Review Question - QID 3424

Anteromedial (Fulkerson) tibial tubercle osteotomy is contraindicated in patients with significant arthrosis of the medial facet of the patella and the medial femoral condyle.

Anteromedial tibial tubercle osteotomy (Fulkerson procedure) involves the transfer of the tubercle to a more anterior and medial location. Changing the vector of the extensor mechanism can help reduce lateral patellar subluxation/dislocation and concomitantly unload areas of arthrosis on the distal and lateral aspects of the patella. When performing a tibial tubercle transfer, the surgeon should beware of proximal lesions or medial facet or condylar lesions. Thus, intact proximal and medial cartilage is required to obtain the maximum benefit from this procedure.

Pascual-Garrido et al, in a Level 4 study, reviewed 62 patients who underwent autologous chondrocyte implantation of the patellofemoral joint for defects an average size of 4cm(2). Those that underwent anteromedialization tended to have better clinical outcomes than those without realignment, however 44% of the patients still required a subsequent procedure.

Paulos et al, in a Level 3 study, prospectively followed 25 patients with a dislocating patella that underwent a derotational high tibial osteotomy, medial, or anteromedial tibial tubercle osteotomy. There were no dislocation recurrences in either group and 92% of the patients stated that they were happy with the results of their surgery and would undergo the procedure again.

Illustration A shows a video of a Fulkerson osteotomy being performed on a cadaveric specimen.