Foot and Ankle
Mohammad Nouri; kavous vaziri; Morteza Jaannesari Ladani
Abstract
Background: The purpose of this study is to investigate the results of surgical treatment for hallux rigidus using the Weil osteotomy method in grade III patients with this disease.Methods: This quasi-experimental study involved a single-group intervention "before and after" the surgery. The research ...
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Background: The purpose of this study is to investigate the results of surgical treatment for hallux rigidus using the Weil osteotomy method in grade III patients with this disease.Methods: This quasi-experimental study involved a single-group intervention "before and after" the surgery. The research population consisted of patients with grade 3 hallux rigidus. The data collection tool used in this study was a checklist based on clinical examinations that evaluated joint movement in both plantar and lateral directions, as well as the Visual Analog Scale (VAS) to measure pain. The range of motion and pain level of the metatarsophalangeal (MTP) join were investigated and recorded before the operation and 1, 3, and 6 months after the operation. All this information was entered into SPSS software version 26.Results: The study groups included 8 (22.9%) male and 27 (77.1%) female patients, with an average age of 77.1 ± 12.17 years. The amount of pain decreased significantly (P=0.00) at the one-month and three-month follow-ups after the intervention, and the amount of passive movement of the joint in the plantar directions significantly increased from one month to three months after the intervention (P=0.00). 17 patients (48.6%) took up to two weeks after surgery, 10 patients (28.6%) between two to four weeks, and 8 patients (22.9%) more than one month to recover the mobility. The average joint space of the patients after the operation in plain radiography was 3.6 ± 0.46.Conclusion: : The Weil osteotomy surgery in hallux rigidus patients showed a significant decrease in pain level, and also a significant increase in joint motion and improvement in the average joint space in short term.
mohammad fakoor; s shahnam mousavi; Ali bahaari
Abstract
AbstractBackground: Medial open wedge high tibial osteotomy (MOWHTO) is effective for the treatment of medial compartment osteoarthritis of the knee. Several studies report that it produces patella baja and increases patellofemoral contact pressure in the patellofemoral joint. Pressure distribution due ...
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AbstractBackground: Medial open wedge high tibial osteotomy (MOWHTO) is effective for the treatment of medial compartment osteoarthritis of the knee. Several studies report that it produces patella baja and increases patellofemoral contact pressure in the patellofemoral joint. Pressure distribution due to underlying varus deformity has a major influence on the onset and development of osteoarthritis in the knee joint. This study is reporting on the effect of MOWHTO on patello-femoral joint.Methods: The present study was a retrospective case series study on the patients with symptomatic osteoarthritis of medial compartment of knee with varus deformity requiring correction, referring in a 2 year period to a teaching hospital. At the last follow-up, assessment of the patellar changes based on Insall and Blackburn indices, and mechanical axis deviation (MAD) measurements was done.Results: A total of 49 knees were recruited. 52.6% of patients were male. The mean age of patients was 26.55±5.876 years and the mean body mass index was 25.05±2.903 kg/m2. No knee needed revision surgery, no intra-articular fracture occured in any patient after surgery.The mean score of VAS[1] increased significantly after surgery (P <0.05). Patellar changes before and after surgery were not statistically significant based on radiographic indices. The mean pre-operative MAD of (−8.90° ± 3.07°) improved to (0.2° ± 2.780°) post-operative value.Conclusion: Based on the above results, proper correction in MAD was obtained and no significant change in patellofemoral joint biomechanics was seen.Keywords: Tibia, patellofemoral joint, Osteotomy, Biomechanics, mechanical axis
Mina Iravani, MSc; Farzam Farahmand, PhD; Soheil Mehdipour, MD
Abstract
Background: High tibial osteotomy (HTO) is a common surgical procedure for treatment of patients with varus malalignment. The success rate of the procedure is strongly dependent on the quality of correction. The purpose of this study was to simulate the HTO in a patient with varus deformity in order ...
