Background: Surgical treatment options in severe patellofemoral arthritis secondary to patellofemoral malalignment are limited. The majority of the surgical procedures include distal patellar realignment through different types of tibial tuberosity osteotomies. The aim of the study was to evaluate the functionality and pain in a cohort of patients with patellofemoral arthritis secondary to patellofemoral malalignment treated by Fulkerson osteotomy plus tricortical bone graft.Material and methods: A retrospective cohort study was conducted on patients with severe patellofemoral arthritis secondary to patellofemoral malalignment treated by Fulkerson osteotomy plus tricortical bone graft between 2001 and 2011. The results were evaluated using the Lysholm scale modified by Fulkerson, and the VAS (Visual Analogue Scale) score. The mean follow-up was 44.0±26.8 months (range, 2-11.9 years).Results: A total of 38 patients (45 knees, 7 bilateral) were treated using the technique described, of whom 35 (92.1%) were female. The mean age was 44.7±10.9 (23-62) years. All of the patients showed an improvement in the VAS score. The results of the functional scales gave 93.3% excellent and good results. No deterioration or major complications were reported during follow-up.Discussion: Fulkerson osteotomy plus tricortical bone graft is a suitable treatment for patellofemoral arthritis due to patellofemoral malalignment, as it improves functionality and decreases pain in the short term.