What is a Tibial Tubercle Osteotomy or Transfer (TTO)?
This is an open surgical procedure that is performed to address chronic patella (kneecap) instability. The kneecap is normally held in place by ligaments and bony architecture of the knee. This procedure is an osteotomy in which the bone is cut to relocate the insertion site of the patellar tendon toward the inside of the tibia or shin bone. This is often done in coordination with a MPFL reconstruction. The goal of these stabilizing procedures is to help prevent damage to the cartilage in the knee and the development of arthritis from continued dislocations of the kneecap. This surgical procedure has had great success in preventing the kneecap from repeat dislocations or coming out of place and restoring people’s ability to live a healthier and active lifestyle.
Who should consider this surgery?
Patients with recurrent dislocations of the kneecap and those that have anatomic factors that predispose them to future dislocations. This is normally performed in younger teenagers but some older adults can benefit from this procedure. People that have significant arthritis already may not be candidates for this procedure. In addition, smokers should not undergo this procedure as the smoking prevents the bone from healing properly.
How is this performed?
The tibial tubercle osteotomy is an open procedure that is performed under general anesthesia. The front part of the tibia or shin bone is cut and moved to the inside and held with screws. The patient will be placed in a brace and use crutches to walk in order to not place full weight down until proper healing of the bone.
Recovery:
The osteotomy or cutting of the bone can take 4-6 months for the bone to heal or fuse. Patients will start in physical therapy immediately following surgery to begin gradually regaining their range of motion in the knee, building their quadriceps strength again and slowly returning to walking. The ability to walk will slowly be advanced from no weight to full weight bearing over the course of 6-8 weeks and depending on the healing of the bone. X-rays will be required periodically until the bone is completely healed. Running or any jumping will not be recommended until the bone is completely healed and no sooner than 5 months after surgery. Return to sport usually is 9-12 months. This surgical recovery is a lengthy one but will make a big difference in improving the quality of a person’s life and giving people more confidence to return to activities you enjoy.