Technical Considerations for an Anteromedializing Tibial Tubercle Osteotomy

Abstract

Background: Tibial tubercle osteotomy and distal realignment allows for adjustment to the patellofemoral articulation in order to improve patellar tracking and redistribute patellar contract pressures. Indications: A healthy, active 39-year-old woman status post right knee tibial tubercle osteotomy presented with >2 years of patellar instability symptoms in the left knee. Imaging revealed a tibial tubercle to trochlear groove (TT-TG) distance of 21 mm and patellar tendon lateral trochlear ridge (PT-LTR) distance of 14 mm. Technique Description: After knee arthroscopy is performed, an open incision is made along the inferomedial patellar tendon. Two pilot holes are created before a sagittal saw is used to make the tibial tubercle osteotomy, before completing it with an osteotome. Anteromedialization and/or distalization of the osteotomy is performed relative to templated values in order to improve patellar articulation. After correction, 3 bicortical screws are placed to achieve stable fixation. Results: There were no immediate complications following surgery. Surgical management led to improvement of the patient’s patellofemoral pain, which allowed return to prior baseline level of function. Discussion/Conclusion: The preferred technique for an anteromedialzing tibial tubercle osteotomy is presented. An anteromedializing tibial tubercle osteotomy is an effective surgical option for patients with evidence of patellar maltracking or central or lateral patellar chondromalacia whom have failed conservative management. This case demonstrates the efficacy of an anteromedializing tibial tubercle osteotomy to provide pain relief by improving patellar tracking and offloading patellar contact pressures on areas of prominent chondral wear.