Tibial Tubercle Transfer

Tibial tubercle transfer, also known as a distal alignment procedure, is used to realign the patella (kneecap) and treat patellar instability, chronic dislocation, or maltracking of the kneecap. This procedure helps reduce pain and improve the function of the knee, particularly in patients with conditions like patellar instability, recurrent dislocation, or patellofemoral pain syndrome.

TTT may be considered when conservative treatments such as physiotherapy, bracing, and medications fail. Common conditions that may benefit from TTT include:

• Maquet procedure
  In this procedure, the tibia tubercle is cut, keeping the patellar tendon attachment intact. The tubercle is elevated by wedging the loosened piece of bone using a bone block. This procedure cannot move the tendon and tubercle medially (towards the inner aspect of the knee).
• Elmslie-Trillat procedure
  This is a procedure like Maquet procedure, but the tendon and tubercle can be moved medially.
• Fulkerson procedure
  In this procedure, the tibia tubercle is moved more towards the inner aspect of the knee. This is achieved by breaking the bone into sharp pieces (splintered) which allows the bit of bone and the tendon to move more medially. After the procedure bits of bone are held in place using screws.
• Hauser procedure
  In this procedure, the tibia tubercle is moved medially, but not moved forward (anterior). Because of the shape of the tibia, the tubercle may shift its position more posteriorly and the patella may press down causing pain.
• Roux-Goldthwait procedure
  It is a distal realignment procedure where the patellar tendon is split vertically. The lateral half of the patellar tendon is pulled under the inner half (medial) and attached to tibia. This pulls the patella over to the centre and helps prevent excess lateral shift.

Most people stay in the hospital for 1 to 2 days after surgery. During this time, Dr Yu will focus on managing pain and checking your early recovery. You will wear a knee brace to keep your leg straight and protect the area where the surgery was done. Crutches will help you move around without putting weight on your healing leg, and you may need them for several weeks.

Physiotherapy usually starts soon after the surgery. It helps you slowly get your movement back, build up your strength, and improve how your knee works.

It can take about 4 to 6 months before you can go back to sports or other high-impact activities, depending on how well your recovery goes.