws (group 2; n = 15) with a minimum follow-up of 2 years. We excluded
patients who underwent medial patellofemoral ligament reconstruction and those with
inflammatory or severe degenerative knee disease. Clinical and radiological data,
as well as complications, were recorded. The functional outcomes were assessed through
Lysholm and Kujala scales and bone healing, through the Cornu scale. In the statistical
analysis, values of p < 0.05 were deemed significant, and grade 1 on the Cornu scale was considered the
parameter for bone healing.
Results As for the functional results, on the Lysholm scale, group 1 presented a median score
of 78 (range: 23–95) points, and group 2, a median of 81 (range: 25–100) points (p = 0.632); On the Kujala scale, group 1 presented a median score of 79 (range: 38–97)
points, and group 2, a median of 80 (range: 39–100) points (p = 0.819). The median time until bone healing was of 2 months in both groups (p = 0.694). Regarding complications, one case of delayed union and one case of symptomatic
hardware removal were observed in each group.
Conclusion No clinical and radiographical differences were observed between the fixation of
ATT osteotomies with one 6.5-mm or two 4-mm screws.
Level of evidence IV.
Keywords patellofemoral instability - anterior tibial tubercle osteotomy - fixation - screws
- bone healing
