Tibial Tubercle Osteotomy

Surgical intervention is warranted when non-surgical modalities such as physical therapy have been ineffective and when multiple knee dislocations have occurred. The tibial tubercle transfer technique entails realigning the tibial tubercle, a protrusion located at the front of the shin bone, to centralize the movement of the kneecap (patella) within the femoral groove. The misalignment of the patella is corrected by moving the tibial tubercle towards the inner portion of the leg. This relieves pressure from the painful regions of the kneecap and reduces discomfort.

The surgical procedure is performed under general anesthesia, and the patient remains unconscious until waking up in the recovery room. Initially, a knee arthroscopy is conducted to inspect the internal components of the knee joint. The procedure involves small incisions or portals through which small instruments are passed, and a video camera is utilized to visualize the anatomy of the knee joint, assess patella tracking and evaluate patella cartilage.

The tibial tubercle osteotomy and transfer are performed through an incision made at the front of the leg, just below the patella. During the osteotomy procedure, an incision is made at a distance of 1 cm medial to the tibial tubercle, which measures 8-10 cm in length. An oscillating saw is used to make a cut medial to the tuberosity, followed by a distal cut. The design of the distal cut is tapered to minimize the risk of tibial fracture. Similarly, a proximal cut is made using specialized tools such as a curved osteotome or reciprocating saw. Subsequently, an osteotomy through the bone cortex is performed without severing the lateral periosteum, which serves as a point of attachment for the osteotomy segment. This technique enables the acquisition of a tibial tubercle segment that is over 2 cm wide, over 1 cm thick, and measures 8-10 cm in length, encompassing all areas of insertion of the patellar tendon. The segment from the tibia is then leveraged using an osteotome to obtain access to the medullary canal of the tibia. The osteotomy segment is then moved into a position that ensures proper tracking of the patella under direct vision. The tracking pattern is verified arthroscopically. The relocated bone is fixed in its new position with screws that may be removed later if they cause irritation.

Following the surgery, the patient may experience mild to moderate knee discomfort for several days or weeks. Oral pain medication will be prescribed to manage the pain. The operated leg should be kept elevated, and ice should be applied to the area for 20 minutes to reduce swelling and pain. The patient will wear a leg brace, which may only be removed while sitting with the leg elevated or when using the continuous passive motion (CPM) unit. Physical therapy exercises should be performed to restore mobility. A healthy diet and plenty of water should be consumed.

Risks and complications associated with tibial tubercle osteotomy surgery are rare but may include compartment syndrome, deep vein thrombosis, infections, and delayed bone healing.