Tibial Tuberosity Realignment Decreases Pressure Applied to Patellofemoral Cartilage

For patients with unrelenting patellofemoral pain, tibial tuberosity realignment procedures are commonly performed to improve patellofemoral alignment and decrease the pressure applied to patellofemoral cartilage. Because malalignment is typically attributed to an excessive lateral force applied to the patella by the quadriceps muscles and the patella tendon, the tibial tuberosity is commonly osteotomized and transferred medially to decrease the lateral force applied by the patella tendon. The tibial tuberosity can also be anteriorized to increase the extensor moment arm of the patella tendon, which decreases the forces applied by the quadriceps muscles during function and subsequently decreases joint compression. Anteriorization and medialization of the tibial tuberosity can also be combined in a single procedure. The goal of the current study was to characterize how medialization, anteriorization and anteromedialization of the tibial tuberosity influence the patellofemoral force and pressure distributions within symptomatic knees. The authors hypothesize that all three realignment techniques decrease the pressure applied to patellofemoral cartilage, but that anteromedialization produces the largest pressure decrease.