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Author Topic: Tibial tubercle transfer surgery...so many questions!  (Read 14040 times)

Offline Strawberrry12

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Tibial tubercle transfer surgery...so many questions!
« on: April 25, 2010, 11:03:08 PM »
Hello everyone!

I'm 16 and a tibial tubercle transfer and lateral release has been recommended to me after seeing a orthopedic surgeon for 20 months while trying physical therapy, taping and bracing, and icing like crazy. I've had 6 dislocations, 5 have been in the last two years. I have pain every day and can't squat, run, or jump. I feel like I'm way to young to have problems like this!! :-[

Anyway, I would like to know if you have had this surgery before and if you would recommend it/do it again. Also, how long was your hospital stay and recovery time?I know it will take about 8-12 months to be totally healed but how long until you could get back to regular life?

I know it will  be painful and long, but I really want my knee to stop dislocating!

Thank you so much for your input! :)

-Bree
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release

Offline oohheykate

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #1 on: April 26, 2010, 02:39:19 AM »
Hey Bree,

I'm kinda in the same boat as you, although I've only dislocated once (that was enough), I can sympathize with you. I'm also sixteen and I've had three knee surgeries on my left knee and I'm going to have a fourth surgery to fix my right knee probably this summer.

I didn't have this specific surgery, but Andi/Doublemom has a great post-op diary called "Andi/Doublemom's TTT/LR Apr. 6, 2010." You can also search TTT in the search bar or look in the post-op diary section. You just have to keep in mind that everyone is different and doctors have different protocals. Some people stay overnight to two days, while others go home the same day. Same thing with weight bearing, some people are WBAT from the start and others are NWB for 6 weeks.

Good Luck with everything,
Kate
-18 years old-
Left knee;
11.07.08- Scope
07.02.09- Lateral Release/Meniscus Repair
11.11.09- diagnosis of Patellar Instability/Patellar Tracking Disorder
12.10.09- Medial Reefing/Lateral Release
01.11- Synvisc
04.14.11- MPFL Reconstruction
06.21.11- LOA & MUA

Offline adevlop

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #2 on: April 26, 2010, 04:03:50 PM »
Hi there Bree,

I can definitely sympathize with you. I am 20 years old and have had multiple major knee surgeries to correct numerous problems and injuries. I had my first TTT done on my right knee in April of 2008, and this coming friday 4/30, i will be having that same TTT done again to revise the one that I had 2 years ago. Yes, it is a very long and painful recovery, but in the end I have found it to be worth it. I will be starting a post-op diary that you can look at, and if you have any questions I would be happy to answer them through email (adevlop@yahoo.com) I would definitely recommend this surgery, as long as you have an experienced surgeon- that is the key!! As long as you work hard at the rehab, the outcome should be very beneficial to you. If i didn't think so, I wouldn't be going through this procedure all over again! Good luck with everything, and let me know if there is anything I can do to help!

Alyssa
knee pain for 13yrs-20yrs old

'06-scope of R knee/cartilage repair
'08-TTT/LR/MI
'08-supartz injections-no relief
'09-open MPFL reconstruction with allograft/hardware removal/arthroscopic debridement
'09-synvisc injections and prp treatment-no relief
'10-TTT revision/cartilage debridement

Offline crankerchick

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #3 on: April 26, 2010, 04:50:14 PM »
Hi Bree, I had a TTT (but no lateral release) 6 months ago. My surgery also included 2 other osteotomies to correct my twisted bones. It's a lot of surgery to go through, but so far it has been worth it for me. The rehab has been tough, but my knee feels good and doesn't feel like it wants to dislocate any more. I am already having a much higher activity level than I did prior to surgery and without the associated knee pain.

There are quite a few satisfied TTT customers out there, but like Alyssa said, it is important to have an experienced surgeon and also equally important to have a thorough evaluation from said skilled surgeon. There are a multitude of reasons for why a kneecap may want to dislocate and it is important to address the root cause before choosing surgery. In my case, it was twisted bones and a TTT alone would have likely been an incomplete approach.

How long it takes to get back to regular life really depends on the doctor. You should discuss this with your doctor (and parents). My doctor gets his patients up and moving soon after a TTT but others are in a brace for 6 weeks and still others are nwb for the entire 6 weeks. Once the bone healing is sufficient usually around 6 weeks, then real rehab can begin. A lot of the people I've talked to have said that at 3 months out, they felt pretty good.

At 6 months out my TTT area feels pretty darn good. If it weren't for the other osteotomies and associated muscle loss, I think I would be back to full function by now.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Strawberrry12

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #4 on: April 27, 2010, 04:37:53 AM »
Thank you to everyone who has responded!

Another thing, What was the deciding factor for you to go through with the procedure?

And some more background on me: My first significant dislocation (actually, it was a subluxation) was 2 years ago. The other one in between was from playing basketball. After the basketball one, the next 3 were when I was just walking. I did rehab. and I was feeling great! So I started up tumbling to try out for cheerleading.

And my most recent one happened when landing a back hand spring. Do you think that my knee never would have subluxed again if I had not done something as high impact as a back hand spring?

