What is tibial tubercle osteotomy surgery? - Procedure, Recovery, Rehab, CPT Code

What is tibial tubercle osteotomy surgery?

Tibial tubercle osteotomy (TTO) is a surgical treatment commonly performed to treat specific knee issues. It entails moving the tibial tubercle, a bony protrusion on the front of the tibia (shinbone), into position. 

Definition 

Tibial tubercle osteotomy is a surgical procedure that attempts to realign the tibial tubercle and change the forces pushing on the knee joint. It corrects patellar instability, maltracking, and some types of patellofemoral pain syndrome. Repositioning the tibial tubercle aids in better patella (kneecap) alignment within the femoral groove, which lessens pain and enhances joint function.

Indications

Tibial tubercle osteotomy is indicated in different conditions, including:

Recurrent patellar dislocation or instability

TTO may be advised to address the underlying anatomical defects causing the dislocation when conservative therapies are ineffective.

Patellar maltracking

TTO can address aberrant patellar tracking brought on by things like a lateralized tibial tubercle or a tight lateral retinaculum.

Patellofemoral pain syndrome 

Patients with persistent knee pain originating from the patellofemoral joint may occasionally be candidates for TTO.

Procedure

Tibial tubercle osteotomy usually involves these steps:

Surgical Technique

In order to separate the tibial tubercle from the underlying bone during surgery, the orthopedic surgeon makes an incision directly above it. The tubercle is then repositioned via specialized instruments. In certain scenarios, additional procedures like lateral release or cartilage repair may be carried out simultaneously.

Fixation Methods

Several fixation techniques can be used to secure the relocated tibial tubercle. Plates, screws, and wires are common solutions. The selection of the fixing technique is influenced by the surgeon's preferences, the history of the patient, and the stability needed for proper healing.

Potential Complications

Tibial tubercle osteotomy may carry some risks and problems, just like any surgical process. Infection, blood clots, nerve or blood vessel damage, slow healing, or nonunion of the bone fragments are a few of these potential complications. In order to reduce complications, patients must discuss these potential risks with their surgeon and adhere to post-operative recommendations.

Recovery and Rehabilitation

The patient's condition and the surgery's extent determine the healing and rehabilitation process after tibial tubercle osteotomy. However, there are some general rules:

Immediate Postoperative Period

The patient will normally stay in the hospital for a brief period following the procedure for monitoring. During this period, it may be necessary to begin pain treatment, wound care, and physical therapy. The surgeon could advise taking painkillers or applying ice to the affected area to minimize swelling.

Long-term Rehabilitation

Once discharged, the patient will continue the recovery process at home. Physical treatment is essential for improving knee function and fortifying the supporting muscles. The therapist will instruct the patient in exercises designed to enhance range of motion, stability, and muscle strength. The surgeon or physical therapist will monitor the patient's progress throughout the rehabilitation process, which may last several months.

CPT Code

The most typical Current Procedural Terminology (CPT) code for tibial tubercle osteotomy is 27455. This code details the realignment and surgical repair of an aberrant tibial tubercle.