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The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia
BACKGROUND: Habitual 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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299790/ https://www.ncbi.nlm.nih.gov/pubmed/28178962 http://dx.doi.org/10.1186/s12891-017-1417-4 |
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author | Chen, Hong Zhao, Daohong Xie, Jingming Duan, Qihui Zhang, Jun Wu, Zhidan Jiang, Jia |
author_facet | Chen, Hong Zhao, Daohong Xie, Jingming Duan, Qihui Zhang, Jun Wu, Zhidan Jiang, Jia |
author_sort | Chen, Hong |
collection | PubMed |
description | BACKGROUND: Habitual 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: The 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 EVIDENCE: III |
format | Online Article Text |
id | pubmed-5299790 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52997902017-02-13 The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia Chen, Hong Zhao, Daohong Xie, Jingming Duan, Qihui Zhang, Jun Wu, Zhidan Jiang, Jia BMC Musculoskelet Disord Research Article BACKGROUND: Habitual 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: The 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 EVIDENCE: III BioMed Central 2017-02-08 /pmc/articles/PMC5299790/ /pubmed/28178962 http://dx.doi.org/10.1186/s12891-017-1417-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Chen, Hong Zhao, Daohong Xie, Jingming Duan, Qihui Zhang, Jun Wu, Zhidan Jiang, Jia The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
title | The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
title_full | The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
title_fullStr | The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
title_full_unstemmed | The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
title_short | The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
title_sort | outcomes of the modified fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299790/ https://www.ncbi.nlm.nih.gov/pubmed/28178962 http://dx.doi.org/10.1186/s12891-017-1417-4 |
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