Keltz Eran, Ofir Dror, Beer Yiftah, Gruber Naama, Falah Mezen, Nierenberg Gabriel
Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel.
The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Rambam Maimonides Med J. 2022 Apr 26;13(2):e0010. doi: 10.5041/RMMJ.10465.
Patellar instability comprises a group of pathologies that allow the patella to move out of its trajectory within the trochlear groove during walking. Symptomatic patients who need surgery commonly undergo soft tissue procedures such as medial patellofemoral ligament repair to strengthen the ligaments that hold the patella in place. However, soft-tissue repairs may be insufficient in patients suffering from patellar maltracking, which is characterized by an unbalanced gliding of the patella within its route. In these patients, a different approach is advised. We aim to provide the mid-term clinical outcomes of the Fulkerson distal realignment operation in selected patients with non-traumatic patellar maltracking.
The clinical outcomes of the Fulkerson distal realignment operation performed in 22 knees of 21 patients were evaluated by a self-administered subjective International Knee Documentation Committee (IKDC) score and the Tegner-Lysholm knee scoring scale.
Before surgery, the median IKDC score was 52, and the median Tegner-Lysholm score was 56. Following surgery (mean follow-up 48 months, range 24-156), the median IKDC and the Tegner-Lysholm scores were 67 and 88, respectively. The improvement was statistically significant (P=0.001 and P=0.002 for IKDC and Tegner-Lysholm scores, respectively). Associated procedures included patella microfracture due to grade III-IV cartilage lesion (International Cartilage Repair Society grading system) in four patients, retinacular releases in three patients, medial capsular augmentations in two patients, and medial patellofemoral ligament reconstruction in two patients. One patient with Ehlers-Danlos disease required excessive medialization of the tibial tuberosity. Surgery-related complications occurred in three patients.
Surgical correction of patellar maltracking with Fulkerson distal realignment combined with associated procedures in individual patients was associated with an increase in subjective and functional clinical scores at medium-term follow-up. Particular attention should address pathologies associated with patellar maltracking and managed accordingly.
4c (case series).
髌股关节不稳定是一组病变，可使髌骨在行走时移出滑车沟轨迹。有症状且需要手术的患者通常接受软组织手术，如内侧髌股韧带修复，以加强固定髌骨的韧带。然而，对于存在髌股关节轨迹不良的患者，软组织修复可能并不充分，其特征是髌骨在其路径内滑动不平衡。对于这些患者，建议采用不同的方法。我们旨在提供Fulkerson远端重排手术在选定的非创伤性髌股关节轨迹不良患者中的中期临床结果。
采用国际膝关节文献委员会（IKDC）自评主观评分和Tegner-Lysholm膝关节评分量表，对21例患者的22个膝关节进行Fulkerson远端重排手术的临床结果进行评估。
术前，IKDC评分中位数为52分，Tegner-Lysholm评分中位数为56分。术后（平均随访48个月，范围24 - 156个月），IKDC和Tegner-Lysholm评分中位数分别为67分和88分。改善具有统计学意义（IKDC和Tegner-Lysholm评分的P值分别为0.001和0.002）。相关手术包括4例因III - IV级软骨损伤（国际软骨修复协会分级系统）行髌骨微骨折，3例行支持带松解，2例行内侧关节囊增强，2例行内侧髌股韧带重建。1例患有埃勒斯-当洛综合征的患者需要过度内移胫骨结节。3例患者出现手术相关并发症。
在个体患者中，采用Fulkerson远端重排联合相关手术对髌股关节轨迹不良进行手术矫正，在中期随访时可提高主观和功能临床评分。应特别关注与髌股关节轨迹不良相关的病变并相应处理。
4c（病例系列）。
