20Shoulder Care
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement
28Knee Care
ACL Tear
Cartilage Injury
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Trochleoplasty
17Hip Care
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Repair
Labral Reconstruction
Nanofracture
Trochanteric Bursa Debridement
2Biologics
Bone Marrow Aspirate Stem Cell Concentrate (BMC)
Platelet-Rich Plasma “PRP”

TIBIAL TUBERCLE OSTEOTOMY

The kneecap (patella) is a small bone in the front of the knee that helps support the extensor mechanism (quadriceps and patellar tendon). As the knee bends, the patella glides along a groove on the femur bone – the trochlea. Some patients have abnormal bony anatomy in the knee, which places more stress on the patella tendon, leading to abnormal stress on the patella. As the knee bends, the patella tracks on the outside of the trochlea instead of in the middle. Some patients with abnormal bony anatomy may develop cartilage damage underneath the patella as well. In those patients with abnormal bone anatomy in the knee with instability and/or cartilage damage, Dr. Keller may recommend surgical intervention.

The goal of surgery is to re-align a bony prominence (tibial tubercle) on the tibia and normalize the patient’s anatomy. The tibial tubercle is a bump on the front of the tibia bone where the patella tendon inserts. By re-aligning the tibial tubercle, Dr. Keller takes stress off of the patellar tendon and also unloads the cartilage underneath the patella. Prior to surgery, Dr. Keller usually obtains and MRI and/or a CT scan for surgical planning. During surgery, Dr. Keller uses a sharp device to cut the tibial tubercle. Dr. Keller then moves the tubercle closer to the inside of the knee and secures it back down to the tibia bone with a medical screw. If the patient has an unstable patella with previous patella dislocations, Dr. Keller will also perform a reconstruction of the medial patellofemoral ligament (MPFL).

Post-Operative Rehabilitation

Following surgery, patients are placed in a hinged brace that is locked straight. Dr. Keller recommends full weight-bearing with the brace locked straight for 4-6 weeks. When the patient is sitting or lying down, Dr. Keller encourages passive knee range of motion exercises with the brace removed. Dr. Keller also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscle. Dr. Keller recommends starting physical therapy two weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee. Most patients can start full weight bearing on the affected leg six weeks after surgery, depending on the location of the defect. Most patients start cutting activities and sporting activity approximately four months after surgery.