Distal realignment can be used with or without proximal stabilization in cases of patellofemoral instability, cartilage lesions of the lateral and distal patellofemoral joint, or cases of lateral patellofemoral overload or tilt. Anteromedialization of the tibial tubercle allows for multiplanar adjustments while providing a long, flat osteotomy that optimizes bone healing and screw placement. In cases of patella alta, distalization can be incorporated during the osteotomy.