My surgeon says I need my shinbone cut to fix my kneecap. Why?

Ligaments hold, bones steer

The MPFL is the main ligament stopping the kneecap from sliding outward, and reconstructing it is a common operation. But if the bones keep steering the kneecap off track, a new ligament alone may be overloaded and stretch or fail.

A tibial tubercle osteotomy changes the steering. It is often added to an MPFL reconstruction when the scans show a clear alignment problem.

The measurements your surgeon may mention

• TT-TG distance: how far outward the tendon attachment sits relative to the groove of the thigh bone, measured on CT or MRI
• Patellar height: whether the kneecap rides high, measured on X-ray or MRI
• Trochlear shape: how shallow or flat the groove is
• Cartilage condition: whether certain parts of the kneecap are worn

No single number decides surgery. They are combined with how often the kneecap dislocates and how much it limits you.

Questions worth asking

Ask which measurement is abnormal in your knee, what would happen with ligament surgery alone, how long you will be on crutches and what restrictions apply to work, driving and prayer positions. It is reasonable to ask for time to think, or to seek a second opinion, before agreeing to a bone operation.

When this is not the answer

Kneecap pain without instability and without a clear alignment problem usually responds to physiotherapy focused on hip and thigh strength. At Aman Hospital, Dr. Gelber explains when an osteotomy is likely to help and when it is unlikely to change your symptoms.