Editorial Commentary: Offloading Patellofemoral Chondral Defects Requires Tailored Tibial Tuberosity Osteotomy Procedures

The presence of patellofemoral chondral defects is common in the setting of patellar instability. Multiple procedures have been described to address concomitant chondral defects including autologous chondrocyte implantation (ACI) and osteochondral allograft (OCA) transplantation, with lack of consensus on the optimal management of such defects. Regardless of the technique used to address the cartilage lesion, offloading the defect with a tibial tuberosity osteotomy (TTO) and stabilizing the patella through medial patellofemoral ligament reconstruction are important components of patellofemoral joint preservation surgeries. Identifying the specific location of the chondral defect allows us to tailor the TTO when offloading the lesion and addressing instability. By specifying the precise amount of tuberosity medialization needed to correct the TTTG distance and the amount of anteriorization to correct the anterior-posterior TTTG (or sagittal TTTG) distance, combined with the amount of distalization needed to correct patellar height, we have been able to improve the way we address the coronal and sagittal alignment of the knee. By improving the precision with which we measure and compare defects based on each patient’s morphology and specific injury patterns, we can tailor procedures to each individual to optimize the management of chondral pathology in the setting of patellar instability.