Table 2.

Surgical Steps for Tibial Tubercle Transfer

1. Position patient supine with the operative knee resting on a radiolucent triangle.

2. Make a vertical skin incision directly over the tibial tubercle (TT) from 1 cm proximal to 6 cm distal.

3. Identify and mark medial and lateral fascial borders of the patellar tendon.

4. Retract muscles of anterior compartment to expose the anterolateral cortex of the tibia.

5. Place osteotomy guide pins from medial to lateral at the angle of desired osteotomy. Ensure pins are placed colinearly.

6. Score medial cortex with oscillating saw along guide pins. Remove pins, and complete osteotomy with the oscillating saw exiting the lateral cortex.

7. The distal cortex may be completed or left intact as a hinge.

8. Elevate the tuberosity fragment with an osteotome.

9. Translate tuberosity fragment to desired position and hold into place with 0.062 K-wires.

10. Fix fragment in position with 3.5-mm fully threaded cortical screws on compression, using a countersink to prevent hardware prominence.

11. Layered closure in standard fashion.

12. Place patient into a hinged-knee brace.