Distal Realignment Procedures

Distal realignment procedures, also known as TTT or tibial tubercle transfer procedures are performed to reposition the kneecap by realigning the tendon under the kneecap to the underlying tibial tubercle. Tibia tubercle is the bony lump on the tibia (bone in the lower leg) below the kneecap. This serves as an attachment point for the patellar ligaments, tendons, and muscles. These procedures are done to prevent patellar subluxation or dislocation.

Distal realignment procedures include:

  • Fulkerson procedure – In this procedure, the tibia tubercle is moved more towards the inner aspect of the knee. This is achieved by breaking the bone into sharp pieces (splintered) which allows the bit of bone and the tendon to move more medially. After the procedure bits of bone are held in place using screws.
  • Roux-Goldthwait procedure – It is a distal realignment procedure where the patellar tendon is split vertically. The lateral half of the patellar tendon is pulled under the inner half (medial) and attached to tibia. This pulls the patella over to the centre and helps prevent excess lateral shift.

"Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner."

  • Australian Orthopaedic Association
  • Australian Knee Society
  • Arthroplasty Society of Australia
  • International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine
  • Asia Pacific Orthopaedic Association
  • Australian Institute for Musculoskeletal Science
  • Royal Australasian College of Surgeons
  • Warringal Private Hospital
  • Asia Pacific Orthopaedic Association