What is Tibial Tubercle Osteotomy?
Tibial tubercle osteotomy is a surgical procedure that is performed along with other procedures to treat patellar instability (kneecap dislocations) and patellofemoral pain. The tibial tubercle transfer technique involves repositioning of the tibial tubercle (a bump in the front of the shinbone) such that the kneecap (patella) changes its position to the centre of the knee. The incorrect position of the patellar is corrected by moving the tibial tubercle medially, towards the inside of the leg. This removes the load off the painful portions of the kneecap and reduces pain as well as repositioning the kneecap. This procedure if often combined with other surgical procedures (e.g. MPFL reconstruction) to provide the maximum benefit.
Indications of Tibial Tubercle Osteotomy
Surgical treatment is indicated when physical therapy and other non-surgical methods have failed and there is a history of multiple kneecap dislocations.
Tibial Tubercle Osteotomy Procedure
The procedure is performed under general anaesthesia. At first, an arthroscope may be inserted to inspect the inside of the knee joint. It involves small incisions or portals through which small instruments are passed and a video camera is used to visualize the anatomy of the knee joint, evaluate patella cartilage and assess patella tracking.
Tibial tubercle osteotomy and transfer are done through an incision made in the front of your leg, just below the patella. A portion of bone attached to tendon is cut and its position changed before reattachment.
The osteotomy segment is moved under direct vision into a position that assures proper tracking of the patella. The tracking pattern can be confirmed arthroscopically. The mobilized bone is then fixed into its new place using screws, which can be removed later if they cause irritation.
Post-surgical Care for Tibial Tubercle Osteotomy
You may have minimal-to-moderate knee discomfort for several days or weeks after the surgery. Oral pain medications will be prescribed. Keep the operated leg elevated and apply an ice bag over the area for 20 minutes. This decreases swelling as well as pain. You may have to wear a leg brace that may be removed only while sitting with your leg elevated. Physical therapy exercises should be performed as it helps in regaining mobility. Eat healthy food and drink plenty of water.
Risks and Complications of Tibial Tubercle Osteotomy
Risks following tibial tubercle osteotomy surgery are rare, but may include compartment syndrome, deep vein thrombosis, infections and delayed bone healing.
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