Tibial Tubercle Osteotomy: Technique for Anteromedialization and Distalization.

Background: Tibial tubercle osteotomy is an effective technique that has been well-described to treat patellofemoral overload and/or instability. Indications: A tibial tubercle osteotomy may be indicated in patients with patellofemoral instability and/or pathologic stress reactions at the patellofemoral joint, along with excessive lateral position of the tuberosity or patellar height abnormality. Technique Description: This video shows 2 types of osteotomies: anteromedialization alone and distalization with anteromedialization. Results: Two techniques were performed for tibial tubercle osteotomies on cadaveric models. Biomechanical studies have shown that anteromedialization, distalization, or a combination of the 2 can decrease patellofemoral joint forces when compared with lateralized and native tubercle positions. Discussion/Conclusion: We present an anteromedializing and a distalizing tibial tubercle osteotomy. This is a reproducible procedure that is an essential tool in the patellofemoral surgeon's toolbox. The customizable nature of the cut allows optimization of patellofemoral alignment and contact forces. Medialization, anteromedialization, distalization, or a combination of these procedures can be completed with careful attention to preoperative planning and intraoperative technique. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.