The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia

BMC Musculoskeletal Disorders

Research Article

Jun Zhang¹  Daohong Zhao¹  Zhidan Wu¹  Jingming Xie¹  Qihui Duan²  Hong Chen²  Jia Jiang³ 

[1] Orthopaedic Department, the Second Affiliated Hospital of Kun Ming Medical University, Dian Mian Road 374, Kunming, China;Sports Medicine Department, the First People Hospital of Kun Ming City, Kunming, China;Sports MedicineDepartment, Huashan Hospital, Fudan University, Shanghai, China;

关键词: Tibial Tubercle;    Patellar Dislocation;    Patellofemoral Joint;    Trochlear Dysplasia;    Medial Patellofemoral Ligament;   

DOI  :  10.1186/s12891-017-1417-4

 received in 2016-05-01, accepted in 2017-01-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundHabitual patellar dislocation is not common in clinical practice, but it has a deep impact on the patient's lifestyle and movement. There has been no large case-control study on habitual patellar dislocation, and the management of it is still controversial.The aim of this study was to observe the efficacy of the modified Fulkerson procedure on patients with habitual patellar dislocation with high-grade trochlear dysplasia without trochleoplasty and to evaluate the results of this procedure.MethodsA total of 25 patients who were admitted to our hospital from April 2007 to October 2013 were included: 7 males and 18 females, aged 17–28 years old, with an average age of 21.5 years old, including 21 cases of unilateral dislocation and 4 cases of bilateral dislocation. The tibial tuberosity transfer procedure (internal rotation, medial transfer and elevation osteotomy) and medial patellofemoral ligament (MPFL) reconstruction were performed in all cases of habitual patellar dislocation that were accompanied by trochlea dysplasia.ResultsThe mean follow-up duration was 36.8 months (range, 25–68 months). A CT scan was performed to compare the tibial tuberosity–trochlear groove distance (TT-TG), the patellar tilt angle (PTA), and the mean Kujala and Lysholm scores before surgery and at follow-up and to measure the angle of internal rotation of the tibial tubercle after surgery. The mean Kujala and Lysholm scores improved significantly (P < 0.05) from 55.65 ± 6.10 and 50.34 ± 6.54 preoperatively to89.24 ± 4.66 and 88.53 ± 4.75, respectively, at follow-up. The tibial tuberosity–trochlear groove distance (TT-TG) decreased significantly (P < 0.05) from 20.24 ± 2.80 mm to 10.50 ± 4.50 mm, and the patellar tilt angle (PTA) decreased significantly (P < 0.05) from28.58 ± 3.28to7.54 ± 5.56. No recurrence was observed, and only one patient had a mild skin infection after surgery. The mean angle of internal rotation of the tibial tubercle was 10 ± 4° after surgery. There were no cases of stiffness.ConclusionsThe modified procedure of tibial tubercle transfer, especially the internal rotation, which can improve the patella stability and knee function, is an effective surgical procedure for the treatment of habitual patellar dislocation associated with high-grade trochlear dysplasia without trochleoplasty.Level of evidenceIII

【 授权许可】

CC BY   
© The Author(s). 2017