Tibial Tubercle Osteotomy for patellofemoral problems

The kneecap fits into the groove in the femur, and when the knee goes straight and bends (i.e. extends and flexes) the kneecap runs in this groove. Sometimes the kneecap is not well contained in the groove and actually pops out of joint (dislocates). The dislocation is generally to the lateral (outer part of the knee) direction and this can be a significant problem, particularly in adolescence and sometimes in young women.

There are various aspects of body shape which might increase the risk of patellar dislocation (see pictures). There are various ways of treating repeated patellar dislocation and these depend on the actual abnormalities that give rise to the problem. The commonest operation in my practice for this type of surgery is a tibial tubercle osteotomy. This is an operation which involves taking a piece of bone on the tibia to which the patella attaches via the patellar tendon and moving it from the outer of the tibia to the inner part tibia (medialising it). This enables the patella (kneecap) to run in a much straighter line and to reduce the tendency of the kneecap to come out of joint.

The operation involves cutting of the bone and re-fixing it with some screws to hold it, usually three or four screws. It is usually involves a one night in hospital, although, it can in certain circumstances be done as a day case. The screws used to hold the bone in place are quite secure and allow full weight-bearing on crutches, but for six weeks after the operation the patient has to avoid any form of bending of the knee under load or of pushing the knee straight under load.

Usually it’s six weeks when some early bone healing is seen and the patient can return to normal movements. Driving is usually possible at two weeks and normal mobilisation at six weeks, but the return to full activity, including running, squats and weight training, etc. between three and six months later, depending on the recovery.