Tibial Tuberosity Osteotomies

Historically, the tibial tuberosity (also referred to as the tibial “tubercle”) was moved empirically to affect force vectors acting at the patellofemoral (PF) compartment of the knee. Maquet moved the tuberosity anteriorly to theoretically decrease PF forces in an effort to manage PF pain associated with arthritis. The techniques of Elmslie and Trillat moved the tuberosity medially to decrease the lateral force vectors to treat episodic or recurrent lateral patellar instability. Currently, tibial tuberosity osteotomies have more narrowed indications, which are directed at normalizing tuberosity position and optimizing PF forces. The extent of anteriorization and medialization are increasing on the basis of objective imaging and laboratory biomechanical force and contact data. With this new attempt to objectify the extent of anteriorization and medialization, the goal is to improve both short- and long-term clinical outcomes.