I’ve already talked about the most interesting part of my surgery, but in order to give the cartilage transplant the best possible chance to succeed, my surgeon will also be performing a tibial tubercle transfer (TTT). This means that he will cut the bone where the patellar tendon attaches to the tibia (feel the bump on your leg just below your knee; that’s the tibial tubercle) and move it slightly to realign my knee and take the pressure off the damaged part.
This particular procedure is used a lot to treat patellar instability and/or patellar dislocation. I have neither of these, but the reason it’s successful is that it unloads the patellofemoral joint. And that’s what I need to happen so the new cartilage behind my knee cap isn’t stressed (we want it to live happily ever after).
There are three main types of TTT, each one named for the physician(s) who popularized the surgical technique. The two that have been bandied about in my world lately are the Fulkerson and the Elmslie-Trillat. The third that hasn’t been discussed is called the Maquet. The Fulkerson is also known as AMZ (short for anteromedialization) because it moves the tibial tubercle to the medial (inside) side of the knee and tilts it out a bit (moves it anteriorly). The Elmslie-Trillat moves the tubercle only to the medial side; it doesn’t tilt the bone wedge out at all.
Regardless of the specific technique, they all require the surgeon to cut through perfectly healthy bone, move it a short distance, and reattach the bone with cortical screws. So when my surgeon was explaining this to me, “First, we’re going to cut through the front of your shin bone, then we’ll flip over the patella and resurface the backside, and then we’re going to screw everything back together,” I heard instead, “We’re going to cut through the front of your shine bone and cause you pain, and then we’re going to cause you more pain, and then we’re going to screw things back together and cause a ton of pain.” Seriously, it sounds like it’s going to be a lot of fun. Don’t be jealous.
This was the part of the whole surgery that bothered me the most, so I started looking for as much information as I could find about the different procedures. I found the most information about the Fulkerson osteotomy (a science word for cutting through bone). It took a little more digging, but I found positive outcomes with the Elmslie-Trillat, too. This procedure is apparently effective in cases of patellar instability. I don’t have patellar instability; I just have anterior knee pain. It’s not as effective when it’s used as the sole treatment for knee pain without instability, so we’ll throw in the De Novo in my case and hope for the best.