Tibial Tubercle Osteotomy

If you’ve experienced ongoing knee pain, patella instability, repeated dislocations, or patellofemoral osteoarthritis, a tibial tubercle osteotomy (TTO) may help realign your knee and improve your mobility.

This is a highly effective surgical procedure that is often used alongside other treatments to:

• Improve patella (kneecap) tracking

• Reduce anterior knee pain

• Prevent further damage to cartilage

• Improve the long-term outcome of knee replacements if required

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🏥 What is a Tibial Tubercle Osteotomy?

Your tibial tubercle is a small bony bump on the front of the shinbone where your patella tendon attaches.
If the kneecap doesn’t sit properly in the groove at the front of the thighbone — often called patellar maltracking — the load is distributed unevenly, which can cause pain, wear, and instability.

Tibial tubercle transfer surgery repositions this bump so that the kneecap glides centrally in the groove as you bend your knee. Moving the tubercle slightly inward (towards the midline of your body) offloads the painful areas and improves alignment.

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🧑‍⚕️ What Does Surgery Involve?

Your surgery will take place under a general anaesthetic, so you’ll be asleep and won’t feel a thing.

Step 1 – Arthroscopy
Before moving the tubercle, a knee arthroscopy (keyhole surgery) is performed. This allows Mr Frame to examine the inside of your knee with a small camera and address any cartilage damage or loose bodies.

Step 2 – Tibial Tubercle Osteotomy
Next, a small incision is made just below your kneecap.

• A controlled cut is made around the tubercle with a precision saw.

• The bony segment is carefully mobilised, making sure all the tendon attachment is preserved.

• Under direct vision and arthroscopic guidance, Mr Frame shifts this bony segment inward to improve patella tracking.

• The new position is secured with strong surgical screws, which can be left in place permanently or removed at a later date if they cause discomfort.

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🏡 After Surgery: What to Expect

✅ Hospital stay: You’ll usually go home the next day or after 1–2 nights in hospital.
✅ Pain management: Oral pain medication will help keep you comfortable.
✅ Brace: You’ll wear a brace to protect the repair. This is usually worn for several weeks and may be removed when you’re seated with your leg elevated.
✅ Physiotherapy: Gentle exercises will help regain mobility and strength.
✅ Ice and elevation: Applying ice packs and keeping the leg elevated will reduce swelling and discomfort.

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🧭 Recovery Timeline

• First 2–4 weeks: Rest and protect the repair.

• By 6–8 weeks: Begin to build strength and mobility under physiotherapy guidance.

• By 3–4 months: Return to most daily activities, with gradual return to sport after 6–9 months.

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⚠️ Risks & Complications

Complications are rare, but as with all surgery they can include:

• Infection

• Blood clots (DVT)

• Nerve or blood vessel irritation

• Stiffness

• Delayed bone healing (non-union)

• Tuberosity fracture
  Your surgical and anaesthetic team will go through all risks with you beforehand and take steps to reduce them.

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💬 Ready to Take the Next Step?

If persistent knee pain or instability is holding you back, Mr Frame at Wessex Knee can help. Book a consultation to discuss whether tibial tubercle osteotomy could be right for you — let’s get you back on the path to an active, pain-free lifestyle.