omy ▁has ▁been ▁developed ▁as ▁a ▁hy brid ▁of ▁two ▁previously ▁available ▁orth op a edic ▁procedures , ▁the ▁tib ial ▁tub eros ity ▁adv ancement ▁and ▁the ▁tib ial ▁plate au ▁level ing ▁o ste ot omy . ▁The ▁tib ial ▁tub eros ity ▁adv ancement ▁neutral ises ▁she ar ▁force ▁within ▁the ▁st if le ▁by ▁adv ancing ▁the ▁tib ial ▁tub eros ity ▁until ▁the ▁tib ial ▁plate au ▁is ▁at ▁right ▁angles ▁to ▁the ▁pat ell ar ▁lig ament . ▁The ▁tib ial ▁plate au ▁level ing ▁o ste ot omy ▁neutral ises ▁she ar ▁force ▁by ▁rot ating ▁the ▁tib ial ▁plate au ▁so ▁that ▁it ▁is ▁approximately ▁horizontal ▁with ▁respect ▁to ▁the ▁long ▁axis ▁of ▁the ▁tib ia . ▁The ▁triple ▁tib ial ▁o ste ot omy ▁comb ines ▁both ▁of ▁these ▁procedures ▁and ▁as ▁such ▁less ▁radical ▁changes ▁than ▁either ▁are ▁required . ▁ ▁S urg ical ▁technique ▁The ▁triple ▁tib ial ▁o ste ot omy ▁involves ▁removing ▁a ▁horizontal ▁small ▁w edge ▁of ▁b one ▁( aver age ▁ 1 6 ▁degrees ) ▁half way ▁along ▁a ▁vertical ▁o ste ot omy ▁in ▁the ▁tib ial ▁tub eros ity . ▁First ly ▁by ▁removing ▁the ▁w edge ▁of ▁b one , ▁the ▁tib ial ▁plate au ▁is ▁level led . ▁Second ly ▁as ▁the ▁horizontal ▁defect ▁created ▁by ▁removing ▁the ▁w edge ▁is ▁closed ▁down , ▁the ▁tib ial ▁tub eros ity ▁is ▁itself ▁advanced ▁by ▁several ▁mill imet res . ▁This ▁comp ares ▁with