TIBIAL TUBERCLE OSTEOTOMY
The kneecap (patella) is a small bone in the front of the knee that helps support the extensor mechanism (quadriceps and patellar tendon). As the knee bends, the patella glides along a groove on the femur bone – the trochlea. Some patients have abnormal bony anatomy in the knee, which places more stress on the patella tendon, leading to abnormal stress on the patella. As the knee bends, the patella tracks on the outside of the trochlea instead of in the middle. Some patients with abnormal bony anatomy may develop cartilage damage underneath the patella as well. In those patients with abnormal bone anatomy in the knee with instability and/or cartilage damage, Dr. Welch may recommend surgical intervention.
The goal of surgery is to re-align a bony prominence (tibial tubercle) on the tibia and normalize the patient’s anatomy. The tibial tubercle is a bump on the front of the tibia bone where the patella tendon inserts. By re-aligning the tibial tubercle, Dr. Welch takes stress off of the patellar tendon and also unloads the cartilage underneath the patella. Prior to surgery, Dr. Welch usually obtains and MRI and/or a CT scan for surgical planning. During surgery, Dr. Welch uses a sharp device to cut the tibial tubercle. Dr. Welch then moves the tubercle closer to the inside of the knee and secures it back down to the tibia bone with a medical screw. If the patient has an unstable patella with previous patella dislocations, Dr. Welch will also perform a reconstruction of the medial patellofemoral ligament (MPFL).
Following surgery, patients are placed in a hinged brace that is locked straight. Dr. Welch recommends full weight-bearing with the brace locked straight for 4-6 weeks. When the patient is sitting or lying down, Dr. Welch encourages passive knee range of motion exercises with the brace removed. Dr. Welch also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscle. Dr. Welch recommends starting physical therapy two weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee. Most patients can start full weight bearing on the affected leg six weeks after surgery, depending on the location of the defect. Most patients start cutting activities and sporting activity approximately four months after surgery.