# Concomitant Tibial Tubercle Osteotomy Decreases Odds of Revision Patellofemoral Cartilage Restorative or Palliative Surgery After Autologous Chondrocyte Implantation for Patellofemoral Cartilage Disorders

## TL;DR

Adding tibial tubercle osteotomy to cartilage implantation reduces the need for repeat surgery in patellofemoral cartilage disorders.

## Contribution

Shows that combining tibial tubercle osteotomy with ACI lowers revision surgery odds compared to ACI alone.

## Key findings

- ACI with concomitant TTO had the lowest odds of revision surgery (odds ratio, 1.75).
- Isolated ACI had the highest odds for revision (odds ratio, 10.13).
- ACI accounted for nearly half of all patellofemoral cartilage restoration procedures.

## Abstract

To utilize a large nationwide database to evaluate the need for revision patellofemoral cartilage restorative or palliative surgery after an index cartilage restoration procedure with and without concomitant tibial tubercle osteotomy (TTO) for patellofemoral cartilage injury.

The PearlDiver Mariner Database was queried for all patients who underwent osteochondral allograft transplantation (OCA), osteochondral autograft transfer (OAT), or autologous cartilage implantation (ACI) or chondroplasty of the patellofemoral joint between 2016 and 2021 using laterality-specific International Classification of Diseases, Tenth Revision and Current Procedural Terminology codes. The 5-year revision patellofemoral cartilage restorative or palliative surgery was evaluated via χ2 analysis. Multivariable logistic regression was used to evaluate the association between 5-year revision patellofemoral cartilage restorative or palliative surgery and index cartilage restorative surgery with and without concomitant TTO.

In total, 502 patients were identified who underwent patellofemoral cartilage restorative surgery, and 61,354 patients underwent patellofemoral cartilage palliative surgery. ACI accounted for nearly half of all patellofemoral cartilage restoration procedures and increased 32% in utilization. Patients who underwent ACI were on average 4 years younger and were more likely to receive a concomitant TTO than those who underwent OCA or OAT. Patients who underwent chondroplasty were older and less likely to undergo revision cartilage restoration. The 5-year revision rates were respectively 16.6%, 13.8%, and 12.7% for ACI, OAT, and OCA, although less than 3% accounted for revision cartilage restoration. Isolated ACI had the highest odds for revision (odds ratio, 10.13; P < .001), although the addition of TTO attenuated those odds, with concomitant TTO and ACI having the lowest odds of revision of any procedure (odds ratio, 1.75; P < .001).

Concomitant TTO with ACI for patellofemoral cartilage disorders is associated with lower odds of revision patellofemoral cartilage restorative or palliative surgery than ACI without TTO when compared to other cartilage restoration procedures.

Level III, retrospective cohort study.