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Background: High tibial osteotomy (HTO) is a common surgical procedure for treatment of patients with varus malalignment. The success rate of the procedure is strongly dependent on the quality of correction. The purpose of this study was to simulate the HTO in a patient with varus deformity in order to explore the interactions between the wedge angle, the mechanical axis, and the knee joint configuration.
Methods: A finite-element model of the knee joint of a patient with varus deformity was developed. The geometry was obtained using the whole limb CT scans and the knee MR images. The bones were assumed as rigid bodies, the articular cartilage and the meniscus as elastic solids, and the ligaments as nonlinear springs. A 600N force was applied at the femoral head in the line of the mechanical axis and the resulting knee configuration was investigated. The HTO was simulated by insertion of wedges with different angles beneath the tibial plateau and application of the resulting alteration of the loading axis in the model.
Results: The results indicated that the actual change of the mechanical axes was always smaller than was predicted by a geometric pre-planning approach that does not consider the effect of soft tissue on the post-operative configuration of the knee joint.
Conclusions: It was suggested that subject-specific models can improve the results of the HTO by simulating the operation before surgery and determining the optimal wedge angle that locates the mechanical axis in the middle of the knee.
Amirreza Sadeghifar, MD; Arash Akbari, MD; Mahmood Karimi Mobarakeh, MD
Abstract
Background: Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur, proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute ...
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Background: Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur, proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute to increase risk of osteoarthritis. The objective of this study was to find the correct location of deformity in genuevarum or genuevalgum.Methods: We studied 40 patients with knee deformity at a mean age of 27.4 years (19-38), prospectively. Standing 3-point view radiographs were obtained on each patient, and the limb axis was determined. The data on limb malalignment was analyzed statistically.Results: In 94.5% of cases the location of varus deformity was proximal of tibia and in 5.5% in distal of femur, the best location of osteotomy. Our study also revealed multiple factors contributing to varus deformity, i.e. distal femur in 67.5%of cases, proximal tibia deformity in 92.5% of cases and ligamentous laxity in 77.5%.Conclusions: Varus knee deformity can be from proximal tibia, distal femur or knee laxity. Before any corrective surgery one must clarify location of deformity
Mahmood Karimi Mobarakeh, MD; Mohsen Mardani-Kivi, MD; Ali Akbar Keikha, MD; Keyvan Hashemi-Motlagh, MD; Khashayar Saheb-Ekhtiari, MD
Abstract
Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy ...
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Background: One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique, the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL.Methods: In a prospective clinical trial, 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients, 40 knees) or without MCL release (29 patients, 36 knees). The outcome was studied comparing the stability in valgus, pattelar height slope of tibial plateau, and also the knee score (KSS) in a 17.4 months (3-24 months) follow-up.Results: The patients from MCL preserving group, with mean age of 26.7±9 improved their scores of 53.5±15.2 to 81.9±13.4. The cases from MCL-releasing group with mean age of 25.5±8.4 improved the score of 52.4±14.6 to 65.4+17.8. The rates of surgical complication and valgus instability were lower in MCL preserving ones, but tibial slope remained unchanged in either group.Conclusions: Both techniques lead to an improvement in the KSS score however it was more significant in MCL preserving group with lower complication and without valgus instability.
Soheil Mehdipour, MD; Farid Abbaszadeh, MSc; Morad Karimpour, PhD; Farzam Farahmand, PhD; Zahra Saghaie, MSc
Abstract
Background: Conventional X-rays, due to 2D viewing, may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space and to built patient-specific guide to achieve the precise correction.Methods: ...
