Abstract

Objective: To evaluate the clinical outcomes, pain relief, and long-term satisfaction in patients with patellofemoral malalignment who underwent anteromedial osteotomy of the anterior tibial tuberosity using the modified Fulkerson technique. Material and methods: This was an observational, descriptive, prospective case series study (level of evidence IV). Forty-three knees in 38 patients (32 women and 6 men; age range: 14–68 years) operated on between 1999 and 2011 were evaluated, with a mean follow-up of 5.8 years (range: 1.5–12 years). The technical modification included a smaller incision (3.5 cm), a 30° medial osteotomy converging with the lateral cut at 45°, and preservation of the tibialis anterior muscle insertion. Pain was assessed pre- and postoperatively using the Numerical Rating Scale (NRS). Results: Anterior knee pain was the main indication for surgery (44.18%). 52.63% of patients presented with severe to unbearable preoperative pain (VNS 710). At the postoperative follow-up, 97.68% of cases showed complete or substantial pain remission within 3 to 12 months. The overall satisfaction level was excellent or good in 95.3% of cases (n = 41 knees). The overall complication rate was 11.6% (including hardware loosening, infrapatellar pain, and superficial infection), all of which were successfully resolved. Conclusions: The modification of the Fulkerson osteotomy technique is an effective, reproducible procedure with low morbidity for extensor mechanism realignment, offering pain reduction and high long-term satisfaction rates.