We are utilizing two seperate OSTicket implementations. One to provide internal support to our agency and our subsidiaries. We have approximately 350 employees (spread across 7 agencies and 12 physical locations in the Southern NH USA area). Our second implementation is used by one of our programs which provides technical support to users on a specific state funded application. This implementation is utilized by all users for the entire state of NH. While neither of these are "purely" a technical support company in the way I think that you imply.
The biggest limitations that we've run into are:
There is no way to tell which company / agency a person comes from besides the domain of the email address they used to open the ticket. Which I wrote a mod to add a db populated Agency drop down. I think that its available here in the 1.6ST mod forum, its also available at (tmib.net)
We wanted to add another status to tickets (specifically Pending) for tickets that were waiting for client/customer feedback. So I wrote a mod to implement it. It should be available in the 1.6ST mod forum, it is also available at (tmib.net). Side note it also automatically closes tickets that are pending for 5 business days.
1.6ST only allows one attachment per ticket message. 1.7 will offer multiple attachments. This was not a show stopper for us though.
Time tracking is non-existant. So we utilized a mod from the forums here to attempt to track time better. (its in the 1.6ST mod forum)
We didn't like having to assign tickets to people when there are only 5 staff in that program, luckily once again someone (scottro) wrote an auto assignment mod (its also in the 1.6ST mod forum and at http://sudobash.net(http://sudobash.net))
Lastly reporting in 1.6ST doesn't really exist. ScottRo once again wrote a mod called Reporting Mod which is available here in the 1.6ST mod forums, and on his web site http://sudobash.net(http://sudobash.net)
Lastly, it seems that when a custom hits reply to a ticket system generated email it doesn't update the ticket properly. This is not something that we have really been concerned with. I'm not sure why but am hoping that it will be fixed in 1.7ST.
I hope that this has sufficiently answered your question.