Tibial tubercle osteotomy (TTO) is an operation to move the bony attachment point of the patellar tendon on the shinbone. It is performed to improve kneecap tracking, treat patellar instability, or offload a damaged area of cartilage behind the kneecap.
An incision is made over the front of the upper shin. The tibial tubercle (the bony bump where the patellar tendon attaches) is carefully cut and moved — typically inward (medialisation) to correct tracking, forward (anteriorisation, Maquet) to offload the patellofemoral joint, or a combination (Fulkerson). The repositioned bone is fixed with screws. The operation takes one to one and a half hours.
TTO is recommended for recurrent patellar dislocation with an abnormally positioned tibial tubercle, patellofemoral pain or arthritis, and as part of cartilage repair procedures behind the kneecap.
Physiotherapy for quadriceps strengthening and patellar tracking, patellar taping, bracing, and activity modification.
CT or MRI to measure the TT-TG distance and assess cartilage. Standard pre-assessment.
Improved kneecap tracking and stability. Reduction in anterior knee pain. Most patients achieve good outcomes.
Temporary loss of flexion.
Prolonged anterior knee swelling.
The screws may be palpable under thin skin.
The osteotomy may fail to heal. Risk approximately 2-5%.
The tibial tubercle may fracture during or after surgery.
Excessive medialisation may cause new tracking problems.
Wound or deep infection.
DVT despite preventive measures.
General or spinal anaesthesia with a nerve block.
Weight-bearing as tolerated in a brace. Range of motion exercises begin immediately. Brace for six weeks. Physiotherapy for quadriceps rehabilitation. Return to sport at four to six months.
X-rays at six weeks and three months. Screw removal at six to twelve months if symptomatic.
Approximately 30-40% of patients choose screw removal because of prominence. This is a minor procedure after the osteotomy has healed.