Cpt 27418: Tibia Tubercle Tuberosity Osteotomy-TTO Procedure

Introduction

Today, I would like to write about the orthopedic knee procedure, tibia tubercle tuberosity osteotomy. The purpose of the surgery is to improve alignment of the patella. This is achieved by making a bony bridge from the tibia tubercle and moving it, with its attachment of the patella tendon more medially than its original location. A process often called by the Surgeon anteriormedialization translation (moving the patella tendon/tibia tubercle tuberosity medially on the anterior side of the knee) . Other common names for this procedure are:

Anatomy

The tibia tubercle is an oblong major bony ridge elevation on the tibia that provides an attachment point for the patella tendon. It acts as a lever for the patella tendon during extension and helps give the patella stability. If the patient is having patella instability, painful patella maltracking (patella is not staying in place) and symptoms of arthritis, one surgical option to correct this is tibia tubercle osteotomy (surgical cutting of a bone or a removal of a piece of bone.)

Procedure

The surgery initially begins with a diagnostic arthroscopic inspection (included in the surgery, not separately charged). Visual analysis of the articular cartilage takes place to see if there is any damage or defects in the cartilage. If found,  a tool (burr, arthrocare ablation wand or shaver ) is attached to one of the scope’s. Next, debridement and shaving for clean up of the articular cartilage are done ( chondroplasty cpt 29877 can be charged if done). At the end of the arthroscopic section of the surgery, the scope is removed and the open procedure begins.

Image result for chondroplasty of knee image

Now, the osteotomy , the cutting of the tibia tubercle begins.

Image result for anterior tibial tubercleplasty images

An incision is made lateral to the patella and carried down along the distal anterior ridge of the tibia. Muscles involved in the extensor mechanism, over the anterior compartment are elevated. An incision is made through the periosteum of the tibia bone, distal to the tuberosity. K- wires are placed, a medial osteotomy is made that follows the plane of the K- wires followed by a lateral osteotomy cut. Oscillating saw and osteotome tools are used to perform these cuts. The tibial tuberosity is then repositioned in its new position. Patella tracking is assessed to check for misalignment or continued maltracking. Once proper alignment is achieved, one or more screws are drilled into the bone to secure the tibial tuberosity bony bridge in its new location.

To learn more about this procedure, check out this YouTube video on it. There are two other common patella procedures, I will blog on next.

Until next time,

Michelle

Video of the procedure

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