Tibial tubercle osteotomies

FAQs on Tibial Tubercle Osteotomy

 

Tibial tubercle osteotomy has emerged as an important technique to treat patellar instability. With the development of advanced medical procedures, such operative management has been able to improve patellar alignment and stability considerably without stressing the cartilage.

What is tibial tubercle osteotomy?

Tibial tubercle osteotomy is surgical method used to treat unstable patella or kneecap and patellofemoral pain through bone realignment. Tibia or shinbone is the largest and strongest leg bone that connects knee with ankle. Tibial tubercle refers to “the bony prominence located on the proximal end of the tibia and attached to the ligament of the patella.” Osteotomy is the surgical technique to abridge, elongate, or change the alignment of a bone.

Thus, tibial tubercle osteotomy is the procedure to treat kneecap instability and patellofemoral pain by restructuring the patellar tendon insertion on the tibia. Surgeons “partially or totally detach, move and reattach the tibial tubercle” using screws. The new alignment puts the patella in a secured position in the groove in the femur preventing instability and patellofemoral disorders and improving patellar movement.

What are conditions treated with tibial tubercle osteotomy?

Tibial tubercle osteotomy is helpful in treating patellar tracking disorder, kneecap dislocation, restricted patella movement, patellar instability, and patellofemoral pain with or without cartilage damage.

The kneecap sits in a groove. As you bend or unbend your leg, the kneecap is displaced within the groove. However, often injury or excessive force causes patellar dislocation and the kneecap does not remain confined to the groove and often it pops out. This leads to patellar instability.

Tibial tubercle osteotomy enables restructuring of the patella on the tibia. The tibial bone connecting the patellar tendon responsible to keep the kneecap attached is moved from the outer tibia to inner tibia and fixed with screws. Such type of alignment is much straighter and keeps the patellar movement within the groove.

The procedure is also beneficial for those suffering from patellar instability and pain associated with arthritic changes in the patellofemoral joint. It helps prevent total knee replacement for almost a decade.

Who is a candidate for tibial tubercle osteotomy?

Tibial tubercle osteotomy is suggested for those with

  • history of recurrent kneecap instability
  • history of frequent patellar dislocations
  • painful patellar maltracking
  • history of persistent patellar and femoral pain
  • chronic anterior knee pain
  • no relief from the above conditions despite using non-surgical methods

 

Tibial tubercle osteotomy is often performed with autologous chondrocyte implantation and medial patellofemoral ligament reconstruction surgeries.

How is tibial tubercle osteotomy performed?

Surgeons perform tibial tubercle osteotomy under general anesthesia. Arthroscopy helps asses the condition of the patellar cartilage and the knee joint from visuals generated by a small tube-like camera.

Another periosteal incision is made just below the kneecap. The upper portion of the tibia just behind the tibial tubercle is cut using an oscillating saw. This is the very place where patellar tendon is connected with tibia. The bone is shifted to a more centralized location and repositioned. Then it is fixed using screws. All incisions are closed and the knee is bandaged.

How long does tibial tubercle osteotomy surgery take?

The procedure takes between 60 to 90 minutes.

Do I need to stay at the hospital after tibial tubercle osteotomy?

As the procedure is performed arthroscopically, patients do not stay more than a night in the hospital. In many cases, patients are discharged same day.

Do I need rest after tibial tubercle osteotomy?

Patients require complete rest for 3 days and partial rest for two weeks. The knee remains swollen for a week. Ice the area for 20 minutes two-three times a day. Patients need to use crutches for six weeks and avoid weight bearing, knee bending or pushing under load.

What are the restrictions following tibial tubercle osteotomy?

  • Keep the incision bandage clean and dry
  • No showering for 3 days
  • Rest for 2 weeks
  • No driving for 6 weeks
  • Use crutches for 6 weeks
  • No weight bearing or knee bending under load for 6 weeks
  • Use a knee immobilizer brace for 12 weeks

What kind of rehabilitation is needed following tibial tubercle osteotomy?         

  • First 2 Weeks: Passive exercises to decrease effects of immobilization and gait pattern normalization. Physical therapy, such as light patellar massage, ankle pumps with elevation, heel slides, hamstring curls, supine assisted flexion hangs, calf and hamstring stretches without load, etc.
  • Week 2 to 6: Progress to WBAT while continuing previous exercises, do sing-leg stance, progressive weight prone hangs, raise the toe while standing or sitting, multi-plane SLR, weight- bearing calf and hamstring elongation, stationary biking, etc. mini squats, proprioception workout, swimming, and lateral step-up after 4 weeks.
  • Week 6 to 12: Elliptical stepper, progressive strength and proprioception training, lateral step-ups, weight hamstring curls, cycling, flexibility exercises, advance closed chain strengthening, etc.
  • After 12 Weeks: Crossovers, box jumps, return to sports, leg loading, strengthening exercises, etc.

How long is the recovery period following tibial tubercle osteotomy?

It takes at least 12 weeks to recover. However, use a patellar stabilizer brace for six months while doing high impact activities.

What are the potential complications of tibial tubercle osteotomy?

Common surgical complications, such as swelling, bleeding, temporary pain, and infection, are reported. However, all these are managed with post-operative care and proper healing.

References

Jacques H. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop. 2010 Feb; 34(2): 305–309.

Bellemans J, Cauwenberghs F, et al. Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sports Med 1997;25:375–81.

Hauser ED. Total tendon transplant for slipping patella: a new operation for recurrent dislocation of the patella. Surg Gyn Obstet 1938;66:199–213.

Farr J. Anteromedialization of the tibial tubercle for treatment of patellofemoral malpositioning and concomitant isolated patellofemoral arthrosis. Tech Orthop 1997;12: 151–64.

Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop 1983;177: 176–81.

Maquet P. Advancement of the tibial tuberosity. Clin Orthop 1976;115:225–31.

 

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