The patellar tendon is both medialised (moved towards the inner aspect) and brought anteriorly (moved forwards).
Why realign the tibial tuberosity?
Some patients who are experiencing pain in the front of the knee, or patellar instability, may be found to have poor alignment of the various anatomical structures that allow the knee to straighten.
For example, the attachment of the patellar tendon to the tibia may not line up well with the groove in which the patella tracks.
Realigning the tibial tuberosity (tibial tubercle) is not a procedure to be undertaken lightly because complications are possible.
"....appropriate patient selection....[is]....paramount."
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
"[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...."
Other relevant links
Tibial tuberosity, Patellofemoral pain, Patellar instability, Maltracking, Distalisation of tibial tubercle
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.