Tibial Tubercle Osteotomy (TTO)

Tibial Tubercle Osteotomies are suitable procedures for problems chiefly relating to patella.

TTO may be needed in the following cases:

  • History of patellofemoral pain and patellar instability.
  • History of multiple dislocations and knee subluxations.
  • Physical therapy that does not yield any result.
  • Failure of non-surgical management.

Pre-operative procedures include:

  • Diagnostic tests like X-rays, MRI etc.
  • Physiotherapy for continuous muscle strengthening.
  • Pre-operative anesthesia.


The initial procedures include providing general anesthesia followed by knee arthroscopy. The main procedure starts with making an incision on the front of the leg, just below the patella. For osteotomy, the periosteal incision is made at a point medial to the tibial tubercle. A precise cut is made to the tuberosity in addition to a distal cut. Using instruments like a reciprocating saw, a proximal cut is also made. The osteotomy is then performed without the need of cutting the lateral periosteum. The tibial tubercle segment is obtained and is levered using an osteotome. By doing this, the access to medullary tibial canal is obtained.

The osteotomy segment is moved into a suitable position that ensures proper patellar tracking. This can be confirmed using an arthroscope.