Tibial Tubercle Osteotomy

A good candidate for Tibial Tubercle Osteotomy (TTO) typically has specific knee issues related to the alignment and tracking of the patella (kneecap) that do not respond to non-surgical treatments such as physical therapy, bracing, and activity modifications.  Patellar instability (when your knee cap dislocates) is the most common indication for a tibial tubercle osteotomy. When performed for instability, it is usually combined with additional procedures to help stabilize the knee cap, like the medial patellofemoral ligament reconstruction.

Some key factors that make a patient a suitable candidate for a tibial tubercle osteotomy include:

1. Chronic Patellar Instability: Patients who experience recurrent dislocations or subluxations (partial dislocations) of the patella are often candidates for this procedure. This instability may be due to structural issues, an abnormal alignment of the patella, or a shallow trochlear groove in the femur (thigh bone).
2. Patellar Maltracking: When the kneecap does not move smoothly in the groove of the thigh bone, it can cause pain, damage to the cartilage, and an increased risk of dislocation. Tibial tubercle osteotomy can help realign the patella, allowing for proper tracking and reducing pain.
3. Cartilage lesions: Patients with persistent pain in the front of the knee that worsens with activities like climbing stairs, squatting, or sitting, and have an injury to their underlying cartilage of their patellofemoral joint, may be indicated for a cartilage transplant procedure.  In these cases, correcting the alignment can reduce abnormal contact pressures on the cartilage, potentially slowing further damage and providing pain relief.
4. High Q-Angle: A high Q-angle refers to the angle formed by the thigh muscles (quadriceps) pulling on the kneecap. When this angle is too large, it can cause the kneecap to be pulled outwards, leading to discomfort, pain, or even instability in the knee. This condition is often linked to problems like knee pain or a kneecap that moves out of place (dislocates). A tibial tubercle osteotomy is beneficial in correcting this alignment, reducing the lateral pull, and improving knee stability.
5. Age and Activity Level: Younger patients, especially athletes, may be more suitable candidates if patellar instability or pain significantly impacts their ability to participate in sports or physical activities. However, a tibial tubercle osteotomy can also be beneficial for older patients experiencing patellofemoral pain due to misalignment.
6. Normal Bone Health: Candidates should have good bone health to ensure that the tibia can adequately heal after the osteotomy. Conditions like osteoporosis may affect the bone’s ability to heal properly after surgery, potentially impacting the procedure’s outcome.

The procedure begins with an incision over the tibial tubercle. Dr. Kaplan will make controlled cuts to the bone and move the tibial tubercle to a new position.  Once the desired position is achieved, the tibial tubercle is secured in place with screws or other fixation devices. This stabilization allows for proper bone healing and long-term realignment of the patella.

Postoperative recovery involves a period of immobilization and limited weight-bearing to allow the bone to heal. A knee brace or splint is often used initially, and patients are advised to use crutches. Physical therapy is an essential part of the recovery process to restore strength, flexibility, and function to the knee. Full recovery and return to activities typically takes several months.

Multiple physical examinations tests and imaging, age, activity level, symptoms, prior treatments and alternative are carefully weighed by Dr. Kaplan to determine whether this is a good procedure for each patient’s specific needs.  Moreover, concurrent procedures are commonly performed including medial patellofemoral ligament reconstruction.

When the patient participates in a complete rehabilitation program, this surgery can significantly improve knee function, reduce pain, and decrease the risk of future patellar dislocations.  Contact Dr. Daniel Kaplan at his office in Manhattan and Brooklyn to schedule an orthopedic consultation to learn more about treatments and procedures for sports injuries. He can help you get back to the sports you love.