New TTO Cerclage Technique

This video, presented by orthopedic surgeon Dr. Grant H. Garcia, demonstrates an updated fixation technique for a Tibial Tubercle Osteotomy (TTO) using a specialized FiberTape cerclage enhancement to significantly improve bone healing and prevent structural failure.

Procedure Overview:

• Alignment & Initial Fixation: The surgeon begins by temporarily holding the osteotomy fragment in its new anterior (forward) and medial (inward) position using temporary pins. After confirming the correct height and alignment, bicortical drilling (drilling through both sides of the bone cortex) is performed.
• Screw Placement: The primary fixation is achieved using 5.0 mm Arthrex headless compression screws. The surgeon places the screws sequentially, utilizing a "top hat" device to sink them fully flush with the bone. The headless design provides excellent compression while dramatically minimizing the need for future hardware removal surgeries. A third screw is added for enhanced stability, a step the surgeon utilizes in about 40% to 50% of cases.
• The Cerclage Tension Band: To maximize compression and protect the bone from fracturing or failing to heal (non-union), an updated cerclage enhancement is added. A heavy FiberTape suture is passed bicortically from lateral to medial, positioned specifically near the distal tip of the osteotomy site—the area most vulnerable to fracture or non-union.
• Tying and Knot Placement: The FiberTape ends are crossed and tied tightly together. Crucially, the knot is tied on the lateral side of the bone, allowing it to be buried deep within the surrounding muscle tissue so the patient cannot feel a hard lump underneath their skin.
• Testing: The construct acts like a dynamic tension band. When the knee is cycled through a range of motion, the FiberTape adds extra compression onto the bone fragment as the knee flexes, stabilizing the osteotomy without over-constraining the joint.