Tibial tubercle osteotomy.

During primary and revision TKA, difficulties with exposure may be due to poor motion, obesity, and patellar baja. To gain accurate component positioning and avoid catastrophic complications with the extensor mechanism, a stepwise approach to optimizing the exposure should be used. In cases where the standard medial parapatellar arthrotomy is inadequate, a quadriceps snip is helpful. Occasionally, exposure will still be limited and in these cases, a tibial tubercle osteotomy can be used following the quadriceps snip. The tubercle osteotomy consistently heals postoperatively and results in less extensor lag than the V-Y quadricepsplasty. To minimize postoperative complications, strict attention to the operative technique should be maintained.