Fulkerson's Modified Elmslie-Trillat Procedure for Objective Patellar Instability and Patellofemoral Pain Syndrome

Rillmann, P.; Oswald, A.; Holzach, P; Ryf, Christian

doi:10.1024/1023-9332.6.6.328

Cited by 9 publications

(8 citation statements)

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“…Rillman et al [128] have proposed a Fulkerson's modified Elmslie-Trillat procedure for objective patellar instability and patellofemoral pain syndrome. Based on their results authors have concluded that the operation is an excellent treatment method with a very low morbidity for patients with patellofemoral malalignment after failed conservative treatment.…”

Section: Distal Realignment Proceduresmentioning

confidence: 99%

The Operative Management of Patella Malalignment

Iliadis¹,

Jaiswal²,

Khan³

et al. 2012

TOORTHJ

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Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment.Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness.A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.

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Section: Distal Realignment Proceduresmentioning

confidence: 99%

The Operative Management of Patella Malalignment

Iliadis¹,

Jaiswal²,

Khan³

et al. 2012

TOORTHJ

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“…Some prior studies 4, 34, 47 observed excellent patient reported outcomes following TT osteotomy for individuals with intractable PFP and no history of patellar dislocation. However, other studies 24, 30 reported only fair results in this population with a less favorable prognosis compared to individuals with a history of patellar dislocation.…”

Section: Discussionmentioning

confidence: 91%

“…Currently, no recommendation exists for the TT-TG distance that should prompt consideration for TT osteotomy in patients with intractable PFP; yet, this surgical procedure is frequently performed after failed nonoperative treatment. 4,16,18,19,24,34,47 Prior studies 3,8,46 assigned a pathological threshold of 15 mm for TT-TG distances when measured using MRI for patients with a history of patellar dislocations. This value is approximately 1.5 SDs above the observed control mean, and 30% of knees with isolated PFP demonstrated TT-TG distances at or above this value.…”

Section: Discussionmentioning

confidence: 99%

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The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

et al. 2017

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Background The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear. Purpose To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 50 knees (38 patients) with PFP and 60 knees (56 controls) without PFP formed the basis of this study. Magnetic resonance imaging was used to determine the TT-TG distance from 3-dimensional static scans. Results The cohort with PFP demonstrated a significantly greater mean TT-TG distance, relative to asymptomatic controls (13.0 vs 10.8 mm, respectively; P = 0.001). Among the cohort with PFP, 15 knees (30%) demonstrated TT-TG distances ≥15 mm, and 3 knees (6%) demonstrated TT-TG distances ≥ 20 mm. Conclusion Most adult patients with isolated PFP have elevated TT-TG distances compared with controls, which likely contributes to the force imbalance surrounding the knee..

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“…17, 20, 26 Using the static distance between the TT and the trochlear groove (TT-TG) for pre-operative screening, TT osteotomy has been shown to yield excellent results for patients with a history of patellar dislocation. 46 While some studies 18, 24, 35, 46 investigating TT osteotomy for patients with intractable PFP, without a history of patellar dislocation, have also observed positive outcomes, other studies 12, 30, 37 have reported medial patellar instability, surgical failure, and a less favorable prognosis compared to cohorts with a history of patellar dislocation.…”

Section: Introductionmentioning

confidence: 99%

The Relationship of Static Tibial Tubercle–Trochlear Groove Measurement and Dynamic Patellar Tracking

et al. 2017

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Background The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension. Yet, the predictive ability of this measure for dynamic patellar tracking patterns is unknown. Purpose The aim of this study is to determine if the static TT-TG distance can predict dynamic lateral displacement of the patella. Study Design Case control Methods The static TT-TG distance was measured at full extension for 70 skeletally mature subjects with (n=32) and without (n=38) patellofemoral pain. The dynamic patellar tracking patterns were assessed from approximately 45° to 0° of knee flexion using dynamic cine-phase contrast magnetic resonance imaging. For each subject the value of dynamic lateral tracking corresponding to the exact knee angle measured in the static images for that subject was identified. Linear regression analysis determined the predictive ability of static TT-TG distance for dynamic patellar lateral displacement for each cohort. Results The static TT-TG distance measured with the knee in full extension cannot accurately predict dynamic lateral displacement of the patella. There was weak predictive ability among subjects with patellofemoral pain (r2=0.18, p=0.02) and no predictive capability among controls. Among subjects with patellofemoral pain and static TT-TG distances ≥15 mm, 8/13 (62%) demonstrated neutral or medial patellar tracking patterns. Conclusions The static TT-TG distance cannot accurately predict dynamic lateral displacement of the patella. A large percentage of patients with patellofemoral pain and pathologically large TT-TG distances may have neutral to medial maltracking patterns.

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Fulkerson's Modified Elmslie-Trillat Procedure for Objective Patellar Instability and Patellofemoral Pain Syndrome

Cited by 9 publications

References 0 publications

The Operative Management of Patella Malalignment

The Operative Management of Patella Malalignment

The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

The Relationship of Static Tibial Tubercle–Trochlear Groove Measurement and Dynamic Patellar Tracking

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