Tibial Tubercle Osteotomies: Techniques and Distalization

Symptomatic patellar instability is a very disabling pathology. It is most likely a result of a number of anatomic and physiologic factors causing a failure of the extensor mechanism to deliver the patella into the femoral sulcus. Several morphological anomalies have been identified which facilitate or allow patellar dislocation [1]. We perform “a la carte” surgery, according to the present anomalies on preoperative radiography and CT scan [2]. In more than 96% of cases, the radiographic examination will detect at least one of the following features in episodic patellar dislocation (EPD) group: trochlear dysplasia, patella alta, tibial tubercle–trochlear groove distance (TT–TG) >20 mm, or patellar tilt >20°. The objective of the tibial tubercle osteotomy is to correct one or two main factors of patellar instability [3]. In order to lower or medialize the distal extensor mechanism, different surgical techniques have been described.