Tibial Tubercle Transfer (TTT)

What is the knee joint?

The knee is a very important joint in the body and consists of the thigh bone (femur) and shin bone (tibia). It plays an extremely important role in supporting nearly the entire weight of the body and does this with the help of surrounding muscles, ligaments and cartilage.

You have many muscles around your knee which help provide stability and allow movement. The main muscles surrounding the knee are the Quadriceps (front of thigh), Hamstrings (back of thigh) and Calf (back of lower leg). 

Ligaments hold your bones together and are therefore integral to stabilising the knee. Anterior Cruciate Ligament (ACL) prevents excessive forward movement of the tibia on the femur. Other important ligaments in the knee are the Posterior Cruciate Ligament (PCL), the Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL).  

There are two main types of Cartilage:

Menisci: disc shaped fibrous cartilage that are situated between the femur and tibia. They provide stability, act as shock absorbers, lubrication and allow equal weight distribution.

Articular Cartilage: This covers the end of the bones and allows them to move smoothly against each other with less friction. It also helps spread the load applied to the joint

What happens during my surgery?

A tibial tubercle or tuberosity transfer (TTT) is a surgical procedure to realign the tracking of the kneecap (patella). It involves removing a small piece of bone on the front of the shin bone and reattaching it with anchors or screws to a different position. This can offload the painful portion of the patella or can increase compression to prevent dislocation.

What happens after surgery?

You are able to start walking on the first day after surgery. You will most likely be wearing a knee brace and you can only remove this for washing and dressing and sometimes for exercises. Your Physiotherapist will advise you further on this.

Moving your leg

Your operated leg must be supported at all times when you are moving it, either using your hands or your opposite leg. Continue this after discharge until you have been advised otherwise by your Physiotherapist.

Pain relief

A nerve block is sometimes used during surgery which means your limb may feel numb immediately after your operation. It is normal to feel some pain as the block wears off and you will be provided with some painkillers to help with this. It is important to take these as prescribed to keep pain to a minimum.

Ice

Ice can be helpful to reduce pain/swelling. Protect your dressings from getting wet with a plastic bag. Wrap a bag of ice/frozen peas in a damp towel and apply for 10-15 minutes. This can be repeated every 3-4 hours. For knee surgery, elevating your leg on pillows can also help.

Wound care

Your wounds will need to be kept clean and dry. The nursing staff will provide you with more information about wound care on discharge.

Driving and work

You should not drive whilst using elbow crutches. Please discuss this with your consultant or physiotherapist. When you can return to work will depend on what job you do.  Your physiotherapist will be able to advise you on this.

Leisure and Sport

This will depend on the healing of your fixation and instructions from your consultant. Often, you are not allowed to do any impact activities, e.g jogging, until 4-6 months after your operation. Return to contact sports is often 6 to 9 months. Your Physiotherapist can also advise you on this.  If you have any questions or need any advice about your exercises, then please contact the Physiotherapy Department between 8am - 4pm Monday to Friday on 0121 812 3254.

Physiotherapy

	You should do this exercise while lying down. A good place to do this exercise is on your bed. Lifting and holding your leg once is one repetition.   Start with your leg straight and tighten your thigh muscle and gentle push the back of your knee into the bed. Hold for 10 seconds and then relax your leg.	Repeat this 3-5 times  3 times daily
	You should do this exercise while lying down. A good place to do this exercise is on your bed. Bending and straightening your leg once is one repetition.       Start with your leg straight, slowly bend your leg by sliding your foot along the floor/bed towards you as far as comfortable (or as far as your brace allows). Hold this position for 2 seconds before straightening your leg.	Repeat this 5-10 times  3 times daily
	You should do this exercise while sitting on a chair. Bending and straightening your leg once is one repetition.      Bend your knee as far as you can or as far as the brace will allow by sliding your foot backwards along the floor. Cross your unaffected leg over your ankle and use it to help bend the knee further. Hold this position for 10 seconds and then straighten your legs.       Do not slide forward nor allow your buttocks to lift up from the chair when you push your knee to bend.	Repeat 5-10 times    3 times daily
	Lying on your back, clench your buttock cheeks together.  You may feel yourself lift a little.    Hold 5 seconds	Repeat 10 times    3 times daily
	It is essential to keep your foot and ankle moving.  Point and flex your foot up and down slowly to feel a stretch in the back of your leg.	Repeat 10 times up and down    3 times a day
	Lying on your non- operated side.   Lock your brace straight Lift and lower your top leg Do not allow your leg to drift forward – keep in line with your body	Repeat 10-20 times Twice daily
	To walk UPSTAIRS Start as close to the step as possible. Hold onto the rail and place other crutch into the opposite hand (as picture) or get someone else to carry it upstairs. Step up with your non- operated leg pushing through your crutches and using the rail. Bring the operated leg to meet it. REPEAT   To come DOWNSTAIRS Again holding a rail, Place your crutch down 1 step, place your operated leg down 1 step. Supporting yourself with the rail and crutch bring the non operated leg down to meet it. (see picture) REPEAT