Tibial Tuberosity Anatomy and Surgery

Tibial tuberosity osteotomy (TTO) is a powerful tool in the treatment of patellofemoral disorders. Pathologies include patellofemoral instability, patellofemoral overload syndromes, chondral lesions and arthritis, as well as knee pain or functional loss due to patellar infera or alta. Osteotomies can be used to alter patellar tracking and to improve stability as well as to offload cartilage lesions. This chapter reviews the anatomy of the patellofemoral joint and presents a look at multiplanar TTO, analyzing its benefits and pitfalls. The historical work of Roux, Hauser, Maquet, Elmslie, and Trillat are analyzed along with the current techniques of Fulkerson and newer modifications by Farr and Paley. Additionally, guidelines for when to utilize the TTO for various pathologies are presented and discussed.