We are offering a new technique for a TTA (Tibial; Tuberosity Advancement) This new surgical technique is called the Modified Maquet Procedure or MMP. When an MMP is done to modify the joint mechanics, a more precise cut is made in the tibia using a saw guide. We use a Titanium wedge implant instead of plates and screws (new bone grows into the foam wedge over time making a very strong repair). There is less movement of tissues during the surgery, a shorter surgery (and anesthesia) time, and we expect these patients to use the leg very soon after surgery. Although total healing time is 8 weeks, graduated leash walks are allowed beginning the day after surgery.