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Background: Conventional X-rays, due to 2D viewing, may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space and to built patient-specific guide to achieve the precise correction.Methods: In this descriptive study, 10 lower limbs with various deformities around the knee were studied. Weight bearing alignment x-rays and CT scans were processed digitally to produce 3D weight bearing models.The landmarks were determined and lower limb indices were calculated to determine the deformities in 3 dimensions Under surgeon's supervision, virtual correction of the deformity was performed, based on which, a patient-specific guide was designed and printed in 3D. The guide was then used in the surgery.Results: The deformity and deviation from standard angles was obsereved in frontal plane in 6 cases, frontal and sagittal planes in one, frontal and axial planes in two, and a three planar deformity in one cases. The results showed that this method is effective in achieving the precise correction of the deformity. In all the patients who underwent surgery, the correction was the same or very close to what had been planned in frontal and sagittal planes (±1). Clinical assessment was used for rotational correction in the absence of postoperative CT-scan.Conclusions: The computer-assisted pre-op planning and patient-specific guide usage can highly optimize the results of corrective osteotomies, especially in difficult deformities around the knee.
Mohsen Movahedi Yeghaneh, MD
Abstract
Background: The aim of this study was to compare the results of percutaneous sub capital metatarsal osteotomy with open distal chevron osteotomy of first metatarsal in hallux valgus surgery. Methods: In a clinical trial study, 29 patients with bilateral hallux valgus (58 foot) were selected randomly. ...
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Background: The aim of this study was to compare the results of percutaneous sub capital metatarsal osteotomy with open distal chevron osteotomy of first metatarsal in hallux valgus surgery. Methods: In a clinical trial study, 29 patients with bilateral hallux valgus (58 foot) were selected randomly. All patients were female and the average age was 31 years old (17-55 yrs). The average time of follow-up was 13 months (6-20 months). Hallux valgus angle (HVA) up to 40° and intermetatarsal angle (IMA) up to 17° were included. For each patient, a percutaneous sub capital osteotomy on one foot and an open distal chevron osteotomy on the other foot were performed at the same time and by the same surgeon. Left or right side deformities were randomly selected for MIS or open procedure. Results: The average HVA correction was similar in both groups but the IMA correction was better in the open distal chevron osteotomy. In the chevron osteotomy, both patient's and surgeon's satisfaction level were in the similar range. In the MIS technique, the level of satisfaction varied between the surgeon and the patient. 86% of the patients were completely satisfied but the surgeon was fully satisfied in only 38% of the cases. Conclusions: Distal chevron osteotomy is recommended as a reliable corrective technique in mild to moderate hallux valgus but the percutaneous sub capital osteotomy can still be considered in selected patients with relatively low IMA.
Saeid Tabatabaei; Ahmad Dashtbozorg; Ahmad Dashtbozorg
Abstract
Background: In patients with late diagnosis of DDH after open reduction of the hip joint, we can use pelvic osteotomy or varus-derotational osteotomy (VDO) of the femur to make the open reduction more stable. The goal of the present study is to report on redirection of the femoral head towards acetabulum ...
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Background: In patients with late diagnosis of DDH after open reduction of the hip joint, we can use pelvic osteotomy or varus-derotational osteotomy (VDO) of the femur to make the open reduction more stable. The goal of the present study is to report on redirection of the femoral head towards acetabulum by femoral osteotomy. Methods : In this prospective study we performed only VDO in 67 hips in 46 patients (36 females, 10 males) after open reduction of the hip in cases of 18 months to 10 years of age whom Salter innominate osteotomy was needed in a hospital in Ahvaz, Iran. The patients were followed up until complete weight bearing and plate removal. Results : Concentric reduction was achieved in 67 hips. Acetabular index showed 6 degrees of reduction after 26 months. No redislocation was seen after plate removal in 61 hips (91%) but pelvic osteotomy was done in 6 hips (9%) due to redislocation or residual displasia. Ninety percent of patients were classified as group 1 or 2 in "severin" classification. Conclusions : VDO is a simple operation with low complication rate. Although more than 90% success rate was observed in these patients, in order to see possible residual dysplasia in these patients longer follow-ups are needed.
