Heatley modified Fulkerson osteotomy for the treatment of patellar femoral pain. A case series
DOI:
https://doi.org/10.1016/j.rccot.2020.07.011Keywords:
Chondromalacia patellae, Patellofemoral joint, Patellofemoral pain syndrome, Patellofemoral painAbstract
Background: Patellofemoral pain syndrome (PFPS) is a possible cause of anterior knee pain that predominantly affects young women. To date, there is no consensus regarding the aetiology, but the evidence suggests that patellofemoral misalignment probably plays a role in the pathogenesis of pain and particularly in chondromalacia. Osteotomies classically used and described in the literature report variable functional results. As the good results described in the literature are in a range between 50%-80%, this indicates some difficulty with the reproducibility of the technique, or its effectiveness, we wish to evaluate the results of a different technique.
Materials and Methods: Prospective case series study of patients with patellofemoral pain syndrome treated with a new osteotomy technique of the anterior tibial tuberosity, anteriormedialized, in V.
Results: A total of 19 knees were evaluated. The mean pain intensity was 9 in the preoperative period, and 4 and 3 in the follow-up at three and six months, respectively. A mean of 33 points on the Kujala scale was obtained in the pre-operative period, and 75 at 3 months and 87 at six months follow-up.
Discussion: A percentage of 94.7% was considered good or excellent results, and 5% of considered as bad. The technique described and used in our study presents a rate of good results similar to those described in the literature with other surgical techniques and with different functional scales.
Level of evidence: IV.
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References
Petersen W, Ellermann A, Gösele-Koppenburg A, et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014;22:2264-74, http://dx.doi.org/10.1007/s00167-013-2759-6.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159-63.
Bolgla LA, Boling MC. An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther. 2011;6:112-25.
MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR. Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am. 2006;88:2596-605.
Baldon Rde M, Nakagawa TH, Muniz TB, Amorim CF, Maciel CD, Serrão FV. Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train. 2009;44:490-6.
Farr J, Schepsis A, Cole B, Fulkerson J, Lewis P. Anteromedialization: review and technique. J Knee Surg. 2007;20:120-8.
Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res. 1983:176-81.
Fulkerson JP. Patellofemoral Pain Disorders: Evaluation and Management. J Am Acad Orthop Surg. 1994;2:124-32.
Fulkerson JP, Becker GJ, Meaney JA, Miranda M, Folcik MA. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med. 1990;18:490-7.
Siegel M. The Maquet osteotomy: a review of risks. Orthopedics. 1987;10:1073-8.
Jack CM, Rajaratnam SS, Khan HO, Keast-Butler O, Butler- Manuel PA, Heatley FW. The modified tibial tubercle osteotomy for anterior knee pain due to chondromalacia patellae in adults: A five-year prospective study. Bone Joint Res. 2012;1:167-73.
Martínez JP, Arango AS, Castro AM, Piña AM, Martínez-Rondanelli A. Validación de la Escala de Kujala para dolor patelofemoral en su versión en español. Rev CES Medicina. 2017;31:47-57.
Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med. 1997;25:533-7.
Buuck D, Fulkerson J. Anteromedialization of the tibial tubercle: a 4-12 year follow up. Operative Techniques in Sports Medicine. 2000;8:131-7.
Bellemans J, Cauwenberghs F, Witvrouw E, Brys P, Victor J. Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sports Med. 1997;25:375-81.