Distal Realignment Procedure

The tibial tubercle is the bony projection located on the tibia below the patella, which serves as the attachment point for the patellar ligaments, tendons, and muscles. These procedures are performed to prevent patellar dislocation or subluxation.

There are various types of distal realignment procedures, including:

• Maquet procedure: This involves cutting the tibial tubercle but leaving the patellar tendon attachment intact. The tubercle is elevated by wedging the loosened piece of bone using a bone block, but it cannot be moved medially.
• Elmslie-Trillat procedure: This is similar to the Maquet procedure, but the tendon and tubercle can be moved medially.
• Fulkerson procedure: This involves moving the tibial tubercle more medially by breaking the bone into sharp pieces. After the procedure, the bits of bone are held in place using screws.
• Hauser procedure: This involves moving the tibial tubercle medially but not anteriorly, as the tubercle may shift its position more posteriorly after the procedure, causing pain when the patella presses down.
• Roux-Goldthwait procedure: This is a distal realignment procedure in which the patellar tendon is split vertically. The lateral half of the tendon is pulled under the medial half and attached to the tibia, pulling the patella to the center and preventing excessive lateral shift.