Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Chen, Hong, Zhao, Daohong, Xie, Jingming, Duan, Qihui, Zhang, Jun, Wu, Zhidan, Jiang, Jia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
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
_version_ 1782506094522793984
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
work_keys_str_mv AT chenhong theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT zhaodaohong theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT xiejingming theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT duanqihui theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT zhangjun theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT wuzhidan theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT jiangjia theoutcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT chenhong outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT zhaodaohong outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT xiejingming outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT duanqihui outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT zhangjun outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT wuzhidan outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia
AT jiangjia outcomesofthemodifiedfulkersonosteotomyproceduretotreathabitualpatellardislocationassociatedwithhighgradetrochleardysplasia