On November 29, 2021, I went in for my fourth (and hopefully final) knee surgery. This time I was taking care of the left leg. If you have been here awhile, you may recall I had a MACI with MPFL Reconstruction done on my right leg. This time around I needed a much bigger procedure done for my left knee. I got the MACI procedure with a Tibial Tubercle Osteotomy.
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What is the Tibial Tubercle Osteotomy?
Very simply put, the Tibial Tubercle Osteotomy (TTO) surgery is a procedure to improve the alignment of the patella. In my case, because the point where my tibia bone attaches to the knee joint was over to one side so far, it caused my patella to be pretty tilted. This tilt caused the patella to damage some of the cartilage beneath it, which in turn caused me pain. With the TTO procedure, the surgeon cuts through the tibia bone and moves it over to better align with the patella. In my particular surgery, my surgeon moved the tibia over one whole centimeter.
What is the MACI Procedure?
A lot of times (not always, of course), when someone needs to have a Tibial Tubercle Osteotomy, they also need to fix the underlying cartilage. If you remember, back in 2018 and 2019 I had knee surgery on my right knee. The MACI was performed at that time. With a MACI procedure, a patient will have a scope done where the surgeon will go in and clean up the underside of the patella and take a biopsy of the cartilage. This biopsy is then sent to a lab to grow more of your own cartilage. Pretty neat! On the day of surgery, the damaged cartilage is removed and the new cartilage is put in its place. You then will be in a full brace and doing PT, while that new cartilage thickens and hardens to match the rest of the cartilage in your joint.
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Knee Surgery Day
On the day of surgery, I have to admit, I was pretty nervous. This surgical plan was a little more serious than the previous surgery for the right leg. However, I trusted my surgeon. I mean, I had to…this was, after all, my fourth surgery with him! The surgery took about two and a half hours. When I woke up, I was in a tremendous amount of pain. The nursing staff were excellent and gave me medication to help with the pain. I also received a nerve block. When I was discharged, I wasn’t feeling any pain at all. One of the last things they told me at discharge was, “you are on some heavy duty narcotics. Absolutely no signing any legal documents”. In my stoned brain I heard, “when you get in the car, pull up Amazon and order some stuff”. So I did. The funny thing is, I have no memory of ordering these leopard disposable face mask, but I did! And boy did we get a laugh out of it when they arrived a few days later!
Recovery from Surgery So Far
I am only a couple weeks out from surgery, but so far everything is going fairly well. The nerve block ended up wearing off quicker than it was supposed to and I was hit with a ton of pain. However, a chat with the nurse helped and we were able to get my pain under control eventually. In chatting with my surgeon about it at my one week follow up, I think that if I had it to do over again, I would opt to not have the nerve block. Instead, I would have had the nurses give me whatever pain medication they could before discharging me. This way, once that starts to wear off, I can stay on top of the pain. With a nerve block, it just wears off and usually without warning. If you are having this surgery done, definitely discuss after surgery pain control with your surgeon.
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All in All, Everything is Good
While the recovery started out with a lot more pain than I was anticipating, in the end it all worked out. I don’t have nearly as much swelling as I did with my previous knee surgeries. I’m also not dealing with a tight IT band like I did when I had surgery on my right leg. The best thing I did leading up to this major knee surgery was hit the gym and get as strong as possible. Trust me, you want to do that. The stronger you can go into knee surgery, the better you come out of it. I will be sure to keep you updated periodically as things change with my recovery. Right now I am on crutches with about 20% weight bearing. Basically I walk with crutches and use my left leg to sort of balance myself, but not really put much weight on it at all.
How is your recovery going now? I had this same procedure (MACI plus TTO) performed on my left knee on December 16, 2021. My recovery has been pretty slow and is still pretty painful and swollen unfortunately. I hit 118 degrees flexion 3 days ago and am still crutching around. Hope the rehab is going well!
Hi there…it’s going OK. I had my surgery on November 29, 2021. I am still on crutches and 50% weight bearing with the brace in the locked position. I have a followup with the surgeon on the 28th of Feb and I am hoping the x-ray shows that the bone form the TTO has healed. It was not healed at my last follow-up. I still have some swelling. They haven’t measured how much I’m bending my knee in awhile, but I am able to ride the exercise bike, so I’m over 110 degrees. A lot of my pain is at the TTO site. How about you?
Wow.. I’ve literally just came out the hospital and I’m here trying to sleep looking up how to sleep and I’ve come across your blog. Thanka for sharing tips on previous blog. To the recliner i go.! I wish you all the best in your recovery.
Oh good luck to you too!! I hope your recovery goes well.
I’m about to have surgery on Friday. I’m in a gray area where I can choose between MACI or MACI TTO due to the location of my cartilage damage. Idk what to choose, but thank you for sharing your experience and tips!
I hope your surgery went well. Which one did you choose? I have to say, I am very happy with my MACI TTO.
Hi there! I have been dealing with knee pain since 2008. Had 3 surgeries myself and its time to get the TTO with MACI, which I probably should have got quite some time ago. I saw you had it late 2021. I was wondering how you are doing now? Any insight would be extremely helpful!
Hi there! I am doing fantastic! No complaints at all. I work out daily, walk the trails by my house. I’m thrilled that I got this done and wish I would have done it years ago.
Hello Leah! I wanted to ask you how you’re doing now after your MACI surgeries? Also where was the location of your cartilage defect? I’ve had the first stage of the procedure. I’m now doubting whether I want to proceed forward with the big surgery: a double osteotomy of the tibia and tibial tubercle, and MACI. I have a 3x4cm Grade 4 cartilage defect right under my patella. Leading up to this, my pain is symptomatic. I’m able to run without pain, but I get sharp pains at times with stairs/kneeling/dancing/rockclimbing. I’m still able to do those things, but feel pain/stiffness the next day or two after. My fear is being left worse off after MACI, especially after such a long recovery. Are you able to be active, or do you feel physically limited by your knees following your surgeries? I’m worried about not being able to run or do sports two years from now. Also, did you get full ROM back in both knees? Thank you!!
I am so sorry that I am just now seeing this. I am doing great! Both knees are fantastic and aside from not getting all the feeling back in the skin around the incision (that took awhile with my right leg), I have zero complaints. I’m doing things I haven’t done in 15 years. I work out every day, walk the trails by my house. I don’t feel limited at all. Now I don’t play sports, but I don’t see why I couldn’t.
I’m going in for TTO and a revised MACI in May 2023 and I’m super nervous. Recovery from my first MACI in March 2021 wasn’t terrible, but my doctor discharged me after two months post-op and my physical therapist didn’t really know how to handle my recovery, and becuase of these factors, the MACI failed so now i have to get it reivsed. Any tips for recovery would be great!
oh wow I’m so sorry to hear that. I would ask your surgeon where you should go to do PT so that you are with someone that can handle the surgery that you had. What do you mean discharged after two months?
My surgeon sees me for a few years as follow up to check everything. I was in PT for MONTHS.
Hi!
My first doctor discharged me as a patient. He told me only come back if I wanted to, no more follow up appointments.
But I just had my revised MACI with TTO today (Wednesday) and have my post op on Friday. The PA said that they will give me the prescription for physical therapy at the post op, but they want me to start in physical therapy as soon as possible.
Not going to lie, I’m nervous about this recovery and the pain. I’m scared I won’t be able to handle the pain, and I’m also scared I will mess up the recovery and have to do this again 😬
Hello! I am sorry I missed this comment. I hope everything has gone OK for you!!