Tibial Tubercle Osteotomy: Anterior, Medial, and Distal Correction

For patients with patellofemoral pain who fail exhaustive nonoperative treatment, surgical intervention may be a viable option for selected patients who have pain on the bases of pathomechanics and/or cartilage lesions. Treatments may be directed at proximal soft tissues and distally at the tibial tubercle such as in a tibial tubercle osteotomy. Tibial tubercle osteotomies can include medialization, anteriorization and/or distalization of the tibial tubercle. Proximaltaization can also be performed in the setting of patella baja, however, it is rarely performed and is outside the scope of this article. Medialization may be used to improve force vectors and contact area, anteriorization can decrease contact pressures, and distalization can normalize patellar height. Factors influencing which techniques are used include concomitant chondral pathology and specific measurements on imaging such as the tibial tubercle-trochlear groove distance, tibial tubercle-posterior cruciate ligament distance, and Caton-Deschamps Index. The following article reviews the indications for and techniques of anteriorization, medialization, distalization, and combinations of the 3, for tibial tubercle osteotomies. (C) 2019 Published by Elsevier Inc.