Patella Realignment Surgery Tibial Tubercle Transfer (TTO)
A procedure to correct patellar alignment by adjusting the tibial tubercle
The patella plays a vital role in knee function, sliding along the femoral groove during movement. Misalignment or maltracking of the patella can cause pain, instability, and difficulty with daily activities or sports.
Common Reasons for Patella Realignment Surgery
- Recurrent patellar dislocations due to anatomical misalignment.
- Chronic knee pain associated with patellar instability or maltracking.
- Cartilage damage on the back of the patella caused by improper tracking.
Goals of the Procedure:
- Realign the patella to improve stability and tracking within the femoral groove.
- Relieve pain and reduce the risk of further cartilage damage.
- Enhance knee function and mobility.
Preparation for Surgery
Dr Ben McGrath will perform a comprehensive evaluation, including imaging studies such as X-rays, MRIs, or CT scans, to determine the cause of patellar instability and plan the surgical approach.
Key Steps in Preparation:
- Consultation: Dr McGrath will discuss the procedure, its benefits, and potential risks, and answer any questions.
- Pre-Surgical Instructions: Patients may need to fast before surgery and adjust medications, such as pausing blood thinners.
- Prehabilitation: Strengthening the quadriceps and other supporting muscles may aid recovery.
- Lifestyle Adjustments: Maintaining a healthy weight and ceasing smoking may improve outcomes.
What Happens During the Surgery?
Patella realignment surgery is typically performed under regional or general anaesthesia.
Surgical Steps:
- Incision: A precise incision is made over the tibial tubercle to access the bony structure.
- Repositioning: The tibial tubercle is carefully detached and repositioned to align the patella within the femoral groove.
- Fixation: The repositioned tubercle is secured using screws or other fixation devices to ensure stability.
- Soft Tissue Adjustments: Any necessary repairs to surrounding ligaments or tissues are performed to optimise alignment and support.
- Closure: The incision is closed with sutures or adhesive strips, and the knee is bandaged for protection.
The procedure typically takes 1 to 2 hours.
Understanding the Risks
As with any surgical procedure, patella realignment surgery carries potential risks:
- Infection: At the surgical site or within the joint.
- Blood Clots: Rare but possible in the legs or lungs.
- Residual Pain or Stiffness: Some patients may experience ongoing discomfort.
- Hardware Issues: In rare cases, fixation screws may need adjustment or removal.
- Delayed Healing: Bone healing at the tibial tubercle site may take longer in some cases.
Dr McGrath follows stringent surgical protocols and employs advanced techniques to minimise these risks.
What to Expect After Surgery
Immediate Post-Operative Care:
- Pain Management: Swelling and discomfort can be managed with prescribed medications and regular icing.
- Assistive Devices: Crutches or a knee brace may be used during the initial recovery period to protect the surgical repair.
- Discharge Instructions: Patients will receive detailed guidance on wound care, physical activity, and follow-up appointments.
Rehabilitation and Recovery
A structured rehabilitation program is essential for successful recovery and long-term outcomes.
Phase 1: Early Recovery (Weeks 0–6)
- Goals: Protect the surgical site, reduce swelling, and regain basic mobility.
- Activities: Non-weight-bearing or partial weight-bearing with crutches, gentle range-of-motion exercises, and cryotherapy.
Phase 2: Strength and Stability (Weeks 6–12)
- Goals: Restore strength and flexibility.
- Activities: Physiotherapy focusing on quadriceps strengthening, balance exercises, and progressive weight-bearing.
Phase 3: Advanced Recovery (Months 3–6)
- Goals: Return to daily activities and sports as appropriate.
Activities: Functional training, advanced strength exercises, and gradual reintroduction of high-impact activities.
Long-Term Outcomes
Patella realignment surgery may help stabilise the patella, improve knee function, and reduce the risk of recurrent dislocations. Long-term success depends on:
- Adherence to the prescribed rehabilitation program.
- Regular follow-up visits to monitor progress and ensure proper healing.
- Maintaining a healthy lifestyle to support joint health.
With appropriate care, many patients experience significant improvements in knee stability, comfort, and quality of life.