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Author Topic: Upcoming Tibial Tubercle Revision...Need Advice  (Read 480 times)

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Offline starboy23

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Upcoming Tibial Tubercle Revision...Need Advice
« on: July 16, 2019, 07:22:02 PM »
Hey guys,

This is my first post on the forum, but I've been a long time lurker. I had a tibial tubercle transfer in feb 2016, along with mpfl reconstruction and the repairing of some cartilage and a meniscus. A year later in  March 2017 I had the screws removed at an outpatient facility in Toronto. However over the next little bit I noticed that although my knee healed, I still have a J sign in my right knee where the operation took place and my kneecap still pulls to the outside of my knee.

I did physiotherapy for a few weeks, before my doc gave me the option at the end of 2018 to have surgery again. This time a revision of the tibial tubercle transfer as he thinks it needs to be shifted over again. I had to put off the surgery twice simply because it was hard to organize time off and be prepared. I have the surgery scheduled for July 30th, and had my pre op on the 15th. And although I'd like to have it done, I'm still wrestling with the idea of putting it off longer since my knee isn't as bad as before my first operation, although not fully 100%. 

I type all this to ask two questions:

1) Should I go ahead with it or cancel it and just deal with it, possibly scheduling a surgery a few years later?

2) Has anyone had a tib tub revision surgery? Is it as bad or as hard of a recovery as a regular TTO/TTT surgery?

Thanks for any advice and input. I'm feeling a bit nervous and confused about how to proceed.
« Last Edit: July 18, 2019, 07:48:25 PM by starboy23 »

Offline Brandon123

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #1 on: July 19, 2019, 09:55:58 AM »
Hi Starboy23,

Sorry to hear your TTT didn't work out 100%. What about seeking a second opinion from a patellofemoral expert (there is a list of some of the most recognized ones on this website) regarding the TTT revision surgery? I haven't read much about TTT revisions, so I guess they are not too common. Considering the fact that outcomes seem a bit uncertain with any TTT, I would probably want to get a second op before going in for a TTT revision. My understanding (note, however, I'm not an expert) is that revisions of anything is typically more problematic than the original surgery.

How is your everyday functioning? Walking, standing, stairs, pain etc.?   
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline starboy23

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #2 on: July 20, 2019, 01:11:45 AM »
Hi Starboy23,

Sorry to hear your TTT didn't work out 100%. What about seeking a second opinion from a patellofemoral expert (there is a list of some of the most recognized ones on this website) regarding the TTT revision surgery? I haven't read much about TTT revisions, so I guess they are not too common. Considering the fact that outcomes seem a bit uncertain with any TTT, I would probably want to get a second op before going in for a TTT revision. My understanding (note, however, I'm not an expert) is that revisions of anything is typically more problematic than the original surgery.

How is your everyday functioning? Walking, standing, stairs, pain etc.?

Thanks for responding,

My everyday function isn't bad. Before my first surgery my knee would give out when I was in public.  Now I can walk, I can run. The issue is that the tibia wasn't moved as far over as it needs to be, so occasionally my patella catches and I have a moment of instability. Sometimes this happens in the winter time dealing with snow and ice. I also do have some soreness when sitting down on the outside of my quad near my knee that comes and goes. I did some physiotherapy about a year ago and saw a little bit of improvement.

 My last surgery improved a lot, but right now I'm at about 80 percent. I can play sports, especially after having the screws removed, but my confidence isn't at its peak. I know if I go through with things, and the recovery is like last time, it'll be at least 8-10 weeks before I'm feeling somewhat normal, hence my apprehension.


Offline Clarkey

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #3 on: July 22, 2019, 08:56:52 PM »
Hi Starboy23,

Would not go ahead with the surgery if I was in your situation, you are able to walk and run without any major pain and discomfort. Your last surgery was a success, would not jeopardize having further surgery. The more surgery you go through speeds up wear and tear and arthritis. Can always go under the knife at a later date when the knee pain increases and your mobility becomes more limited. As you pointed out recovery from any type of knee surgery is very lengthy and frustrating, both physically and mentally.

Of course it is your decision at the end of the day if happy and satisfied to go ahead with your scheduled surgery surgery.

Good luck.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline starboy23

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #4 on: July 23, 2019, 04:22:29 AM »
Hi Starboy23,

Would not go ahead with the surgery if I was in your situation, you are able to walk and run without any major pain and discomfort. Your last surgery was a success, would not jeopardize having further surgery. The more surgery you go through speeds up wear and tear and arthritis. Can always go under the knife at a later date when the knee pain increases and your mobility becomes more limited. As you pointed out recovery from any type of knee surgery is very lengthy and frustrating, both physically and mentally.

