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The aim of this research would be to report the problem prices straight linked to the surgical technique of a V-shaped TTO, where tubercle is completely released from the periosteum using a step-cut osteotomy. METHODS The retrospective case series comprised a large cohort of 263 knees with patella alta in 203 patients which underwent a V-shaped TTO, with or without additional realignment treatments, between March 2004 and October 2017. Information had been obtained from readil