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The case involves a 19-year-old non-professional dancer with preoperative KOOS 72 who developed a proximal stress fracture three months postoperatively, progressing toward the tibial diameter. Radiographs guided treatment, and surgical fixation with a lateral locking plate achieved complete consolidation by 10 months.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/stress-fracture-after-tibial-tuberosity-osteotomy-analyzing-the-contributing-factors-learning-point/447415/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/stress-fracture-after-tibial-tuberosity-osteotomy-analyzing-the-contributing-factors-learning-point/447415.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the key learning point about proximal tibial stress fractures after TTO?","Question",{"text":112,"@type":113},"Proximal tibial stress fractures are a rare but significant complication after tibial tuberosity osteotomy. Prevention depends on precise surgical technique, gradual rehabilitation, and early identification of symptoms; fixation is a reliable treatment when fractures arise.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"When did the stress fracture appear in the case report?",{"text":117,"@type":113},"Radiographs at three months showed onset of a stress fracture below the TTO site. It progressed on subsequent follow-up to involve about two-thirds of the tibial diameter.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the fracture treated and what was the outcome?",{"text":121,"@type":113},"The patient underwent surgical fixation using a lateral tibial locking plate to prevent propagation. Ten months after plating, the fracture had fully consolidated, with a KOOS score of 90.5 and uneventful hardware removal.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},447415,1791062139,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Case Report  Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 187-191   \nStress Fracture after Tibial Tuberosity Osteotomy –Analyzing the  \nContributing Factors  \nAnton Maliarov1, Aviram Albagly 2, Oren Ben-Lulu1  \nLearning Point of the Article:  \nProximal tibial stress fractures area rarebut significant complication following tibial tuberosity osteotomy. Prevention relies on precise surgical technique, gradual rehabilitation, and earlyidentification of symptoms,while surgical fixation remains a reliable treatment when fractures arise.  \nAbstract  \nIntroduction: Tibial tubercle osteotomy (TTO) is an appropriate surgical procedure for patellar instability and chronic patellofemoral pain; however, complications such as proximal tibial fracture occurin 1–1.8% ofcases.  \nCase Report: A 19-year-old non-professional dancer underwent TTO with medialization for patellofemoral pain. Postoperatively, rehabilitation followed a structured protocol. At 3 months, radiographs revealed an onset of stress fracture below the TTO site, progressing and involving two-thirds ofthe tibial diameter on the last follow-up. Surgical fixation with a lateral tibial locking plate was performed to prevent propagation. Ten months after plating, the fracture had fully consolidated, while a Knee Injury and Osteoarthritis Outcome score was 90.5, and the hardware was removed without complications.  \nConclusion: Proximal tibial stress fractures post-TTO are rarebut require early recognition and intervention. This case highlights the caution required in rehabilitation and the necessity of surgical intervention as a viable treatment to ensure proper fracture healing and successful recovery.  \nKeywords: Tibial tubercle osteotomy, patellofemoral pain syndrome, proximal tibial stress fracture, surgical complications of the knee.  \nIntroduction  \nChronic patellar pain syndrome, lateral patellar instability, and localized patellofemoral osteoarthritis are widely recognized indications for tibial tubercle osteotomy (TTO) [1]. Several surgical options exist for addressing patellar instability and/or patellofemoral pain and osteoarthritis. These include soft-tissue procedures such as medial patel lo femoral ligament reconstruction or repair, lateral patellar release, and various femoral and tibial osteotomies [2]. While these techniques are generally effective for most patients, complications may arise in 4–8% ofcases [3].  \nInitially, the procedure outlined by Elmslie–Trillat involves medial displacement of the tibial tuberosity (TT) to realign the knee extensor mechanism [4]. However, other types of TT transfer, such as dist alization, anteriorization (Ma quet ’s technique), and anteromedialization (Fulkerson’s technique), are also documented and canbe applied [5].  \nProximal tibial fractures are uncommon and usually arise intraoperatively or within 8–14weeks postoperatively [6].  \nThis article details a unique case of a stress proximal tibial fracture that was initiated 3 months after TTO for chronic patellofemoral pain syndrome. In addition, we analyze the  \n\n| \u003Cbr>Access this article online\u003Cbr>\u003Cbr>Website: [www.jocr.co.in](www.jocr.co.in)\u003Cbr>\u003Cbr>DOI:\u003Cbr>[https://doi.org/10.13107/jocr.2025.v15.i12.6502](https://doi.org/10.13107/jocr.2025.v15.i12.6502) | Author’s Photo Gallery |  |  |\n| --- | --- | --- | --- |\n|  | | | |\n|  | \u003Cbr>1Department of Orthopedic Surgery, Bnai Zion Hospital, Haifa, Israel.\u003Cbr>Address of Correspondence:\u003Cbr>Dr. Anton Maliarov,\u003Cbr>Department of Orthopedic Surgery, Bnai Zion Hospital, Haifa, Israel. [E-mail:](E-mail: dr.antonmaliarov@gmail.com)[ dr.antonmaliarov@gmail.com](E-mail: dr.antonmaliarov@gmail.com) |  |  |\n| Submitted: 08/09/2025; Review: 27/10/2025; Accepted: November 2025; Published: December 2025 |  |  |  |\n| DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6502](https://doi.org/10.13107/jocr.2025.v15.i12.6502)\u003Cbr>© The Author(s). 2025 Open Access. This article is distributed under the terms of the Creative Commons Attri","cbCailW087fHMK8n","https://ap.wps.com/l/cbCailW087fHMK8n","pdf",7742570,"English","# Learning Point of the Article\n# Abstract\n## Introduction\n## Case Report\n## Conclusion\n# Keywords\n# Introduction","[{\"question\":\"What is the key learning point about proximal tibial stress fractures after TTO?\",\"answer\":\"Proximal tibial stress fractures are a rare but significant complication after tibial tuberosity osteotomy. Prevention depends on precise surgical technique, gradual rehabilitation, and early identification of symptoms; fixation is a reliable treatment when fractures arise.\"},{\"question\":\"When did the stress fracture appear in the case report?\",\"answer\":\"Radiographs at three months showed onset of a stress fracture below the TTO site. It progressed on subsequent follow-up to involve about two-thirds of the tibial diameter.\"},{\"question\":\"How was the fracture treated and what was the outcome?\",\"answer\":\"The patient underwent surgical fixation using a lateral tibial locking plate to prevent propagation. Ten months after plating, the fracture had fully consolidated, with a KOOS score of 90.5 and uneventful hardware removal.\"}]","Stress Fracture after Tibial Tuberosity Osteotomy - Analyzing the Contributing Factors - Learning Point | PDF",1790720250,13]