What is Tibial Tubercle Transfer?
Tibial tubercle transfer is a surgical procedure that is performed along with other procedures to treat patellar instability. The tibial tubercle transfer technique involves realignment of the tibial tubercle (a bump in the front of the shinbone) such that the kneecap (patella) traverses in the center of the femoral groove. The patellar maltracking is corrected by moving the tibial tubercle medially, towards the inside of the leg and can help prevent repeat dislocations.
Who might benefit from a Tibial Tubercle Transfer?
Patients with recurrent patellar dislocations when physical therapy and other non-surgical methods have failed.
What happens in Tibial Tubercle Transfer Surgery?
The procedure is performed under general anesthesia. At first, an arthroscope will be inserted to inspect the inside of the knee joint. It involves small incisions or portals through which small instruments are passed and a video camera is used to visualize the anatomy of the knee joint, evaluate patella cartilage and assess patella tracking.
Tibial tubercle transfer is done through an incision made in the front of your leg, just below the patella. A periosteal incision of 8-10 cm is made at 1 cm medial to the tibial tubercle. With the help of saw, a cut is made in the bone medial and distal to the tuberosity.
Similarly, a proximal cut is made using appropriate instruments such as a curved osteotome or reciprocating saw. Then, an osteotomy through the bone cortex is performed without cutting the lateral periosteum. The lateral periosteum serves as a point of attachment for the osteotomy segment. By doing this, a tibial tubercle segment, which is more than 2 cm in width, more than 1 cm in thickness, and 8-10 cm in length can be obtained. It includes all portions of insertion of the patellar tendon. The segment from the tibia is then levered using the osteotome to provide access to the medullary canal of the tibia.
The osteotomy segment is then moved under direct vision into a position that assures proper tracking of the patella. The tracking pattern can be confirmed arthroscopically. The mobilized bone is then fixed into its new place using screws, which can be removed later if they cause irritation.
What happens after Tibial Tubercle Transfer Surgery?
You may have moderate knee discomfort for several days or weeks after the surgery. Oral pain medications will be prescribed. Keep the operated leg elevated and apply an ice bag over the area for 20 minutes. This decreases swelling as well as pain. You will have to wear a leg brace that may be removed only while sitting with your leg elevated. Physical therapy exercises should be performed as it helps in regaining mobility.
Risks and Complications of Tibial Tubercle Transfer
Risks following tibial tubercle osteotomy surgery include compartment syndrome, deep vein thrombosis, infections, damage to nerves or blood vessels, and delayed bone healing.