Seyyed Morteza KazemiSeyyed Morteza Kazemi; Seyyed Mohammad Qoreishi; Mahdi Bahari Mehrabani; Farshad Safdari
Abstract
Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with ...
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Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with a group of normal subjects.
Methods: 75 patients with primary genu varum and 75 normal persons, contributed to a case-control study. The medial distal femoral mechanical angle (MDFMA), medial proximal tibial mechanical angle (MPTMA) and joint diversion angle (JDA) were measured and compared between the two groups. The percentage of patients with >3 degrees in both distal of femur and proximal of tibia were determined.
Results: The mean of MDFMA and MPTMA was significantly lower and the mean of JDA was significantly higher in genu varum group compared to normal group (p < /em>3 degrees.
Conclusions: The alignment of distal femur and proximal tibia is significantly different in patients with primary genu varum and normal controls. Abnormal alignment of joint line is a common finding in both primary genu varum and normal people but more commonly in the cases of genu varum. As double level osteotomy may be required in many patients with genu varum, it is important to investigate distal of femur alignment before high tibial osteotomy
Mahzad Javid; John H Wedge
Abstract
Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical ...
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Background: Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. Methods : We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 20 patients comprised 11 lateral pillar (LP) groups B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Results: Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two. One of the two LPC hips became SIII and one SIV. The three female patients had one LPB, one LPB/ C, and one LPC hip, and surgery resulted in SIII hips in all. Conclusions: Combined osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor to fair results.
Mahmood Karimi Mobarakeh; Mohsen Mardani-Kivi
Abstract
Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole, but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament, quadriceps alignment ...
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Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole, but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament, quadriceps alignment and Q-angle and tibial plateau slope. The goal of high tibia osteotomy is more normal load distribution in nonarthritic knee in young persons, and slowing degeneration in arthritic knee in adults. All the high tibia osteotomies cause patellofemoral biomechanical changes, through tubercle displacement, or patellar tendon fibrosis or calcification. Q angle also increase with lateral displacement of tibial tuberosity when osteotomy is done proximal to the tibial tuberosity. The medial collateral ligament needs to be released in open wedge high tibia osteotiomy. If intact medial ligament is necessary, osteotomy should be done distal to medial collateral attachment. The proximal tibia configuration is roughly similar to a rectangle. Lateral cortex is in right angle to the posterior one. The posteromedial corner opens three times the anterior one in open wedge osteotomy otherwise there would be tibial slope change.
Mahmood Karimi Mobarakeh; Mohsen Mardani Kivi; Sohrab Keyhani; Hadi Safaee
Abstract
Background: High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. ...
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Background: High tibia osteotomy remains an acceptable method for prevention of medial comportment knee osteoarthritis. The conventional technique is a closing wedge osteotomy. We planned to study short-term results of a medial open wedge high tibia osteotomy using T-Buttress plate and a metal wedge. Methods: In this case series study, 60 patients (76 knees, 27 male and 33 female) underwent an open wedge high tibia osteotomy surgery using a T-Buttress plate and a metal wedge in a in a teaching hospital in Kerman-Iran. Patients were assessed clinically and radiographically including Modified Hospital for Special Surgery Knee Scoring System (HSSKS), anatomical and mechanical limb alignment, Insall-Salvati patellar height index and proximal tibia posterior slope angle. Results: The mean tibia-femoral angle changed from -6.8 to +4.33 degrees. 26(43.3%) patients needed iliac cancellous graft. The mean metal wedge size was 11.07 mm (8-15 mm). The mean Modified HSSKS promoted from 75.5 to 98.73. The observed complications were: fracture in five, intraarticular screw penetration in four (one in proximal tibia-fibular joint), infection in two and under-correction in one patient. There was no non-:::union:::, proneal nerve injury, over-correction, plate failure, deep vein thrombosis and bone graft donor site complication. The mean posterior tibia slope changed from 8.05±1.95 to 8.68±1.54 degrees and patellar height index changed from 1.06 to .97. Conclusion: This procedure is a safe and reliable technique and lessened the need for an autograft. Significant improvement in score of Modified HSSKS was seen post operatively.
