AANA/SOMOS Course Materials (August 2021)-TTO & MPFL Demo

Video Transcription

Video Summary

This detailed surgical discussion focuses on performing a Tibial Tubercle Osteotomy (TTO) tailored to patient needs, particularly addressing patellar instability and cartilage issues. The presenters emphasize that distalizing the tibial tubercle often results in medialization as well, potentially reducing the need for separate medialization procedures. The Fulkerson procedure is highlighted as a reliable option, enabling controlled medialization and anteriorization.<br /><br />Key surgical steps include a generous 6-7 cm incision for adequate exposure, careful soft tissue handling preserving cuffs for closure, and use of guides for precise osteotomy angles—commonly 45° to 60°. The importance of protecting neurovascular structures and maintaining a periosteal hinge for blood supply is stressed. Fixation typically uses 3.5 mm screws placed to minimize hardware irritation.<br /><br />For combined procedures, the osteotomy is performed prior to medial patellofemoral ligament (MPFL) reconstruction. MPFL reconstruction techniques include anchor fixation in the patella and soft tissue tunnels near the adductor tubercle. Graft preparation and tensioning strategies aim to avoid over-constraint to preserve knee motion.<br /><br />Alternative approaches discussed include using a quadriceps tendon graft if allograft is unavailable and the less invasive MQTFL technique. The surgeons underscore anatomic accuracy, cautious tensioning, and tailored interventions to avoid overtreatment and complications, stressing that larger incisions can enhance safety without patient complaints.

Keywords

Tibial Tubercle Osteotomy

patellar instability

Fulkerson procedure

osteotomy technique

MPFL reconstruction

quadriceps tendon graft

periosteal hinge preservation

knee surgery fixation