Current concepts regarding tibial tubercle osteotomy my philosophy and experience

Abstract

Tibial tubercle transfer (TTT) is a powerful way to control patellofemoral mechanical function. Before using TTT, one must understand the fundamental mechanical problem in the patellofemoral joint and determine that transferring the tibial tubercle is the most appropriate way to restore optimal function of the joint. Usually this means that the surgeon wants to provide more balanced tracking of the patella thereby compensating for underlying structural problems that have caused lateral patella instability or overload. When the patella is tracking out of its optimal alignment pattern, it is possible to alter the path of patella movement permanently, by TTT. Often TTT is the most benign PF realignment alternative for the patient, particularly when compared to derotational osteotomy of the femur or tibia. Once the tracking vector is normalized by TTT, peripatellar retinacular structures may be adjusted to provide additional support for the patella. In this author's opinion, retinacular structures (including the medial patellofemoral ligament [MPFL]) should not be used to displace patella tracking, but rather to guide it gently in its proper course of movement, attempting always to balance articular loading optimally. © 2010 Springer-Verlag Berlin Heidelberg.