Tibial tubercle osteotomy (TTO): A review of impactful papers in the literature

Background: Tibial tubercle osteotomy (TTO) is a procedure that can be used as an alternative to total knee arthroplasty (TKA) or to address patellar instability in patients experiencing dislocation events. The purpose of this paper is to systematically evaluate the most cited articles pertaining to TTO through bibliometric analysis. Methods: A search using the Web of Science database with keywords pertaining to TTO was conducted in April 2024. Articles with the most citations that met all inclusion criteria were analyzed to determine information such as level of evidence (LoE), article topic, journal of publication, year published, country of origin, and institution of origin. Results: The average number of citations was 79 (range of 42-334). The decade with the most publications was from 2010 to 2019 (n = 26; 52%). Clinical Orthopaedics and Related Research was the journal with the largest number of published articles (n = 9, 18%). The United States (US) (n = 25; 50%) and France (n = 4; 8%) were the two countries with the most publications. Mayo Clinic (n = 3, 6 %), Ohio State University (n = 3, 6%), and Rush University (n = 3, 6%) were the institutions contributing the most articles. The LoE most reported was level 4 (n = 22; 44%). Topics were primarily related to clinical outcomes (n = 38; 76%). Conclusion: This analysis revealed that most articles were related to clinical outcomes and have been published since 2000. By analyzing the characteristics of the most cited articles, an understanding of current research and identification of areas for further exploration can be determined for TTO. Study Design: Cross-sectional study. Level of Evidence: III.