John Fulkerson

Recently have encountered 3 surgeons who close quad tendon defect after harvesting quad free tendon for ACLR. They report quad inhibition and blame the graft Just leave it open and you will rarely see quad inhibition. Why add a hernia repair? pubmed.ncbi.nlm.nih.gov/1653…

Is as simple as this if the patella is lateral and dislocated, anteromedial TTO with a little distalization gets the patella safely inside the lateral convexity, raises the patella past the spur and unloads. Just rebuild the MPFC to further stabilize. Rarely need trochleoplasty

If the patella is unstable and tracks laterally or with a J, move it to be stable. Leave the trochlear cartilage alone

The new era of tibial tubercle transfer. Custom 3-D printed AMTTO guides. Look for the Trivara guide

First description of the MQTFL in world literature-2013. I am deeply indebted to Miho Tanaka for combining her anatomic dissections with mine subsequently in order to provide a more detailed description of the anatomy (JBJS, 2016) and then popularizing MQTFL reconstruction

Just look at an AP view of a 3-D CT and you can see where the patella needs to go. Move the tibial tubercle to get I there, off of the flat or convex proximal trochlea. No need to excavate (deepening trochleoplasty) preserve the joint

Flat proximal trochlea. 3D shows us the path. No excavation, just move the patella to where it needs to be for easy access to the trochlea- joint preservation

I’ve received images of seven failed trochleoplasties over the last few years, yet I haven’t seen an article on this topic. As I don’t do femoral trochleoplasties myself, other than proximal spur resections, I’d love to see images or comments on this topic. Attach in comments?

Contrary to rumor, I am not retired, but doing less surgery- now focussed on 3D custom TTO guides at Yale Orthopedics.

Precision over presumption—why "patellofemoral syndrome" is not an adequate diagnosis aofoundation.org/who-we-are/…

Tibial tubercle transfer yields joint preservation in patella instability patients

So much better and easier patellofemoral.org/precision…

No guess work here. With 3D you see it all. Lateral entry to trochlea- just move the tibial tubercle to facilitate patella entry in a stable way. No need to alter the beautiful and congruous trochlea. Knee locked in extension- reliable TTTG, fixed proximal EPTP Easy with 3D plan

TTTNT=Tibial tubercle transfer no trochleoplasty Or: move to it, don’t groove it. Joint preservation always

Save this dysplastic flat proximal trochlea of a recurrent patella dislocator. Just move the patella closer to the groove. Simple and joint preserving. Tried and true. No trochleoplasty needed

Move it to the groove. Joint preservation stabilization

Move it to the groove. No trochleoplasty

Move it to the groove. Joint preservation stabilization. No trochleoplasty

No trochleoplasty needed. Just move the patella so it becomes permanently stable

Why does deepening trochleoplasty lead to arthritis?—Subchondral bone stiffening (Radin)