Patellonfemoral Disorders Treated by Distal Realignment

王清貞(Ching-Jen Wang) ； 陳良美(Liang-Mei Chen) ； 陳漢祥(Han-Hsian Chen)

《Journal of Orthopaedic Surgery Taiwan》 16卷1期 (1999/03) Pp. 61-68

並列摘要

We retrospectively reviewed the results of Fulkerson’s distal realignment for patellofemoral disorders in 35 knees in 30 ptients with a mean follow-up of 40 months (12-72). This included 27 females and 3 males. The average age at surgery was 34 (16 to 52). Our indications for surgery included patients with patellofemoral disorders associated with patellofemoral malalignment with increased Q angle, patellar instability and patellofemoral arthrosis that did not respond to conservative treatments for at least 3 months. In most cases, 1.0 cm medial transfer and 1.0 cm to 1.5cm anterior transfer of the tibial tuberosity were performed to correct the patellofemoral malalignment with increased Q angle, and to decrease the patellofemoral pressure. Rigid internal fixation of the tibial tuberosity with three cortical screws allowed patients early weight bearj-ing, early knee motion and accelerated rehabilitation.
With our patient selection criteria, there were 91.4% good-to-excellent sub-jective satisfactory results, and 85.7% good-to-excellent objective satisfactory results in our series. There was no skin complication encountered with anterior transfer of tibial tuberosity of 1.5cm or less in our series. The reoperation rate was 26%, however, two third of the reoperations were for removal of screws which should improve with the application of screw countersink and flat head screw. We conclude that Fulkerson’s distal realignment procedure for patellofemoral disorders is a reliable surgical procedure and satisfactory out-come in 91% can be expected providing early knee motion and rehabilitation after surgery.