Knee · Kneecap & alignment
MPFL + tibial tubercle osteotomy
Kneecap Instability with Malalignment — MPFL Reconstruction and Tibial Tubercle Osteotomy
The condition
The kneecap (patella) glides in a groove at the end of the thigh bone, held on the inner side by the MPFL ligament, which tears when the kneecap dislocates. In some knees, the kneecap tendon attaches too far to the outside or the kneecap sits too high, making it more likely to slip again.
The surgery
Two procedures are done together, typically as an outpatient. A tibial tubercle osteotomy (TTO) moves the bump on the shin bone where the kneecap tendon attaches into a better position, fixed with screws, and the MPFL is rebuilt with a cadaver tendon graft. The final plan is determined during surgery.
Recovery at a glance
- Weight-bearing
- Crutches and a brace locked straight for walking and sleep: touch-down weight for 4 weeks, then up to half. Full weight after the 6-week x-rays, typically by 8 weeks.
- Motion
- Gentle bending right away: 90° by 2–3 weeks and 120° by 6 weeks. No active straightening out of the brace for 6 weeks.
- Daily life
- Desk work often within 2 weeks. No kneeling on the front of the shin until healed. No driving while taking narcotic pain medication.
- Running
- After x-rays confirm the bone has healed, typically 4–6 months.
- Sports
- Cutting no sooner than 6 months; full return typically 6–12 months.
A general guide. Your restrictions and timeline may change based on what is found and done at surgery.
Risks & benefits
Benefits: Most patients have a stable, better-aligned kneecap and return to activity. Risks are uncommon and include infection, blood clots, the kneecap slipping again, the bone cut healing slowly or not healing, shin bone fracture, hardware irritation that may require removal, injury to nearby structures (such as nerves, blood vessels, or cartilage), stiffness, persistent pain, and the need for further surgery. These will be reviewed with you in detail before surgery.
Patient Surgical Information
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Before & after every surgery