2017 ISAKOS Biennial Congress Paper #73

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

Hong Chen, MD, PhD, Kunming, Yun Nan CHINA
Daohong Zhao, MD, Kunming CHINA
Jun Zhang, MD, Kunming, Yunnan Province CHINA
Qi Hui Duan, MD, Kunming, Yun Nan CHINA

The First people’s Hospital of Kunming,China , Kunming, Yun Nan, CHINA

FDA Status Cleared

Summary

The modified procedure of tibial tubercle transfer, especially internal rotation is an effective surgical procedure for the treatment of habitual patellar dislocation associated with high-grade trochlear dysplasia without trochleoplasty, which can improve the patella stability and knee function. Clinical effect is good.

Abstract

25 patients (7 males and 18females) were included from April 2007 to October 2013, with a mean age of 21.5 years (from 17 to 28 years), 21 cases of unilateral dislocation, and 4 cases of bilateral dislocation. The tibial tuberosity transfer procedure (internal rotation, medial transfer and elevation osteotomy) and the medial patellofemoral ligament (MPFL) reconstruction were performed in all cases of habitual patellar dislocation who were accompanied with trochlea dysplasia.Mean follow-up was 36.8months(range, 25- 68months).CT scan was performed to compare tibial of tuberosity–trochlear groove distance (TT-TG) ,patellar tilt angle (PTA), the mean Kujala and Lysholm score before surgery and at follow-up, and measure angle of internal rotation of tibial tubercle after surgery. The mean Kujala and Lysholm score improved significantly (P<0.05) from 55.65± 6.10 and 50.34 ± 6.54 preoperatively to 89.24 ± 4.66 and 88.53±4.75 at follow-up. Tibial tuberosity–trochlear groove distance (TT-TG) decreased significantly (P< 0.05) from 20.24± 2.80 mm to 10.50± 4.50mm, and patellar tilt angle (PTA) decreased significantly (P<0.05) from 28.58±3.28 to7.54±5.56. No recurrence was observed, only one patient had mild skin infection after surgery. The mean angle of internal rotation of tibial tubercle was 10±4° after surgery. There was no case of stiffness.