Technical Considerations for an Anteromedializing Tibial Tubercle Osteotomy.

Area of Science:

• Orthopedic surgery
• Biomechanics
• Sports medicine

Background:

• Patellofemoral pain and instability can significantly impact patient function.
• Tibial tubercle osteotomy and distal realignment are surgical techniques to address patellar maltracking.
• Accurate measurement of tibial tubercle to trochlear groove (TT-TG) and patellar tendon lateral trochlear ridge (PT-LTR) distances is crucial for surgical planning.

Purpose of the Study:

• To present the technique for anteromedializing tibial tubercle osteotomy.
• To demonstrate the efficacy of this procedure in improving patellar tracking and relieving pain.
• To highlight its utility in patients with failed conservative management.

Main Methods:

• An open incision is made along the inferomedial patellar tendon after knee arthroscopy.
• A tibial tubercle osteotomy is created using a sagittal saw and osteotome.
• The osteotomy is anteromedialized and/or distalized to optimize patellar articulation, with fixation using bicortical screws.

Main Results:

• The surgical management resulted in no immediate complications.
• The patient experienced improvement in patellofemoral pain.
• The patient was able to return to their prior baseline level of function.

Conclusions:

• Anteromedializing tibial tubercle osteotomy is an effective surgical option for patellar maltracking and chondromalacia unresponsive to conservative treatment.
• This technique improves patellar tracking and redistributes patellar contact pressures, leading to pain relief.
• The presented case illustrates the successful application of anteromedializing tibial tubercle osteotomy for symptomatic patellar instability.