Thanks for all the help!

-Bree ;)
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release

Offline dawn999hall

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #5 on: April 27, 2010, 05:47:32 AM »
Bree - I had a Lateral Release and TTT in Jan 2006 when I was 35 years old.  I was a soccer player and had my first dislocation when I was about 27 years old.  Subluxed regularly after that - I totally hear you when you say no squats, etc.  it was always so painful!  The surgery was not treat...I was totally No Weight Bearing for 6 weeks and then still on crutches for a few more weeks and then in a brace.  The surgery was a little painful but the rehab was the real pain!  I had some complications and had to have 2 surgeries - be sure NOT to use your quads to lift your leg after the surgery you could pull your screws out!  Use a scarf or towel under your heal - you will easily get the hang of it - but my surgeon was VERY conservative after I had to have the surgery re-done and so the getting flexion and extension back was hard work and very painful - extension mores so than flexion which really surprised me.  Your being 16 is on your side - young'uns heal so fast!!  Your incision will probably be 3-5" from your knee down your shin, try to keep the swelling down after surgery so the scar won't be so bad - swelling will make for more scar tissue.  Your main problem in the first 6-8 weeks will be bathing and boredom and the incision will start to itch when it is healing.  It took me a long time but I can do squats, walking lunges and hiking.  Depsite my complications I do not regret the surgery at all...but I remember being VERY anxious about it...I would do it again in a heart beat - I do not have the pain everyday.  I had problems with the screws especially when there were rain storms and so I had the screws removed.  I have had a LOT of surgeries and the advice I have for you is have a positive attitude before you go under the anesthesia - I really believe that helps when you come out the other side!  Good luck and use ice and your pain meds and you will be fine!

Offline crankerchick

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #6 on: April 27, 2010, 12:24:55 PM »
My deciding factor to find a solution to my knee problems was simple recognition that things couldn't get much worse. I lived with the instability and pain for years, but it was only intermittent. The pain was worse when I was younger and active. But last year, the instability got really bad for me. I was subluxing daily just walking around to do simple things like cross the street or go to the bathroom. I wasn't doing any of my activities at that point, like bowling, mountain biking, or photography nature walks (and these were the things I took up when I stopped playing sports because of my knee).

I decided to have my particular surgery after doing tons of research and getting multiple opinions, eventually good opinions from patella specialists. In the end, the procedure I chose "just made sense."

Regarding lifting your leg after surgery. Whether or not you will be allowed to lift it really depends on your doctor. It is very important to get moving as quickly but as safely as possible. The longer you don't use your muscles, the more they will atrophy and stiffen. Your doctors protocol will reflect the confidence he has in the hardware he selects for you. I selected my doctor for many reasons, but one was because of his aggressive approach to rehab. I had 3 osteotomies at once but my rehab still started in the recovery room with stretching and quadriceps exercises. I was on the bike 6 days after my surgery and everyday for an hour after that.

This is something you should discuss with your doctor rather than follow advice on the internet. Every doctor is different in their approach and guidelines.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline fraud_ninja

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #7 on: April 27, 2010, 02:58:34 PM »
I have had four TTT's, two on each leg.  I have been an unsatisified customer and now I am probably the most satisfied customer on this entire board. lol

My biggest advice is similar to what others have posted on this thread already.  Make sure you get opinions from well qualified patella specialists.  I made the mistake with my first two TTT's in trusting my surgeon too much.  My first surgeon is a brillant surgeon and very good at what he does, but he is not a patella specialist.  Although he did everything the way it should have been done, my first TTT's left me in horrible shape with far more pain than before surgery.  After my first TTT's I could never even walk around the block without horrible pain.

It was at that point that I went to a patella specialist.  The patella specialist made all the difference in the world.  He revised my TTT's and did MPFL recons.  The result was a complete 180 degree turn around.  I went from unable to walk around the block to now a little over two years since my surgerys I am training for a half marathon.  There is literally no activity I cannot do these days.  Now I do get occassional soreness and my knees are cranky from time to time, but nothing like what it used to be and nothing that does not go away after a day of taking it easy.

Brianne
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline Strawberrry12

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #8 on: May 02, 2010, 11:47:14 PM »
thanks for all the responses everyone!
I'm now waiting until May 18 to see the doctor again so he can let me start physical therapy. But now I've developed another weird thing...there's now pain right below my kneecap!  :-[ Does that mean that something could be torn? Like an ACL? I really hope not! This just keeps getting more and more fun.  ::)

Thanks for all the help
-Bree
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release

Offline Strawberrry12

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #9 on: May 15, 2010, 02:52:26 AM »
Hey everyone,
I'm getting really discouraged over here  :-[ It's been 2 months and I'm still in a lot of pain and I'm losing hope on avoiding a TTT/LR! I'm supposed to do leg raises and when I was doing them yesterday, my knee partially slipped out on the 5th one!! And I'm supposed to contract my quads and hold it but that hurts a lot. I'm so frustrated :( There's been a lot of pain and it's affecting my life. I go to a big high school with lots of walking around and I just can't handle it anymore. I'm a 16 year old having trouble walking like i'm 80  :-[
Sorry that I'm rambling, I'm just frustrated and really want a new solution.

