In cases of patellar (kneecap) instability with recurrent subluxation (kneecap jumping over the edge of its groove), surgeons may attempt to improve the stability by realigning the patella by changing the forces through the whole patellar system - what is known as extensor mechanism. That is the quads muscle, quads tendon, patella, patellar tendon, tibial tubercle, and the side restraints of the patella (retinaculum).
If the operation involves structures at or above the kneecap, it is called a proximal realignment. If the operation involves structures below the kneecap, it is called a distal realignment.
The Fulkerson Procedure, or Fulkerson osteotomy, is a distal realignment procedure, where the tibial tubercle (the bony bump an inch below the kneecap) is cut and moved medially and anteriorly (ie towards the inner aspect and forwards). This has the effect of improving the extensor mechanism alignment, and also decreases the pressure under the patella.
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