Why and Where to Move the Tibial Tubercle Indications and Techniques for Tibial Tubercle OsteotomyMiddleton, Kellie K. MD, MPH*; Gruber, Simone BA*; Shubin Stein, Beth E. MD*,†Sports Medicine and Arthroscopy Review: December 2019 - Volume 27 - Issue 4 - p 154–160 doi: 10.1097/JSA.0000000000000270 Review Articles Buy Abstract Author InformationAuthors Article MetricsMetrics Patellofemoral disorders including pain and instability are common orthopedic problems, particularly in the adolescent population. Patellofemoral pain is usually anterior, poorly localized, and diffuse. Because of its multifactorial etiology, patellofemoral pain can be clinically challenging to diagnose and manage. With regards to instability, predisposing factors include trochlear dysplasia, patella alta, patellar tilt, and an elevated tibial tuberosity and trochlea groove distance. Initially, nonoperative management is recommended to treat patellofemoral maladies such as overload, maltracking, and acute first-time dislocations. However, tibial tubercle transfer (TTT) is commonly used to address cases of symptomatic malalignment and overload and recurrent patellar instability. The tubercle can be translated in multiplanar directions to correct patellar height, maltracking associated with instability, and to offload chondral defects. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is essential for optimizing results after TTT. Individualizing the direction and degree of tubercle transfer on the basis of patient parameters is critical to producing successful long-term results after surgery. This article will review the indications for performing a TTT and highlight the various techniques. *Department of Orthopaedic Surgery, Hospital for Special Surgery †Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY Disclosure: The authors declare no conflict of interest. Reprints: Beth E. Shubin Stein, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.