Babak Siavashi, MD طSiavashi, MD; Abbas Abdoli Tafti, MD; Mohammadreza Golbakhsh, MD; Mir Mostafa Sadat, MD; Mohammad Javad Zehtab, MD; Dariush Gouran Savadkoohi, MD
Abstract
Background: Femoral neck non:::union::: could be a disaster in young and middle age patients. Conventional valgus osteotomy of femur is done without freshening of non:::union::: site. We would like to report our experience with valgus osteotomy of hip after freshening of the non:::union::: site.Methods: ...
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Background: Femoral neck non:::union::: could be a disaster in young and middle age patients. Conventional valgus osteotomy of femur is done without freshening of non:::union::: site. We would like to report our experience with valgus osteotomy of hip after freshening of the non:::union::: site.Methods: In a case-series study, from all young and middle-aged patients with non:::union::: femoral neck fracture who were treated with freshninig of non:::union::: site and valgus ostetomy, 22 patients (18 males, 4 females) with mean age of 34 (20-47) entered the study. There were 10 broken implants in the heads with a one year follow-up. The cases were evaluated for :::union:::, necrosis and also changes in Harris hip scores.Results: Preoperative Harris hip score was 63 and postoperative score increased to 89. The neck shaft angle was reached about 150 degrees. In 2 cases necrosis developed and in 3 cases collapse of neck occurred with intrusion of implant into the joint and the implants were removed immediately. Mean time to :::union::: was 4.5 months.Conclusion: Freshening of non:::union::: site before valgus osteotomy in non:::union::: femoral fracture produces high :::union::: rate with low complications.
Sohrab Keihani, MD; Ali Akbar Esmaieliejah, MD; Mohammad Reza Abbassian, MD; Seyyed Morteza Kazemi, MD; Ali Akbar Esmaieliejah, MD; Hamid Reza Seyed Hosseinzadeh, MD; Amer Sadeghi, MD
Abstract
Background: Medial opening-wedge valgus high tibial osteotomy has gained popularity. However, the reported complication rate is high. The technique has been modified to remedy the problems of patellar descent and alteration in angle of the inclination of the tibial plateau and delayed :::union:::. Our ...
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Background: Medial opening-wedge valgus high tibial osteotomy has gained popularity. However, the reported complication rate is high. The technique has been modified to remedy the problems of patellar descent and alteration in angle of the inclination of the tibial plateau and delayed :::union:::. Our aim is to compare the modified retrotubercle opening-wedge osteotomy with the conventional technique.Methods: In a clinical trial study, 72 consecutive patients with varus knees who were candidates for high tibial valgus osteotomy were, randomly treated with either conventional medial opening-wedge upper tibial osteotomies (34 patients) or retrotubercle opening-wedge osteotomies (38 patients) from Feb 2006 to Feb 2008. These matched cases were evaluated for patellar height and upper tibial slope as well as tibial inclination measurements. The intra and inter-observer reliability of the radiographic measures were also assessed before surgery and in a mean follow up of 13 months (10-21 months).Results: In retrotubercle open-wedge osteotomies no surgical change in patellar length or any patellar infra was seen. The tibial plateau inclination also showed no significant change from the pre-operative values. On the other hand, the conventional medial open-wedge technique showed significant reduction in patellar height as well as increase in tibial plateau inclination as compared to pre-operative values.Conclusion: In high tibial valgus osteotomies for genu varum retrotubercle medial open-wedge osteotomy negates the ill-effect of conventional open-wedge osteotomy in producing patella infra or increased tibial plateau slope or change in Q-angle of quadriceps mechanism.
