A new surgical technique for tibial tubercle transfer in total knee arthroplasty

Several methods are described for extensor mechanism realignment in total knee arthroplasty, including lateral release, medial reefing, V-Y quadricepsplasty, and tibial tubercle transfer. Each has its indications, merits, and pitfalls. The advantages of tibial tubercle transfer include precise realignment of the quadriceps mechanism, the ability to properly locate the patella proximally or distally, and maintenance of quadriceps power. The authors present a new technique for tibial tubercle transfer in total knee arthroplasty. Important points include (1) full-thickness medial and lateral soft tissue flaps that are anchored to bone and cover the transferred tubercle at the end of the procedure; (2) osteotomy of a long (10-cm) strip of tubercle and tibial crest; (3) placement of the osteotomized segment in a prepared, inset cancellous bone bed; and (4) fixation of the graft with multiple staples that hold the graft in place without being inserted through the graft. The method described will allow surgeons to perform tibial tubercle transfer reproducibly while avoiding the frequently cited complications of nonunion, loss of fixation, and wound slough.