Indications and Technique of Distal Tibial Tubercle Anteromedialization

Anteromedialization of the tibial tubercle (ie, Fulkerson osteotomy) serves multiple purposes. The procedure can be used for both patellar instability and focal arthritic change, or a combination of the 2. The theory behind the osteotomy is to restore the abnormal force vectors pulling on the patella and offload the pressure on the damaged cartilage. Studies have shown that the best results are observed with patellar instability or cartilaginous changes either on the distal or lateral patellar facet. The procedure has demonstrated statistically significant improvements in patient satisfaction in long-term studies. The technique involves an oblique, tapered osteotomy cut of the tibial tubercle that can be adjusted to accommodate more medialization or more anteriorization, depending on the specific situation. Rehabilitation involves an initial period of nonweightbearing with the focus on immediate active flexion and passive extension. Once the osteotomy has healed (6 weeks), the patient is progressed with ambulation and then extensor mechanism strengthening. As with all surgery, avoiding complications is the key to the success of the osteotomy and they are discussed below.