Mohammad Taghi Peivandi, MD; Seyed Reza Sharifi, MD Sharifi, MD; Eghbal Sadri, MD
Abstract
Background: There are many different methods of treatment for Kienbock's disease or avascular necrosis of the carpal lunate. We are reporting our experience with lunate excision, capitate osteotomy and inter capitate bone grafting.Methods: Eleven male patients with stage III lunatomalacia treated by ...
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Background: There are many different methods of treatment for Kienbock's disease or avascular necrosis of the carpal lunate. We are reporting our experience with lunate excision, capitate osteotomy and inter capitate bone grafting.Methods: Eleven male patients with stage III lunatomalacia treated by lunate excision capitate osteotomy and intra-capitate bone grafting were assessed with a mean follow-up of 6 years (2-10 years). The cases were evaluated in terms of pain, function, grip power and return to pre-treatment activities.Results: Pain decreased significantly in all but one case. Grip strength had returned to above 70% of the strength of the opposite hand in all but one patient.Conclusions: Capitate osteotomy and inter-capitate bone graft without intercarpal arthrodesis in Kienbock disease is a safe and reliable technique for stage III disease.
Mahmood Bahari, MD; Hassan Rahimi, MD; Mohammad Gharedaghi, MD; Javad Afzali, MD
Abstract
Background: ِِDouble osteotomy of first metatarsal has been advocated as a procedure of choice for severe hallux valgus in adolescent age group. We would like to report our experience with such an osteotomy in Meshhad.Methods: Over a five year period (1999-2004), 26 feet in 17 adolescents - mean age ...
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Background: ِِDouble osteotomy of first metatarsal has been advocated as a procedure of choice for severe hallux valgus in adolescent age group. We would like to report our experience with such an osteotomy in Meshhad.Methods: Over a five year period (1999-2004), 26 feet in 17 adolescents - mean age of 15.5 years - with moderate to severe hallux valgus underwent double first metatarsal osteotomies. With a mean follow-up of 26 months, the cases were evaluated by American Orthopaedics Foot & Ankle Society Hallux Metatarso-phalangeal-interphalangeal scale (AOFAS/HMI). In this study pre and post hallux valgus (HVA), intermetatarsal (IMA), and distal metatarsal articular (DMAA) angles, and the relation between the angles and patient satisfaction were evaluated.Results: The mean angular corrections for hallux valgus (HVA), intermetatarsal (IMA) and distal metatarsal articualr (DMAA) angles were 26.65, 6.20 and 5.55 degrees respectively. Four cases could not be reached and from the remaining 13 patients, 2 cases had required second surgery for non-:::union::: and 3 cases had stiffness in MTP (metatarsophalangeal) joints. Sixteen cases reported good to excellent results.Conclusions: Double first metatarsal osteotomy for severe hallux valgus is a reasonable procedure in adolescents which maintains the correction. Non-:::union::: and first MTP joint contractures are the two main side effects.
Fardin Mirzatolouie, MD
Abstract
Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well-known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. ...
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Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well-known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. The goal of this survey was assessment of Fulkerson surgery for patellar instability and its effect on apprehension test.Methods: In a clinical trial study, 12 patients (9 females, 3 males) with mean age of 38.3 years (28-60 years) underwent tibial tubercle osteotomy for symptomatic patellar subluxation. Mean follow-up time was 10 months (6-18 months). The pre and post operative assessment of change in “apprehension test”, knee function and radiographic changes were respectively evaluated by visual analog scale (VAS) and with Bristol pain score, Fulkerson scoring and lateral pattelo-femoral angle or Merchant view.Results: The results in 8 patients were excellent or good, 3 fair and one poor. Eight cases believed the surgery had been effective. The Fulkerson score of 48.75 improved to 71.6, while Bristol pain score of 7.3 decreased to 4.1 and VAS for apprehension test of 7.5 decreased to 5.16. The “Apprehension test” did not change in 3 patients, and one case developed significant limitation of motion.Conclusions: Fulkerson tibial tubercle osteotomy in selected patients improves knee function and decreases pain in short-term, but does not improve patellar alignment.
