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Tibial Tubercle Osteotomy

Tibial tubercle osteotomies are important surgical techniques in the operative management of patellar instability and patellofemoral pain.

When is a patient a candidate for tibial tubercle osteotomy?

·         History of multiple knee subluxations or dislocations

·         History of patellar and femoral pain

·         Physical Therapy has been exhausted

·         Non surgical management has failed

What is involved pre operatively?

·         continuation of therapy to help strengthening the quadriceps

·         x-rays

·         MRI- Dr. Luhmann decides if necessary

·         Pre operative anesthesia consult depending on patients needs

What is involved with the surgery?

·         The surgical approach is relatively straight forward and the osteotomy is a low risk technique

·         The osteotomy technique is a greenstick-style distal osteotomy that avoids periosteal stripping appears to optimize bony consolidation, thereby minimizing postoperative fractures

·         Below are x-rays of the stages of healing

What does post operative incision care consist of?

·         Day 3 patient may remove ace wrap and dressing

·         Steri strips are to remain intact until shriveling up or falling off

·         Patient may shower after day 3

·         Patient may not bath or swim until released by Dr. Luhmann

           

Post operative care?

·         Patient will be NON weight bearing on the affected leg for 6 weeks

·         Patient will require use of crutches

·         Patient will wear a knee immobilizer

·         Patient will start slow Range of Motion Exercises at home

When is the Follow up Visits?

·         7-10days post operatively

·         6 weeks post operatively

·         3 months postoperatively

·         As needed

When can the patient start to bear weight?

·         Generally 6 weeks postoperatively

·         Then the patient can bear weight without crutches in the knee immobilizer for about a week then wean out of the knee immobilizer

When can the patient return to full activity?

            This is individualized for each patient, but generally 3 months after surgery.

Some patients may require the use of a patellar stabilizing brace for contact sports.

When to call the office?

·         fever greater than 101

·         increased pain not tolerated by pain medication

·         Redness or drainage at the incision site

           

Important Phone Numbers:

Orthopedic Appointment Desk                 (314) 454-2500

Debbie Krenning                                       (314)454-4191

Kim Ballard, RN, BSN                                 (314)454-5221

After Hours                                               (866) 582-8055

Hospital Main Number                              (314) 454-6000

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Pediatric Physicians Include:

Matthew Dobbs, MD
J. Eric Gordon, MD
Scott Luhmann, MD
Mark Miller, MD
Jeffrey Nepple, MD
Perry Schoenecker, MD

Pediatric Nurse Practitioners Include:

Christi Abeln, APRN, MSN, BCPNP
Barb Stiffler, RN, MSN, CPNP

Pediatric Hand & Upper Extremity Physicians:

Charles Goldfarb, MD
Lindley Wall, MD

Pediatric Musculoskeletal Oncology Physicians:

Cara Cipriano, MD
Douglas McDonald, MD, MS

Pediatric Spine Physicians:

Keith Bridwell, MD
Michael Kelly, MD
Ronald Lehman, MD
Lawrence Lenke, MD
Scott Luhmann, MD

Pediatric sports medicine physicians: 

Mark Halstead, MD
Jeffrey Nepple, MD