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Author Topic: Tibial Tubercle Transfer  (Read 3901 times)

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Offline Brumby

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Tibial Tubercle Transfer
« on: January 23, 2004, 05:15:20 AM »
Hello!

I am in a major quandry at the moment....  The doc has told me that my left leg requires a Tibial tubercle transfer and medial quadriceps plication, and the only information I can find about it is freaking me out!!
(op is hapening on 2nd March 2004).

I am hoping that someone can either fill me in on some info (if they're willing to wade through what will probably become a somewhat large post).  

The doc is reputed to be an excellent surgeon, but what he has in skills, he tends to lack in reassurance....  :o
He's already worked on an Uncle's hip and has done an excellent job!

A bit of history:
I'm 33 and have been a non-competitive cyclist all my life.  I competed in (Olympic style) weightlifting for about 3 years - never pushed anything overly huge (maybe 130kg at most) - this was while I was late teens/early 20's.  I have been involved with karate (traditional - no tournaments) for about 9 years now, and it has been the BEST treatment for my back since a car accident in 1991 (also hurt the left knee then as well!  Had a lower lumbar laminectomy to help fix the back).  

The problem with the knee started when I was training with someone at karate about a year ago when (after everything was finished) I tried to stand up and there was a loud *crack* - I looked down to see the lower part of my left leg off at 45-degrees to the side.  I grabbed the leg to stop it getting worse and it cracked again and went straight back in.  I was expecting myself to start screaming in pain at any time after hearing about stories of dislocated knees.  There was none.  I was able to put weight on it virtually straight away.  
I put ice on it and was gentle for a few months and wore a brace.

A few months later, at another training session, I took a step backwards and the same knee decided to collapse under me (going inwards instead of outwards this time).  I had the brace on in the morning, but took it off during lunch and forgot to put it back on.
Same thing - grabbed leg - 2nd big crack - no screaming (my partner was most upset that I hit the deck without him getting to lay a hand on me!  ::) )

Now - I have a mate who is a Naturopath and has been for nearly 30 years.  He says that my knee is like his and that it comes out when I'm very tired or dehydrated (both times this was true), and that he can fix it with one of those electric pulse machines.  He says that the muscle on the inside of the patella needs to be coaxed back into it's original shape and that the surgery to fold it over and stitch it will make it thinner and weaker and more prone to stretching and breaking later in life - and that I should not have surgery.

The doc says that he can't explain everything that is in the text books and cover 30+ years of experience to a non-medical person in 5 minutes, and that the simple fact is that the lower tendon (?) (attaches to tibea) is the problem because when I tension the muscles in my leg (bigger than average if I can say this without sounding egotistical  :) ) then the patella is pulled sideways and exposes the joint.  He says to operate and move the 'anchor point' so that it will be more in line and prevent this happening.

So, if anyone has had experience with this, I would greatly appreciate some advice with:
- recovery times / pain / experience with this?
- how long on crutches?
- time needed off my feet completely?
- time before I can start using it again?
- if I will be able to stretch while I can't do anything else (I can really tight hips and hamstrings, and this would be a great opportunity to spend time stretching them out.... :) )
- I have a black belt grading at the end of the year (I said it was traditional - nothing moves fast (timewise  ;) ) and I'm really hoping that it would be good before then so I can get myself conditioned for it.
- I'm also doing Salsa dancing & Meregue (Latin American) - any idea how long before I can go back to that?

I know these are probably silly questions that will depend on my recovery time and can't really be related to anything else - but I HATE surgery and going under the knife.  Reassurance would be good.... please....  ;)

If you made it this far - you're doing well and probably need a sleep.... :)

Thanks

Offline Marie

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Re: Tibial Tubercle Transfer
« Reply #1 on: January 23, 2004, 06:36:45 AM »
Look under "The Patello-femoral joint" post section...

http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=PF_joint

There are a number of VERY recent posts about the procedure, including one recent patient who's doing splendidly after having a TTT.  Plus I just outlined the whole recovery period (in general terms) for another member.

A lot of OSs are lacking in their bedside manner (it took me 3 post-op appts before my OS recognized my face...  he used to have to look at my x-rays to "recognize" me, but I figure I'd rather have him know my knee than know me).  If his rep is good, you're probably in good hands.

I'd recommend reading www.patellapain.com under the surgery link to get an understanding of the procedure.

lol... I'm 4 months post-op and tried a little salsa dancing last week... seemed like a good idea at the time (I could do it!!!), but my knee swelled up afterwards, so I'm not so sure I'm quite salsa-ready as of yet... someday soon, though, I think.  ;)

Good luck!!!
Marie
24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).  
Slow ROM recovery (126).
My new PT is awesome!!!

