Open-Wedge High Tibial Osteotomy With Complete Tibial Tubercle Osteotomy to Preserve Patellar Height

Distalization of the tibial tubercle is a concern during open-wedge high tibial osteotomy, particularly when a large correction is required, considering the potential for patella baja and patellofemoral problems. This Technical Note describes the use of open-wedge high tibial osteotomy combined with complete tibial tubercle osteotomy to maintain the position of the tibial tubercle during correction. Performing tibial tubercle osteotomy first allows placement of a thin retractor beneath the fragment during the transverse osteotomy, helping to protect the fragment and reduce the risk of an incomplete osteotomy. Temporary fixation of the tibial tubercle to the proximal tibial fragment before wedge opening is a key step in maintaining the original position of the tubercle and preventing distalization during correction. This technique is a practical option for selected patients requiring substantial varus correction when preservation of patellar height is desired.