Review and Technique

Fulkerson originally designed the tibial tuberosity anteromedialization technique to address patellofemoral pain associated with patellofemoral chondrosis in conjunction with patellofemoral tilt and/or chronic patellar subluxation while avoiding the complication rate of the Maquet tibial tuberosity elevation.12 The anteromedialization technique transferred areas of patellofemoral loading through medialization, which also improves patellofemoral joint congruity (improved joint contact area), and anteriorization to transfer forces proximally, while theoretically decreasing the absolute magnitude of the patellofemoral resultant force.15 This theoretical decrease in resultant force and increase in contact area would thus decrease joint surface stress, potentially decreasing the condition of overload contributing to pain.1 Long-term clinical follow-up has verifi ed the effi cacy of the procedure and a decrease in the complication rate previously associated with the Maquet anteriorization technique.4 Currently, interest has been renewed in anteromedialization in conjunction with cartilage restoration of the patellofemoral compartment. For cartilage restoration treatments, stress on the restoration must be optimized/minimized. The importance of optimizing patellofemoral joint stress was not initially realized in patellofemoral joint cartilage restoration, demonstrated by the poor results of patellofemoral autologous cultured chondrocyte implantation for patellofemoral cartilage defects, as originally reported by Brittberg et al.3 In this early series, patellofemoral malalignment was not corrected, and fi ve of the seven patellofemoral autologous cultured chondrocyte implantation patients did poorly, in contrast with a high success rate at the tibiofemoral articulation. Subsequently, with attention to alignment and elevation through anteromedialization, the results of patellofemoral autologous cultured chondrocyte implantation have approached that of the tibiofemoral joint.25,30 This article assesses anteromedialization clinical studies, analyzes relevant biomechanics, and concludes with a review of the technique, including applications in cartilage restoration. Anteromedialization