Tibial Tubercle Anteriorization and Distalization Using the Multi-Directional Tibial Tubercle Transfer (MD3T) System.

Background: Tibial tubercle osteotomy (TTO) is a well-established procedure that improves patella-trochlea contact area and reduces aberrant forces causing maltracking or compression of the patellofemoral joint (PFJ). Contemporary TTO surgery often involves anteriorization, medialization, distalization, or combinations like anteromedialization (AMZ). The classic Fulkerson AMZ is a time-tested standard, but the technique does not allow for isolated planar adjustments such as straight anteriorization and may not be viable for subsets of patients with medial patellofemoral cartilage lesions due to the resultant medial shift of contact forces. The Multi-Directional Tibial Tubercle Transfer (MD3T) system enhances TTO precision and modularity, enabling customizable realignments. Indications: Anteriorization-type TTO reduces PFJ compression and addresses pathologies such as focal chondral defects, patellofemoral pain, maltracking, and instability. Distalization-type TTO corrects patella alta in patients with a Caton-Deschamps Index ≥1.2. However, distal displacement of the tubercle can increase compressive forces in the PFJ; thus, care must be taken to avoid overcorrection and resultant overloading of the articulating surfaces. The MD3T system supports both anteriorization and distalization, ensuring controlled corrections. Technique Description: The MD3T employs a proprietary wedge system for precise uniplanar or multiplanar corrections during TTO. For uniplanar adjustments, a single wedge suffices; multiplanar procedures may require 2 transposable wedges. A specialized saw guide guides osteotomy cuts, and the tubercle is repositioned with bone void fillers placed under the proximal tubercle for anteriorization or superiorly for distalization. This approach maintains cortical integrity and reduces the need for extensive dissection. Results: The MD3T system allows for precise anteriorization and distalization while preserving both cortices and eliminating the need for extensive stripping of the anterior compartment, thereby reducing the risk of catastrophic iatrogenic neurovascular injuries. Discussion/Conclusion: The MD3T system simplifies TTO by providing consistent, precise corrections in multiplanar alignments. Its wedge technique preserves cortical structures, reduces neurovascular injury risk, and enhances surgical efficiency. This system effectively simplifies the intricacies associated with this complex surgery, allowing surgeons to reconstruct favorable biomechanics for their patients and establish a solid groundwork for achieving optimal clinical outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.