The Outcomes of Modified Fulkerson Osteotomy Procedure to Treat Habitual Patellar Dislocation Associated with High-Grade Trochlear Dysplasia

Chen, Hong; Zhao, Daqing; Zhang, Jun; Duan, Qi Hui

doi:10.1016/j.arthro.2017.08.062

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…AMZ of the TTO is a common treatment option for several patellofemoral joint disorders including chondromalacia, patellofemoral arthritis, and patellar instability. It is effective in severe cases of patella instability, such as excessive lateralized tibial tuberosity, trochlear dysplasia, preoperative OA change, and habitual patellar dislocation [20,[31][32][33]. AMZ of the TTO can modify tracking and/or patellofemoral contact forces to affect the unloading of chondral defects of the patella or trochlea, correct multiplanar suboptimal alignment, or be used in conjunction with soft-tissue stabilization procedures for instability [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: A retrospective cohort study

Hashimoto¹,

Nishino²,

Tomihara

et al. 2022

Preprint

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Background In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. Methods Between 2009 and 2020, 30 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR + AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. Results Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR + AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. Conclusion Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.

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Section: Discussionmentioning

confidence: 99%

The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: A retrospective cohort study

Hashimoto¹,

Nishino²,

Tomihara

et al. 2022

Preprint

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show abstract

“…Lateralizing force vectors such as an increased TT-TG (> 20 mm) and increased Q angle can be addressed with patella tendon-modifying procedures in skeletally immature patients, similar to tibial tubercle osteotomies (TTO) in skeletally mature patients [24]. The goal of correction is to achieve an approximately normal TT-TG distance of 10-15 mm [33]. In skeletally immature patients, standard TTOs such as the Trillat, Maquet, and Fulkerson are not suitable because of the risk to the proximal tibial physis and tibial tubercle apophysis.…”

Section: Osseous Deformity Correction: Guided Growth or Osteotomymentioning

confidence: 99%

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Vellios

Trivellas

Arshi

et al. 2020

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery. Recent Findings Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity). Summary PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.

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“…[52] The success rates for the AMZ have been reported to range from 86 to 97%, but the indications for surgery are not isolated to PFJI. [53][54][55][56][57] TTO is often used only for distalization of the patella (X53) to address instability without altering TT:TG. It is also important to note that trochleoplasty can also allow for proximal realignment and correct for 10 mm of distalization and 4 mm of medialization [9] so offers a more anatomical approach to correcting such abnormalities.…”

Section: Tibial Tubercle Osteotomy (Tto)mentioning

confidence: 99%

Recent advances and future trends in patellofemoral instability

Anand

Kambhampati³

2020

JASSM

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Patellofemoral joint instability (PFJI) is a challenging condition affecting primarily young patients. It can be both physically and mentally disabling. There are numerous factors which contribute to stability of the patellofemoral joint and thorough clinical assessment and appropriate radiological investigations are essential in determining which risk factors need to be corrected to prevent further episodes of dislocation. One of the key operations utilized in the management of PFJI is medial patellofemoral ligament (MPFL) reconstruction, to restore the patellar restraint against lateral translation. The complications that can result from MPFL reconstruction can be largely divided into complications resulting from technical error or selection of operation for a patient’s specific risk factors. Some risk factors of PFJI can precipitate the need for additional operations being performed alongside MPFL reconstruction, including trochleoplasty, lateral retinacular lengthening, and tibial tuberosity osteotomy. Failure to identify the need for concurrent operations will result in persistent PFJI. This update article will outline the approach to assess a patient presenting with PFJI and the risk factors which should be identified and corrected. It will also cover the various management options with respect to these factors, with some important considerations for each.

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The Outcomes of Modified Fulkerson Osteotomy Procedure to Treat Habitual Patellar Dislocation Associated with High-Grade Trochlear Dysplasia

Cited by 7 publications

References 14 publications

The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: A retrospective cohort study

The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: A retrospective cohort study

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

Recent advances and future trends in patellofemoral instability

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