Offline Brumby

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Re: Tibial Tubercle Transfer
« Reply #2 on: January 23, 2004, 06:40:50 AM »
Marie:

Thanks heaps for that!! :)

I tried a search on google and a bit of one through this site, but I didn't scan the forums.... (laziness can be a curse sometimes....  ::) )

Offline Natalie.D

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Re: Tibial Tubercle Transfer
« Reply #3 on: January 23, 2004, 01:25:37 PM »
Brumby,

Both of my TTTs were a success.  Recovery for me was about 4-5 months until I was pretty much able to do everything I wanted to, on crutches non-weight bearing for 3 weeks, then crutches but weight bearing for a further 3-4 weeks (but everyone is different).  I was able to start doing static quad exercises while I was still in my cast (had cast on for 6 weeks).  I found that the pain was not too bad as long as I kept up with some sort of painkillers.  Good luck.

Natalie.
« Last Edit: January 23, 2004, 01:27:15 PM by nmcbride »
Dislocations since age 12
Trochlear Dysplasia
Maltracking
Hypermobile
LR/MR-failed
TTT, LR, MR L knee 95-Success
TTT, LR, MR R 02-Success
Screws out
Partial tear ACL
Severe end stage OA
4 Debridements
Partial Meniscectomy
Failed Microfracture
11mm Defect LFC
Bone Spurs, Kissing Lesions

Offline abi

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Re: Tibial Tubercle Transfer
« Reply #4 on: January 23, 2004, 01:53:40 PM »
After years of dislocations, I finally had my TTT done last april. Touch wood, its been a success so far.
I was in hospital for 6 days after my op,and in a brace for 6 weeks (unable to weight bare). After the 6 weeks I assumed I would be able to disgard the cruthes and brace, unfortunately I was wrong! I was told by my physio and consultant that 'under no circumstances was I to walk unaided for the next 3 weeks!'
For 5 months after my op, I had physio and accupuncture twice a week. Which helped loads.
I'm now waiting to have the screw removed in february as it sticks out, making me unable to kneel and sit crossed legged etc.
Quick question for anyone able to help?!
Any ideas how to find out what sort of TTT I had?after reading the message board I noticed there were different types? ;D

Offline Marie

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Re: Tibial Tubercle Transfer
« Reply #5 on: January 23, 2004, 03:11:20 PM »
Abi - the easiest would probably be to call your OS or request to see your surgery notes.   ;)
24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).  
Slow ROM recovery (126).
My new PT is awesome!!!

Offline Leentje

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Re: Tibial Tubercle Transfer
« Reply #6 on: January 23, 2004, 10:34:55 PM »
Quote

So, if anyone has had experience with this, I would greatly appreciate some advice with:
- recovery times / pain / experience with this?
- how long on crutches?
- time needed off my feet completely?
- time before I can start using it again?
- if I will be able to stretch while I can't do anything else (I can really tight hips and hamstrings, and this would be a great opportunity to spend time stretching them out.... :) )
- I have a black belt grading at the end of the year (I said it was traditional - nothing moves fast (timewise  ;) ) and I'm really hoping that it would be good before then so I can get myself conditioned for it.
- I'm also doing Salsa dancing & Meregue (Latin American) - any idea how long before I can go back to that?



I had a Fulkerson aug. 2002. I can now say I was completely recovered @ 9 months post-op, though my knee won't never ever be normal again, due to several deformities and cartilage damage. I didn't have much pain when i was in the cast or immediately post-op, but getting ROM back was not pleasant! Can proudly say pain was never higher than a 4 on a 1-10scale! 8) I had fixed so much on the pian itme and blood rush that I didn't want to undergo the surgery, now I wish I had it done much sooner as I didn't experience both (well, had some pain ;))

I was in a full leg cast and on crutches for 3 weeks (OS initially told me would be 6 weeks!). then started PT (9x) which was agressive but I had full ROM back 5 weeks post-op (after 6 sessions ;)). I could walk without a limp after 9 weeks, I couldn't work for 11 weeks (I am a nurse spec. ortho). I thought I wouldn't be able to return this soon and the hospital didn't want to give me a light duty job >:() but I did better then expected when I returned!!
5 months post-op I was completely free to start running again and soon I was playing badminton again. Now I play 3 hrs of badminton a week but have stopped running (as my knee subluxed last week while I ran :-/) I only wear a brace while playing sports 'cause if i dodn't my knee feels likes it want to give out, badminton entails lots of sudden movements, bad for the knees :-X, OS knows and told me to enjoy it while I still can, I love my boss ::)!)

Exercise your quads right now as otherwise if the're weak you'll have a hard time afterwards... quads get very weak very soon esp. after open surgery. So start exercising right away! Get youself organised, get lots of magazines, fill the freezer with food, find that backpack (how can U carry things while on crutches!?), charge your mobile phone card, etc...

Most important relax and go for it!!! We'll be here if you need us!!!!!!!!!!!!!!!!!

~Helena

Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline yodalover

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Re: Tibial Tubercle Transfer
« Reply #7 on: January 24, 2004, 02:44:50 AM »
I just had a TTT on wednesday the 14th (9 days ago)

I can answer your questions about pain and on crutches I think...

