Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori, 036-8562, Japan.
Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):2062-70. doi: 10.1007/s00167-011-1832-2. Epub 2011 Dec 28.
Excellent results of anteromedialization of the tibial tuberosity for recurrent patellar dislocation have been reported; however, the contribution of the preoperative anatomic factors to postoperative patellar instability has not been well established. The purpose of this study was to investigate the mid-term results and the incidence of postoperative patellar instability after Fulkerson procedure for recurrent patella dislocation, and to determine the radiologic predictor of the postoperative patellar instability.
Sixty-two knees of 41 patients underwent Fulkerson procedure with or without lateral retinacular release for recurrent patellar dislocation and were followed-up for 85-155 months. Predisposing anatomic factors for recurrent patellar dislocation were evaluated preoperatively, including valgus knee alignment (femorotibial angle), patella alta (Insall-Salvati ratio), trochlear dysplasia (trochlear depth), lateral patellar displacement (congruence angle) and lateral malposition of the tibial tuberosity (tibial tuberosity-trochlear groove distance). The relationship between the measurements of anatomic factors and postoperative patellar instability, which was defined by the patellar re-dislocation or residual apprehension after surgery, was analyzed.
The Fulkerson score and the Kujala score were significantly improved from the median of 65 (35-80) points and 68 (36-82) points preoperatively to 95 (60-100) points and 92 (57-100) points at the final follow-up, respectively. Three knees (4.8%) experienced postoperative patellar re-dislocation and 4 knees (6.5%) showed the positive apprehension sign at the final follow-up. The statistical analysis showed that the postoperative patellar instability correlated with only patella alta.
Patella alta was the only predictor of postoperative patellar instability after Fulkerson procedure. These results indicated that isolated Fulkerson procedure should not be indicated for recurrent patellar dislocation with severe patella alta.
Case-control study, Level III.
前内侧胫骨结节移位术治疗复发性髌骨脱位效果极佳，但术前解剖因素对术后髌骨不稳定的影响尚未得到充分证实。本研究旨在探讨 Fulkerson 手术治疗复发性髌骨脱位的中期结果和术后髌骨不稳定的发生率，并确定术后髌骨不稳定的影像学预测指标。
41 例患者的 62 膝因复发性髌骨脱位行 Fulkerson 手术（伴或不伴外侧支持带松解），随访 85-155 个月。术前评估复发性髌骨脱位的易患解剖因素，包括膝外翻（股胫角）、髌骨高位（Insall-Salvati 比）、滑车发育不良（滑车深度）、外侧髌骨移位（髌骨吻合角）和胫骨结节外侧位置异常（胫骨结节-滑车沟距离）。分析解剖因素测量值与术后髌骨不稳定（定义为术后髌骨再脱位或残留髌骨恐惧征）的关系。
Fulkerson 评分和 Kujala 评分分别从术前中位数 65（35-80）分和 68（36-82）分显著改善至末次随访时的 95（60-100）分和 92（57-100）分。3 膝（4.8%）术后发生髌骨再脱位，4 膝（6.5%）末次随访出现髌骨恐惧征阳性。统计学分析显示，术后髌骨不稳定仅与髌骨高位相关。
髌骨高位是 Fulkerson 手术后髌骨不稳定的唯一预测指标。这些结果表明，对于伴有严重髌骨高位的复发性髌骨脱位，单纯 Fulkerson 手术不应作为首选。
病例对照研究，III 级。