Does anyone know any other simpler leg exercises I can do?
Thanks for all the help
-Bree
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release

Offline lynneM

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #10 on: May 16, 2010, 08:18:36 PM »
Hi - I have a thread on here being 7 weeks post TTT & LR. Everyone is different however from my own experience of many many repeat patella dislocations from the age of 11 to 34 .......... if you are young and get sound advice ..... I would not hesitate in taking that advice and opting for a surgical solution. I have had nearly 30 years of pain, being laid off sport and being reduced to almost nothing other than walking on the flat - all becasue I was told surgery would NOT help - for literally years. I had given up on doctors until aged 37 even standing still became an adrenalin sport and I reluctantly consulted the 9th orthapedic surgeon I have seen since being a child. I am already - although there is a long way to go ..... very very pleased with the results of this procedure. I know if I had had this as a young and much fitter person it would have been easier to recover from than it has been and in all honesty ....... it really has not been that bad. Its down to determination and doing all of the work you are instructed to do in rehab. My surgeon has told me that this procedure should have been done when I was about 14 for the best results. So dont be afraid as long as you check the doctor out ......... the long term effects for me of continually being in pain, imobile and fed up are far worse than having this operation done ....... 1000 times !!!!! Good luck.
October 2006 Arthroscopy & Patella Scrape
May 2007 MPFR & Gracilis
March 2010 TTT & LR

Offline Strawberrry12

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #11 on: May 17, 2010, 12:12:02 AM »
lynneM,

thank you for the advice. I go back to the OS on Tuesday of this week, so I really hope I am given another option of what to do! If I am offically given the opportunity to have a TTT then I'll do it. I know it'll be hard but from what i've read on here, PT is key to having a good recovery. Unfortunately the decision to do the TTT is not just between me and my OS, but also my parents. So now there's 4 people who all have opinions and things they want out of all this. I think you're right about getting it done as young as possible.   ;)

-Bree
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release

Offline lynneM

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #12 on: May 18, 2010, 07:13:37 PM »
Hi Bree ....... was just catching up with posts and am thinking you have seen your doc today. Hope it has gone ok and all the adults have given you a chance to have your say. To give you an idea of what u can expect but of course based only on my experience  ..... I have walked a mile today - 8 weeks post op ... no pain, no maltracking of the patella what so ever. Feels great. 4 weeks ago I could only bend my knee to 20 degrees ...... today I hit 110 degrees. I have not been taking pain killers for 5 weeks. I needed pain killers the first 7 days and then I only took them another week as they were anti inflamatories and helped with the swelling. I know there are many people on here who have a terrible time ..... however I have had 3 knee ops and honestly immediately afterwards it is managable ........  after the first couple of weeks it is annoying but ok    ..... I think sometimes some of the posts on this site are overly negative - I will probably be shot down in flames for saying that but I really believe it  ....... no pain no gain honey but the gain sure is worth it ...... hope you get sorted.
October 2006 Arthroscopy & Patella Scrape
May 2007 MPFR & Gracilis
March 2010 TTT & LR

Offline Strawberrry12

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Re: Tibial tubercle transfer surgery...so many questions!
« Reply #13 on: May 19, 2010, 06:55:10 AM »
I saw my doctor today, and we have finally settled on a decision. I am going to have a TTT/LR this summer! My OS says he has done it on several girls my age and they all love the results and come back asking to have it on the second knee. This is good that he is very confident in it! He told me that there wasnt a chance of it getting much better on its own and there is absolutely no reason why I shouldn't heal well and have fabulous results. Yes, I did finally get a say in all this! i said that I'm tired of living with a knee that gives out on me and they heard me out, for once! I still have to set a date after I talk wiith my parents and figure out the summer. The only thing is that I may miss out on flute camp that I already did an audition for and was accepted :( I think it'll be worth it though. I feel very educated on the surgery by reading a lot online and on this board. I was told to do the surgery "when I'm ready" and I think I am! thank you to all the knee geeks who have posted so many helpful things on kneegeeks!  ;)

-Bree
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release

Offline Strawberrry12

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TTT & LR- I got my date..
« Reply #14 on: June 03, 2010, 03:15:19 AM »
Alright, latest news is that I'm having my surgery on August 2nd which is quite a ways away. This date will allow me to go to camp and then have the surgery literally the day after I get back! Crazy, but worth it :) So for the meantime, what are some things that I should buy or make sure I have around the house to ensure that I'm comfortable during recovery? If you guys have a link to a post that has my answers I would love that. I'm not very good at navigating this site haha.
One last question, my knee brace is irritating my skin because I have really sensitive skin. what should I do about that? Would pre-wrap work?
Thank you for all the input!

-Bree
-18 years old-
2002- 7 years old, first subluxation
4 more subluxations
9/'10- MRI: microfracture, damage and stretched ligaments
PT, all was going well, got into sports again
03/20/10- 6th subluxation: worse yet!
8/2/10 MPFL repair and lateral release