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What Is Tibial Tubercle Transfer?

Tibial tubercle transfer is knee surgery that repositions the bony attachment of the patellar tendon on the upper tibia. It is also called tibial tubercle osteotomy because the surgeon cuts the tubercle as a controlled bone fragment before moving it. The fragment can be shifted medially, anteriorly, distally, or in a combined direction depending on the patellar problem. Screws are commonly used to hold the transferred bone while it heals.

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What Is Tibial Tubercle Transfer?

Tibial tubercle transfer is knee surgery that repositions the bony attachment of the patellar tendon on the upper tibia. It is also called tibial tubercle osteotomy because the surgeon cuts the tubercle as a controlled bone fragment before moving it. The fragment can be shifted medially, anteriorly, distally, or in a combined direction depending on the patellar problem. Screws are commonly used to hold the transferred bone while it heals.

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Why Is Tibial Tubercle Transfer Performed?

The procedure is used for selected patients with recurrent patellar instability, patellar maltracking, patella alta, or painful overload of part of the patellofemoral joint. Imaging and examination are used to evaluate tibial-tubercle position, patellar height, trochlear anatomy, cartilage damage, limb alignment, and other contributors to symptoms. Medialization can reduce excessive lateral pull, distalization can lower a high-riding patella, and anteromedialization can shift contact away from damaged cartilage. The operation is often combined with medial patellofemoral ligament reconstruction or another stabilization procedure when multiple abnormalities are present.

How Is Tibial Tubercle Transfer Performed?

The surgeon creates an osteotomy around the tibial tubercle while preserving a bone fragment attached to the patellar tendon. The fragment is moved in the planned direction according to the mechanical problem being corrected. Screws are placed through the tubercle fragment into the tibia to maintain its new position during bone healing. Arthroscopy, cartilage treatment, ligament reconstruction, or other procedures can be performed during the same operation when indicated.

What Is Recovery Like After Tibial Tubercle Transfer?

The knee is protected with a brace and crutches while the osteotomy begins to heal. Weight-bearing and knee flexion are limited initially according to the transfer direction, fixation, and associated procedures. Physical therapy progresses range of motion, quadriceps strength, gait, and later running or sport-specific activity. Return to impact activity commonly takes several months because bone healing must be adequate before high loads are placed through the patellar tendon.

What Are the Risks and Complications?

Possible complications include infection, blood clots, stiffness, persistent pain, delayed union, nonunion, tibial fracture, and loss of fixation. The screws can become painful and are sometimes removed after the osteotomy has healed. Excessive or insufficient transfer can leave altered patellar tracking or create new pressure on the joint. Rare but serious complications include compartment syndrome and neurovascular injury.

Frequently Asked Questions About Tibial Tubercle Transfer

Is tibial tubercle transfer the same as tibial tubercle osteotomy?

Yes. The terms are commonly used for the same family of procedures in which the tibial tubercle is cut, repositioned, and fixed in a new location.

Why is the tibial tubercle moved medially?

Medialization reduces excessive lateral pull on the patella and can improve tracking in selected patients with lateralized tubercle anatomy.

Why is the tibial tubercle moved downward?

Distalization is used to lower a high-riding patella, or patella alta, when abnormal height contributes to instability or delayed engagement in the trochlea.

Are screws removed after tibial tubercle transfer?

Not routinely in every patient. Hardware can remain in place, but painful or prominent screws are sometimes removed after the bone has fully healed.

References

Patellofemoral Pain Syndrome. OrthoInfo, American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/. Date Accessed August 13, 2026.

Patellofemoral Instability. Hospital for Special Surgery. https://www.hss.edu/health-library/conditions-and-treatments/patellofemoral-kneecap-instability. Date Accessed August 13, 2026.

Tibial Tubercle Osteotomy: Indications, Outcomes, and Complications. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC11479627/. Date Accessed August 13, 2026.

Complications After Tibial Tubercle Osteotomy for Patellofemoral Instability: A Systematic Review and Meta-analysis of the Literature. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC12454980/. Date Accessed August 13, 2026.

Radiographic and Clinical Outcomes After Tibial Tubercle Osteotomy for the Treatment of Patella Alta: A Systematic Review and Meta-analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/34038256/. Date Accessed August 13, 2026.