Patellofemoral instability is a common cause of anterior knee pain. Acute traumatic lateral dislocation is commonly associated with an injury of the medial patellofemoral ligament (MPFL) – the structure that is used to stabilize the kneecap (patella) with recurrent kneecap instability. However, patients who demonstrate lateralization of the tibial tubercle with increased tibial tubercle to trochlear groove (TT-TG) distance, often display chronic instability even following an MPFL reconstruction. In these cases, our preferred technique is to perform a tibial tubercle osteotomy to reestablish the aligment of the patellofemoral joint and reconstruct the MPFL. For those that have not had surgery with recurrent patellar instability and who demonstrate increased angle (Q-angle) and increased TT-TG distance, we prefer a tibial tubercle osteotomy with a MPFL reconstruction. Also known as a Fulkerson osteotomy, this is Dr. Provencher’s preferred method for anteromedialization and treatment of chronic patellar instability.