What is a tibial tubercle osteotomy?

The anatomy in plain words

The kneecap sits inside the quadriceps tendon above and the patellar tendon below. The patellar tendon anchors to a bony prominence just below the knee called the tibial tubercle. If that anchor point sits too far to the outside, or too low or high, the kneecap may be pulled off course every time the knee bends and straightens.

An osteotomy, meaning a controlled bone cut, lets the surgeon move the anchor point to a better position.

What it is used for

• Recurrent kneecap dislocation where the tubercle is positioned too far outward
• A high-riding kneecap that does not engage the groove early in bending
• Wear of the cartilage on the lower or outer part of the kneecap, to shift load to healthier areas
• Often combined with MPFL reconstruction or cartilage procedures

How the operation is done

Through an incision at the front of the upper shin, the surgeon cuts a strip of bone carrying the tubercle, moves it inward, forward or downward by a planned amount and secures it, usually with two screws. Arthroscopy of the knee is often done at the same time to check the cartilage.

The amount of movement is planned beforehand from X-rays, MRI or CT measurements of kneecap height and alignment.

Is it right for you?

Many kneecap problems settle with physiotherapy, and an osteotomy is considered only when the bone alignment is a clear part of the problem. At Aman Hospital, Dr. Gelber combines your history, examination and scans before suggesting it, and explains alternatives such as rehabilitation or soft-tissue surgery alone.