Sherman SL, et al. - Researchers intended to optimize patellofemoral cartilage restoration and instability with tibial tubercle osteotomy (TTO, a procedure that may be utilized to address a wide array of patellofemoral joint pathology). Patellar instability, including either a lateralized force vector or abnormal patellar alta and patellar focal cartilage defects or chondromalacia, were the most prevalent indications for TTO. By modifying patellar tracking in the trochlear groove and/or changing the contact pressures endured by the patellofemoral cartilage, customization of the TTO could efficiently address the patellofemoral joint pathology. When done in conjunction with soft-tissue stabilization and/or biological augmentation of chondral injuries, TTO could be most auspicious. Especially, isolated anteromedialization was suggested for focal, distal lateral patellar lesions, combined anteromedialization and cartilage restoration for medial, central, and/or panpatellar cartilage pathology, medialization with soft-tissue stabilization for a lateralized tubercle position and distalization with soft-tissue stabilization for patella alta. When a TTO was performed for patellar instability, clinical studies demonstrated good to outstanding results at long-term follow-up, whereas TTO performed for chondral defects exhibited good to outstanding outcomes that corresponded strongly with the size and location of the chondral defect. Therefore, TTO is a helpful tool for the treatment of patellofemoral joint pathology with a relevant patient selection.