I had a TTT arthroscopically. (outpatient)

The pain was pretty good right afterwards because they did a nerve block before they sent me home.

Two days later the nerve block wore off completely and the pain was worse then.   It hurt to move my leg at all.   It was bearable if I took the pain meds as prescribed. (prescribed 1-2 pills every 4-6 hours... was taking 2 every 4 hours)

Now, 9 days after surgery,   the pain is there, but not near as bad... it no longer hurts with every movement.   The access holes don't hurt so much any more.   I'm now taking my pain meds 1 pill every 5-6 hours.

As for crutches,  i had to use them while I was in the imobilizer until the nerve block wore off.   After that,  it was hard to carry my weight on the operated leg so I used 2 then 1 crutch for several days each...   at this point, I can get around at home without crutches, if I need to go out i'll probably take and use them for safety. My dr said that on my post op appt on the 26th, I should need crutches at all.

So, that's what I know...   I hope it's helpful... and I'll keep posting in the "post-op" section as the time goes on :)

-Paula

Left Knee - Modified Elmslie TTT with a lateral release and patella shaving - January 14, 2004
Right Knee - same surgery - June 9, 2004

Offline Kimby

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Re: Tibial Tubercle Transfer
« Reply #8 on: January 25, 2004, 07:49:28 PM »
Brumby - had my left TTT and medial ligament reconstruction done (and am having the right knee done this year) in August 2003 following failed bilateral patella tendon transversals (which I'm finding out were early versions of the TTT).  Yes, there's pain, but if you take your pain meds at regular intervals you should be OK.  I'd say the recovery really kicks in at about 4-5 months - I'm 5 1/2 months post-surgery and though my quad is still a bit weaker than I'd like it to be, it's been wonderful not having the constant chronic subluxations, dislocations, grinding, popping, clicking and everything like that.  I do still have arthritis - my doctor is good, but no one is THAT good - which causes pain, but the other stuff has stopped and I'm really looking forward to having my left leg done.

You're doing all the right stuff - find out about the surgery and whatnot, but I don't think - other than this website - there's much out there.  BUT, there is TONS of info on this website - especially in the bulletin board, so check around and see !

Good luck with your surgery!

Kim
1982 - R patella tendon transversal
1983 - L patella tendon transversal
2003 - R TTT and patella medial ligament   reconstruction
2004 - L TTT and PMLR

Offline Brumby

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Re: Tibial Tubercle Transfer
« Reply #9 on: January 27, 2004, 06:49:43 AM »
Hey!

I just wanted to thank everybody for the positive input and the info - it really puts my mind at rest  8) (well - until they go to shove that bloody great horse needle in my arm - I really hate going under...  :-/ )

I'll keep a watch on the board and put a precis on how it goes...  ;)

Luckily I was born with substantial thigh strength (the joys of being the son of a cyclist and having the love of it myself!  ;D ) , so hopefully that should not be a great problem there....  8)

Again - thanks to all, and hope to yak soon....

Offline cat

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Re: Tibial Tubercle Transfer
« Reply #10 on: January 27, 2004, 03:36:57 PM »
Hey Brumby,
Sounds like we are going under the knife for similar procedures teh same day. We will have to keep in touch so we can compare notes.
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline Brumby

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Re: Tibial Tubercle Transfer
« Reply #11 on: January 28, 2004, 12:52:45 AM »
The same day?  

Help!! Stalker! Stalker! JUST KIDDING!!! ;D

Yes - that would be good.  What are you in for? (sounds like a prison term.... :)

Offline cat

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Re: Tibial Tubercle Transfer
« Reply #12 on: January 28, 2004, 04:26:02 AM »
Stalker, eh? I don't move very fast these days so you will be able to get away rather easily. ;D
My op is first a scope, then a proximal and distal realignment. At least that's what is says on this paper I have. He told me he would scope first to check out the knee then open me up to do a z-release and something on the medial side. Cant remember what that was. Then he would do an antero-medialization, a fulkerson. I go in at 9 and surgery is at 10:30. How about you? Have you decided what kind of anesthesia you want? I might opt to stay awake. Might be kinda interesting.
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline Brumby

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Re: Tibial Tubercle Transfer
« Reply #13 on: January 28, 2004, 05:41:09 AM »
I never really thought about asking if there were different types of anaesthesia, but since I kinda like the thought of my insides staying inside, I doubt that I want to be awake for it....  ;)

All I really know about it at the moment is the usual no eating the night before and that they hack into me sometime the next morning.  Shortly after that comes the frustration of not being able to walk for a while....
:(

Seriously informed, ain't I?  ::)

Offline cat

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Re: Tibial Tubercle Transfer
« Reply #14 on: January 29, 2004, 03:38:24 AM »
 ;D I believe in being 'informed' after having dealt with some of my previous docs. ;D
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07















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