The modified tibial tubercle osteotomy for anterior knee pain due to chondromalacia patellae in adults

Abstract

ObjectivesTo assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae.MethodsA total of 47 consecutive patients (51 knees) with arthroscopically proven chondromalacia, who had failed conservative management, underwent a modified Fulkerson tibial tubercle osteotomy. The mean age was 34.4 years (19.6 to 52.2). Pre-operatively, none of the patients exhibited signs of patellar maltracking or instability in association with their anterior knee pain. The minimum follow-up for the study was five years (mean 72.6 months (62 to 118)), with only one patient lost to follow-up.ResultsA total of 50 knees were reviewed. At final follow-up, the Kujala knee score improved from 39.2 (12 to 63) pre-operatively to 57.7 (16 to 89) post-operatively (p < 0.001). The visual analogue pain score improved from 7.8 (4 to 10) pre-operatively to 5.0 (0 to 10) post-operatively. Overall patient satisfaction with good or excellent results was 72%. Patients with the lowest pre-operative Kujala score benefitted the most. Older patients benefited less than younger ones. The outcome was independent of the grade of chondromalacia. Six patients required screw removal. There were no major complications.ConclusionsWe conclude that this modification of the Fulkerson procedure is a safe and useful operation to treat anterior knee pain in well aligned patellofemoral joints due to chondromalacia patellae in adults, when conservative measures have failed.

Arthroscopic deepening trochleoplasty for chronic anterior knee pain after previous failed conservative and arthroscopic treatment. Report of two cases

“…Nevertheless those procedures are not correcting the underlying pathomorphology. In respect to a modified version of the Fulkerson osteotomy, Jack et al, in a 5 year follow-up of patients with chronic AKP, found that the Kujala score went from 39.2 to 57.7 and with a success rate of 72% [38] . Patients with lowest Kujala score and younger patients benefitted the most.…”

Complications in Patellofemoral Instability Surgery

“…Fulkerson 23 noted in his series that 1 out of 51 cases sustained a late fracture through the screw site in the tuberosity shingle and was successfully treated with reoperation and bone grafting of the fracture site. Jack et al 31 reported in their study that a patient sustained a nondisplaced fracture through the proximal screw hole after falling. This was successfully treated nonoperatively.…”

“…Wound complications including skin necrosis have been reported after the Maquet procedure 38,39 but have not been commonly reported after anteromedializing osteotomies. Jack et al 31 reported in a study of 51 knees that only 1 patient had a superficial infection that was treated with antibiotics and resolved within 2 weeks. Arthrofibrosis had also been reported in early studies after TTO 23 ; however, recent larger series have not reported this as a complication after this procedure.…”

“…Arthrofibrosis had also been reported in early studies after TTO 23 ; however, recent larger series have not reported this as a complication after this procedure. 31,36 Trochleoplasty Trochleoplasty was initially popularized in Europe as a method of addressing trochlear dysplasia in the treatment of patellar instability. Because it is often performed in conjunction with other stabilization procedures, the complications of this procedure are difficult to isolate.…”

The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review

“…The surgical treatment of AKP is not discussed in the literature with the same quality of studies as has been demonstrated for the conservative treatments [4][5][6]. Generally there are few randomised controlled trials (RCTs), and those that have been conducted have failed to prove that surgical therapy is more effective than nonsurgical treatments [7].…”