Among the patellofemoral joint patologies, instability, cartilage damages and arthrosis are frequently observed. Tibial tubercle osteotomy (TTO) is a very effective surgical technique in the treatment of these pathologies that have not responded to conservative treatment. Tibial tubercle osteotomy can be combined with soft tissue procedures or cartilage repair techniques. Many TTO techniques have been defined in the historical process. Choosing the appropriate TTO is the most important step in the success of the treatment. For this reason, it is very important to fully understand the complex biomechanics of the patellofemoral joint. With appropriate TTO method and a proper surgical technique, TTO is an effective surgical technique in both patellofemoral instability and patellofemoral joint arthrosis.