Tibial Tubercle Osteotomy

Candidates for TTO typically include individuals who have chronic patellar instability, patellar tracking disorders, or osteoarthritis that is isolated to one portion of the knee. It’s particularly suitable for patients who have not responded to conservative treatments such as physical therapy and medications.

The procedure is typically carried out under general anesthesia. Your knee surgeon Dr. Ben Mayo then makes an incision over the tibial tubercle, the prominence at the top of the tibia where the patellar tendon attaches. Then a special saw is used to cut the tibial tubercle. It is then moved to a more appropriate position that improves patellar tracking.The moved bone is then secured in its new position with metal screws.

Recovery time after TTO can vary depending on the individual and their specific condition. Generally, you can expect to use crutches for approximately 6 weeks after the surgery. Desk jobs or light activities can typically be resumed after several weeks, while high-impact activities and sports may require 4 to 6 months or more to resume, allowing for adequate healing and rehabilitation.

Immediately after surgery, your knee will likely be immobilized in a brace to protect the surgical site. You will recover from anesthesia then go home the same day. Pain can be managed with prescribed and over the counter medications. Physical therapy will typically begin soon after surgery to promote healing, reduce swelling, and begin restoring range of motion.

Post-operative physical therapy is essential to regaining strength and mobility in the knee.

• Early Stage (Weeks 1-6): The initial focus is on managing pain, reducing swelling, and restoring range of motion. This is done through gentle exercises and movements.
• Middle Stage (Weeks 6-12): The emphasis shifts towards regaining strength, stability, and mobility in the knee. The physical therapist will prescribe exercises for these goals.
• Late Stage (Weeks 12 and beyond): The final stage of rehabilitation focuses on a return to normal function, including walking without crutches, going up and down stairs, and eventually returning to sports or high-demand activities.

While TTO is generally safe, it does come with some potential risks:

• Infection: As with any surgical procedure, there is a risk of infection, although it’s quite rare.
• Blood clots: Deep vein thrombosis (DVT) can occur, but the risk is low. You will be on aspirin for one month after surgery to minimize this risk
• Nerve or blood vessel damage: This could potentially lead to numbness or weakness in the leg, although this is rare.
• Nonunion or malunion of the bone: In some cases, the bone may not heal properly or might heal in the wrong position, which might require further surgery.
• Fracture: If something were to happen such as a fall or too much stress on the leg before the bone has healed, it is possible to fracture your shin bone.

Not undergoing a recommended TTO can have potential risks:

• Continued knee pain and instability: Without intervention, symptoms such as knee pain, instability, and problems with knee function may continue or worsen over time.
• Further damage to the knee joint: Prolonged instability and malalignment can lead to further damage within the knee joint, potentially leading to conditions like osteoarthritis.