Anteromedialization of the tibial tubercle (Fulkerson operation) predictably leads to pain reduction and better function in initial and moderate patellofemoral arthritis. This has been shown in the literature and is supported by our own results. The indication is based on symptoms, clinical evaluation, X-rays, and MRI. The Fulkerson operation combines recentering of the patella and reduction of patellofemoral pressure. Aftertreatment together with rehabilitation last for 6-8 months because anteromedialization leads to temporary destabilization of the proximal tibia. Proximal tibial fracture is a complication of Fulkerson operation if the tibia is stressed too early.