The Fulkerson osteotomy is an operation to re-align the tibial tuberosity antero-medially to alter the direction of the forces going through the kneecap.
Page updated August 2023 by Dr Sheila Strover (Clinical Editor)
What is distal realignment?
The Fulkerson osteotomy is one of a group of procedures to realign the patella (kneecap) distally (ie the lower end of the patella-tendon complex). The tibial tubercle is fixed in its new position with screws.
Other distal realignment procedures include:
- Maquet procedure
- Elmslie-Trillat procedure
- Hauser procedure
- Roux-Goldthwait procedure
- many variants and modifications
Quick links
Forum discussions
- Fulkerson Osteotomy Questions
Brief overview about what to expect from surgery.
- Fulkerson Procedure ?'s
A young person asking about what to expect from this procedure.
- Fulkerson and Screws..anybody had em out?
Talking about screw discomfort and screw removal after a Fulkerson procedure.
Peer-reviewed papers
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Quote:
"[Tibial tubercle osteotomy] is a well-described procedure used for realignment of the extensor mechanism....to reduce joint reaction forces and realign problematic contact areas in the setting of patellofemoral joint disorders....However, TTO is not without risk of complications....[such as] osteotomy site nonunion....[and]....tibial fracture...."
Citation: Ridley TJ, Baer M, Macalena JA. Revisiting Fulkerson's Original Technique for Tibial Tubercle Transfer: Easing Technical Demand and Improving Versatility. Arthrosc Tech. 2017 Aug 7;6(4):e1211-e1214. doi: 10.1016/j.eats.2017.04.013. PMID: 29354419; PMCID: PMC5622023.
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Quote:
"....appropriate patient selection....[is]....paramount."
Citation: Grimm NL, Lazarides AL, Amendola A. Tibial Tubercle Osteotomies: a Review of a Treatment for Recurrent Patellar Instability. Curr Rev Musculoskelet Med. 2018 Jun;11(2):266-271. doi: 10.1007/s12178-018-9482-3. PMID: 29721692; PMCID: PMC5970117.