MPFL reconstruction or tibial tubercle osteotomy: which one do I need?

Two operations, two different problems

MPFL reconstruction addresses the soft-tissue problem: the ligament on the inner side of the kneecap that was torn by previous dislocations. It works like replacing a broken tether.

A tibial tubercle osteotomy (TTO) addresses an alignment problem. The bony bump below the knee where the patellar tendon attaches is cut, moved inwards, downwards or both, and fixed with screws. This changes the direction of pull on the kneecap and, if it is moved down, lowers a kneecap that sits too high.

How the decision is made

• MPFL reconstruction alone is usually considered when the main problem is the torn ligament and the bones are close to normal
• An osteotomy is usually added when MRI or CT shows the tendon attachment sits far to the outer side, or when the kneecap rides markedly high
• A trochleoplasty, which deepens the groove, is reserved for selected patients with a severely flat or bumped groove
• Cartilage wear under the kneecap can also influence the choice, because moving the tubercle can unload damaged areas

How recovery differs

After MPFL reconstruction alone, walking returns relatively quickly and sport is commonly resumed at around four to six months. After an osteotomy, the cut bone must heal, so weight-bearing and bending are usually protected for around six weeks, return to sport is often later, and the screws are sometimes removed later if they are prominent.

An osteotomy is not done in teenagers who are still growing, because it would damage the growth plate under the tubercle.

A personalised plan in Doha

At Aman Hospital, Dr. Gelber reviews your measurements with you on the scans, explains which factors are present and why a given combination is recommended. Doing only what is needed keeps recovery as short as possible while treating the real cause of the instability.