Of course it is your decision at the end of the day if happy and satisfied to go ahead with your scheduled surgery surgery.

Good luck.

[email protected]

Thanks for getting back to me. I forgot to mention in my initial post my knee subluxes in the winter sometimes when it's slippery outside but I haven't had any dislocations. I had one instance where I had to put ice on it because it caused a little bit of swelling.

I didn't know surgery can speed up arthiritis. That's fascinating.

Offline Brandon123

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #5 on: July 23, 2019, 09:49:37 AM »
I would probably also (like Clarkey above) try to avoid an additional surgery if my daily functioning was as good as yours. And instead try all sorts of conservative treatment to fix the "minor" problems you're still experiencing. You can always have surgery again in the future. But as also said, it is your call and something you must decide with your surgeon. Before surgery, however, I would try to get a second opinion by another surgeon, to be certain it makes sense to revise your TTO. But time is running out so in order to get a sec opinion you would probably have to postpone your surgery. Note, however, only take our opinions is input into your decision. In the end of the day, you must do what you feel is right.   
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Clarkey

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #6 on: July 23, 2019, 06:28:10 PM »
I would probably also (like Clarkey above) try to avoid an additional surgery if my daily functioning was as good as yours. And instead try all sorts of conservative treatment to fix the "minor" problems you're still experiencing. You can always have surgery again in the future. But as also said, it is your call and something you must decide with your surgeon. Before surgery, however, I would try to get a second opinion by another surgeon, to be certain it makes sense to revise your TTO. But time is running out so in order to get a sec opinion you would probably have to postpone your surgery. Note, however, only take our opinions is input into your decision. In the end of the day, you must do what you feel is right.

As Brandon and I have already pointed out it your choice and decision if you like to go ahead with the surgery. I went through my 3rd scope on my right knee and happy with the result after my physio ruined my 2nd scope. No longer have sharp shooting pain while walking and can squat and kneel with less intense pain. Only downside unable to run still, that is hard to come to terms with. Would not risk a 4th scope as I scar up easily. Once you have had surgery on the knee it never going to be 100% OK again. As you get older wear and tear will start to set in if you do regular high impact sports. A sports medicine doctor are good at looking into none invasive ways to reduce knee pain before going under the knife. A sport physiotherapist would also recommend from my own personal experiences. Have gained a lot of good seeing both before having my 3rd surgery in January 2018.

[email protected]      
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline starboy23

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #7 on: July 24, 2019, 12:00:49 AM »
I would probably also (like Clarkey above) try to avoid an additional surgery if my daily functioning was as good as yours. And instead try all sorts of conservative treatment to fix the "minor" problems you're still experiencing. You can always have surgery again in the future. But as also said, it is your call and something you must decide with your surgeon. Before surgery, however, I would try to get a second opinion by another surgeon, to be certain it makes sense to revise your TTO. But time is running out so in order to get a sec opinion you would probably have to postpone your surgery. Note, however, only take our opinions is input into your decision. In the end of the day, you must do what you feel is right.

As Brandon and I have already pointed out it your choice and decision if you like to go ahead with the surgery. I went through my 3rd scope on my right knee and happy with the result after my physio ruined my 2nd scope. No longer have sharp shooting pain while walking and can squat and kneel with less intense pain. Only downside unable to run still, that is hard to come to terms with. Would not risk a 4th scope as I scar up easily. Once you have had surgery on the knee it never going to be 100% OK again. As you get older wear and tear will start to set in if you do regular high impact sports. A sports medicine doctor are good at looking into none invasive ways to reduce knee pain before going under the knife. A sport physiotherapist would also recommend from my own personal experiences. Have gained a lot of good seeing both before having my 3rd surgery in January 2018.


[email protected]   

I appreciate the perspective. My main issue is just tracking and soreness. This first surgery did fix some of that but you're right that my knee can't be 100% like before a surgery. Although I wish the doc had moved my tibia more during the first TTO

Offline Brandon123

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Re: Upcoming Tibial Tubercle Revision...Need Advice
« Reply #8 on: July 30, 2019, 09:30:09 AM »
I understand that it is frustrating that your knee is still causing some problems. Let us know what you decided and keep us updated on your progress!
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment















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