Patellofemoral Instability in Athletes: Treatment via Modified Fulkerson Osteotomy and Lateral Release | oneedsvoice

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Patellofemoral Instability in Athletes: Treatment via Modified Fulkerson Osteotomy and Lateral Release

key information

source: American Journal of Sports Medicine

year: 2010

authors: Tjoumakaris FP, Forsythe B, Bradley JP

summary/abstract:

BACKGROUND:
Surgical treatment of patellofemoral instability can successfully diminish episodes of subluxation and dislocation, as well as symptoms of pain and instability.

HYPOTHESIS:
Surgical treatment of lateral patellar instability in a strictly athletic population will facilitate return to sports.

STUDY DESIGN:
Case series; Level of evidence, 4.

METHODS:
From 1999 to 2004, 41 Fulkerson osteotomies combined with an arthroscopic lateral release were performed in 34 athletes for patellofemoral instability. Three patients were lost to follow-up. All patients participated in sports at least 3 times per week in at least one sport for 4 months of the year. There were 4 male and 30 female patients; 7 patients underwent bilateral, staged procedures. There were 14 high school, 12 collegiate, and 8 recreational athletes. Results were obtained by an independent examiner.

RESULTS:
The mean age was 20.05 years (range, 14-54 years) with a mean follow-up of 46 months (range, 22-71 months). Patients averaged 1.3 dislocations before reconstruction (range, 0-6). The average Lysholm score was 91.8 (range, 67-100) at follow-up. The International Knee Documentation Committee (IKDC) scores were A (normal) in 27 knees, B (near normal) in 12, and C (abnormal) in 2. Seventeen patients had symptomatic hardware removed at an average of 8 months. There were 2 complications: one saphenous neuroma that resolved, and one recurrent dislocation in a patient later diagnosed with Ehlers-Danlos syndrome.

CONCLUSION:
This series is the largest to date documenting the successful treatment of patellofemoral instability in athletes with concomitant Fulkerson osteotomy and arthroscopic lateral release. Forty-nine percent of patients in our series required removal of screws from the osteotomy site.

organisation: Hospital of the University of Pennsylvania, Penn Sports Medicine

DOI: 10.1177/0363546509357682

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