Tibial tubercle transfer


Anterior pain in the knee is a common cause of dysfunction in the knee and is often due to problems in the way the patella (knee cap) moves up and down in the joint as the knee moves from flexion to extension.


Chronic anterior pain due to either instability of the patella or maltracking of the patella in the groove is improved by realigning the patella to travel more normally in the groove. As this unloads the cartilage it settles the pain.

Pre-operative instructions

It is important for you to have good quads tone before the surgery. You need to train your muscles with isometric exercises. It is best to avoid squats as this makes the pain worse and may cause worsening of the quads wasting. It is a good idea to practice use of crutches before admission as you will need to use them after your surgery.


A small transverse incision is made over the bony prominence which is felt below the patella tendon which is the attachment of the tendon. The tendon attachment with a reasonable amount of associated bone is carefully cut from the front of the tibia and migrated medially to cause the alignment of the quads muscle and patella tendon to be restored to a more normal position. This is then fixed with a single screw and washer.

Post-operative instructions

Initially you will not be able to take any weight on the leg and you will need to use crutches. No brace is required and you can move the knee within the limits of comfort. You may switch your quads back on by simple straight leg lifting exercises. It is important to avoid weight-bearing, as this places a strain on the transferred bone and fracture through the screw hole is best avoided.


As this is a minimally invasive procedure the risks are reasonably small but do exist. You may develop a blood clot or even an infection in the bone. Fracture the transferred bone can occur and causes the bone not to heal so would necessitate further surgery to rectify this. By protecting your weight-bearing this will be avoided. These problems are generally exceedingly rare.

Treatment Alternatives

Once the patella has dislocated multiple times or your knee cap remains chronically painful, it remains unstable and it is not possible to regain the stability by just training your muscles so there is no non-surgical alternative to deal with this form of knee instability.

Related Information

Patella pain and instability