Osteotomy of the Tibial Tubercle for Anteromedialization

Patellofemoral instability is a common cause of anterior knee pain, especially in younger and more active patients. Treatment of instability varies considerably depending on the patient's symptoms as well as the cause of the instability. Lateral instability has a particularly broad spectrum of treatment algorithms including patellar taping, arthroscopy, lateral release, medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and osteotomy of the tibial tubercle for realignment. Acute traumatic lateral dislocation is commonly associated with a tear of the MPFL and, therefore, needs to be addressed. However, patients who show lateralization of the tibial tubercle with an increased tibial tubercle-to-trochlear groove distance, tibial tubercle-to-posterior cruciate ligament distance, and Q-angle measurements often display chronic instability even after an MPFL reconstruction. In these cases, an osteotomy of the tibial tubercle is required to establish proper alignment and minimize the risk of recurrence of instability. The objective of this Technical Note is to describe our preferred method to complete a Fulkerson tibial tubercle osteotomy for anteromedialization and treatment of chronic patellar instability.