Tibial Tubercle Osteotomy in the Adolescent Patient

Abstract

Patellofemoral instability (PFI) is an increasingly prevalent issue affecting pediatric and adolescent patients. Anatomic factors, including lateralization of the tibial tubercle and patella alta, can contribute to increased risk of initial and recurrent PFI. In the case of recurrent PFI, chondral injuries of the patellofemoral compartment can occur. These anatomic pathologies can be surgically addressed using tibial tubercle osteotomy (TTO), adjusting the angle and direction of the osteotomy as needed to achieve the desired correction. We discuss the indications and present our technique for performing TTO, including the modifications that can be made to the procedure to address the specific pathoanatomy of the patient. Key Concepts • Lateral patellar instability is a common condition impacting adolescent patients with tibial tubercle lateralization and patella alta being common modifiable risk factors for recurrence. • The tibial tubercle osteotomy is a versatile procedure permitting the treatment of patellofemoral instability and associated cartilage injuries by adjusting the angle of the osteotomy cut and tubercle transfer as needed to address the specific pathology. • Risks of osteotomy are greater than soft tissue reconstruction procedures alone, but many can be mitigated with meticulous osteotomy and soft tissue closure techniques.