Anteromedial Tibial Tubercle Osteotomy for Recurrent Patella Subluxation

Abstract

Background: Patellofemoral pathology resulting from improper biomechanics is difficult to treat, and lateral patellar instability requires individualized treatment, which may include tibial tubercle osteotomy (TTO) with anteromedial repositioning. Indications: Symptomatic patellofemoral instability with maltracking, particularly in cases with a tibial tuberosity-trochlear groove distance >16 mm. Technique Description: We describe an oblique osteotomy from medial to lateral. A careful completion of the osteotomy is made with an osteotome, and the resulting fragment is mobilized to achieve anteromedial repositioning—as well as distalization in cases of patella alta. Two bicortical screws with a washer are used for fixation of the tibial tubercle following anteromedialization. Results: Systematic reviews demonstrated that the treatment of the lateral patellar instability requires an individual treatment and the anteromedial TTO is a very important procedure alone or in association with medial patellofemoral ligament. Discussion/Conclusion: Recurrent lateral patellar instability is a challenging condition with complex causes and various treatment options, but anteromedial TTO provides an effective way to improve clinical outcomes and correct patellar maltracking, with relatively low complication rates. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.