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High accuracy of the osteotomy angle can be achieved without the use of calibrated guides when performing anteromedialisation tibial tubercle osteotomy
  1. Jakob Ackermann1,
  2. Alexandre Barbieri Mestriner2,
  3. Kirstin Marie Shu Small3,
  4. Emily Sheehy4,
  5. Andreas H Gomoll5
  1. 1 Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Dept. of Orthopaedic Surgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
  3. 3 Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  4. 4 Dept. of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  5. 5 Sports Medicine Service, Dept. of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
  1. Correspondence to Dr Andreas H Gomoll, Hospital for Special Surgery, New York, New York, USA; gomolla{at}


Objectives Tibial tubercle osteotomy (TTO) is a frequently performed procedure for the treatment of patellar instability and allows for chondral defect unloading when performed in conjunction with cartilage repair. Accurate intraoperative execution of the osteotomy is of utmost importance to achieve the desired outcome. The purpose of this study is to validate the intraoperative accuracy of the osteotomy angle of TTO.

Methods Between January 2007 and May 2017, a total of 212 patients underwent TTO; however, only patients with postoperative axial (magnetic resonance) imaging were eligible for inclusion. Thus, 124 patients (126 knees) (58.5%) were evaluated in this study. The osteotomy angle was assessed by two independent reviewers (fellowship trained radiologist and orthopaedic surgeon) using MRI and compared with preoperative planning.

Results Patients were on average 32.89 years (range 15–56, SD 9.7) of age at the time of surgery with an equal gender contribution (50% women vs 50% men). Postoperative MRI was conducted at 12.53 months (range 2–91 months, SD 12.2) follow-up. Postoperative MRI-measured osteotomy angles averaged 104.1% of planned angles and showed a high intraclass correlation coefficient of 0.87. The accuracy of the osteotomy cut did not vary with the planned steepness of the cut (p=0.984).

Conclusion This study demonstrates that the high accuracy of the osteotomy angle can be achieved without the use of calibrated guides. Good exposure and visualisation of the TT intraoperatively are paramount for the precision of anteromedialisation TT osteotomy using the Fulkerson’s technique.

Level of evidence Level IV, retrospective case series

IRB protocol number 2017P001677

  • tibial tubercle osteotomy
  • patellofemoral
  • patellar instability
  • knee pain
  • anteromedialization
  • osteoarthrtitis
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  • Contributors All authors have contributed to the design of the work and/or the acquisition, analysis, or interpretation of data for the work. All authors have also helped drafting the work and/or revising it critically for important intellectual content, and final approval of the version to be published has been given by all authors. They also agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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