Advice after your nerve block for surgery
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You are reading this leaflet because you and your orthopaedic surgeon have decided together that this procedure may be of some benefit to you. It is intended to help you understand the operation and what to expect if you decide to go ahead with the procedure.
We hope that it will assist in reducing any anxiety you may have, answer some of your questions and offer some practical advice.
It is not intended to be a comprehensive guide, and it is essential that you discuss any further queries that you may have with your consultant surgeon.
What is patella alta?
The kneecap (patella) helps the thigh muscles straighten your leg. As you move your knee, the patella slides up and down in a groove at the end of your thigh bone. It is attached to the top of your shin bone by the patella tendon.
If the patella sits higher than it should, this is called patella alta. This can cause pain or make your kneecap feel unstable because the muscles are not working in the best position.
Patella instability means the kneecap may partly slip or fully come out of its groove when you move your knee. This can be painful and may cause wear on the underside of the kneecap, which can lead to osteoarthritis.
What is tibial tubercle osteotomy (TTO)?
A tibial tubercle osteotomy (TTO) is done whilst you are asleep under general anaesthetic. The surgeon makes a cut on the front and side of your knee, up to 10 cm long. They use a small camera to look inside the joint and fix any other problems they find.
The surgeon then removes a thin piece of bone from the top of your shin bone where the patella tendon attaches. This piece is about 8 cm long and 1 cm thick. They move the bone into a better position and fix it in place using screws or plates. This helps your kneecap sit lower and more securely in its groove.
Sometimes an MPFL reconstruction is also done at the same time. X rays may be taken during the operation to check everything is in the right place.
Once the bone is fixed, the knee is washed out and the cuts are closed. Local anaesthetic is injected to help with pain, and your knee is bandaged before you go to the recovery area.
What are the benefits and outcomes of the surgery?
The aim of this operation is to move your kneecap into a better position in its groove. This should help stop the feeling of instability and reduce pain. The surgery is usually very successful, and about 90% of people are happy with the results.
What are the risks of surgery?
There are some risks with any operation, but serious problems are rare. Before surgery, your surgeon will explain these risks and ask you to sign a consent form.
Common risks after knee surgery include:
- Wound healing problems (less than 2%)
- Infection, sometimes needing antibiotics (less than 2%)
- Stiffness, which may require extra physiotherapy (less than 5%)
- Blood clots (DVT/PE), which may need blood thinning medication for up to 6 months (less than 1%)
- A small risk linked to the general anaesthetic, which can be discussed with your anaesthetist
Specific risks of this operation include:
- It is normal to have some numbness around the scars and potentially an area of numbness over the outer aspect of their knee. This isn’t often troublesome and usually reduces with time. It can occasionally be permanent.
- It is normal to have some swelling and stiffness of your knee after the operation
- A small proportion of patients are left with persistent pain at the front of their knee after any knee operation
- There is a small chance of fracture occurring around the site of the osteotomy in the tibia
- There is a very small chance of the bone not healing. This is caused by non-union and may require additional procedures
- There is a chance of over or under correction of the TTO and this may lead to ongoing symptoms
- Sometimes the metalwork used to secure the osteotomy is prominent and needs to be removed some months post-operatively
- Recurrent instability occurs in <1% of patients undergoing this procedure. If this is the case, then further procedures may be required at a later stage
- Performing TTO and preventing further instability of the patella does not necessarily protect you from developing osteoarthritis in the future. This is due mainly to any damage that has already been done
What are the alternatives to TTO?
The first option is to carry on with physiotherapy and exercises to strengthen the muscles around your kneecap. Some people choose to manage their symptoms this way and decide not to have surgery.
There are also surgical options, but how well they work can vary.
Your kneecap is supported by several soft tissues. These can become weaker over time, especially if the kneecap does not sit properly in its groove.
The most important of these tissues is the MPFL, a strong band that connects the inside of the kneecap to the thigh bone. It helps stop the kneecap from slipping out. If it is weak or damaged, it can be repaired or rebuilt. This is often done at the same time as a TTO when the kneecap is unstable.
If your kneecap sits in a very shallow groove, you may need an operation called a trochleoplasty. This is a bigger surgery where the surgeon makes the groove deeper, so the kneecap sits more securely. It is only needed if the groove is very shallow or missing.
If your pain is mainly due to arthritis, a type of knee replacement may be more suitable. This can involve resurfacing the kneecap and the groove (a patellofemoral joint replacement).
What happens before surgery?
Before your surgery, you’ll be invited to a pre assessment appointment. During this visit, a nurse will chat with you about your medical history and your home situation, and they will check things like your blood pressure, pulse, and temperature.
If you smoke, it’s important to stop before the operation, as this helps the bone heal properly.
You may also need a few routine tests, such as blood tests, an ECG (a simple heart tracing), and sometimes a chest X ray.
If anything needs a closer look, you may be asked to meet with an anaesthetist to make sure everything is safe for your procedure.
What happens after surgery?
After your operation, you will wake up in the recovery room, where a nurse will be there to help you. Once you are fully awake, you’ll be taken back to the ward.
You can put weight on your operated leg straight away, but you may need crutches and a brace for support. You should start gently bending and straightening your knee as soon as possible while sitting or lying down, as this helps prevent stiffness and weakness.
When walking, you’ll need to keep your knee brace locked straight for up to 6 weeks. Physiotherapy will start soon after the surgery to help you regain movement and build strength. Your rehab plan may vary slightly, but the aim is to gradually increase your activity with guidance from your physiotherapist.
You should plan to take at least six weeks off work. You can usually start driving again at around 4–6 weeks, once you no longer need crutches or the brace. Most people can return to sports after 3–4 months.
Will I have to stay in hospital?
We aim to discharge you within 24 hours of your surgery. Some people can go home the same day, and this will be talked through with you when you arrive for your procedure. Please make sure you have someone who can come to the hospital to take you home.
What is the follow-up care?
As well as regular physiotherapy you will also have follow-up appointments with your surgeon. Your first follow-up appointment with your surgeon’s team is usually six weeks after surgery.
If you are concerned about post-operative complications please contact the ward you were discharged from
Useful Contacts
Heatherwood Hospital:
- Orthopaedic pre assessment 0300 614 7778 / 0300 614 7147
- Arthroplasty Nurse Heatherwood 07789927177
- Nurses Station Treetops Heatherwood 0300 614 4175
- Physio/OT Office Treetops Heatherwood 0300 614 4178
Frimley Park Hospital:
- Frimley Park Physiotherapy 07570 974390
- S2 Elective Ward Frimley 0300 613 3781 / 0300 613 3783
- Elective Helpline Frimley 0300 613 2556
Wexham Park Hospital:
- Ward 1 Wexham Park 0300 615 3010 / 0300615 3012
- Outpatient Physio Wexham 0300 615 3501 / 0300615 3500
- Wexham Park Physiotherapy 07717 199851
Contact us
If you have any queries relating to this information, please contact the Orthopaedics service.
About this information
Service:
Orthopaedics
Reference:
N/082
Approval date:
13 March 2026
Review date:
1 March 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.