Two Year Outcomes of Southwick-Fulkerson Osteotomy. Chloe Mellecker John P. Albright MD Department of Orthopaedic Surgery.

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Presentation transcript:

Two Year Outcomes of Southwick-Fulkerson Osteotomy. Chloe Mellecker John P. Albright MD Department of Orthopaedic Surgery

Problem ] Repeat patellar dislocators

Patient Population ] Patellar dislocations or instability ] Bony attachment ] Patellar tendon ] Soft tissue attachment ] Quadriceps tendon ] Medial Patellofemoral Ligament (MPFL) ] Lateral Patellofemoral Ligament (LPFL)

Patellar tracking correction Pre-Operative Post-Operative

Southwick-Fulkerson Osteotomy ] Anteriomedialization of the tibial tubercle

Tibial Tubercle-Trochlear Groove Distance

MPFL Repair/Reconstruction ] Torn with dislocation ] Repair (re-tighten) ] Reconstruction

Intraoperative Stimulation ] Femoral Nerve Catheter ] Quadriceps Contraction Provides Active Movement

Hypothesis Patients who receive… 1) Southwick-Fulkerson Osteotomy 2) MPFL reconstruction or repair 3) Femoral nerve stimulation guidance …will have decreased recovery times and improved final outcomes.

Assessment ] Survey ] Knee Osteoarthritis Outcome Score ] International Knee Documentation Committee Score ] General Recovery Questions ] Physical Exam ] J Sign ] Apprehension ] Subsequent Dislocations

Results Return Rate31/37 (83.8%) Average Follow-up3.72 (2-5.95)

Patients n (%)Avg Age (Range) Men9 (29%)25.77 (16.38) Women22 (71%)23.36 (14- 47) Total31 (100%)24.06 (14- 47)

MPFL Procedure n (%) Repair16 (51.6%) Reconstruction15 (48.4%) Total31 (100%)

Clinical Results n (%) Subsequent Dislocations 1 (3.2%) Apprehension4 (12.9%) Crepitus22 (71%)

J-Sign n (%) None14 (45.2%) Slight8 (25.8%) S-Sign8 (25.8%) Obvious1 (3.2%)

Patient Satisfaction n (%) Surgery “Successful” 29 (93.5%) Would Repeat29 (93.5%) Reached Pre-Operative Goals 24 (77.4%)

Recovery Times

MPFL Type RepairReconstructionDifference (p-value) KOOS Symptom (p=.0666) KOOS Pain (p=.0508) KOOS ADL (p=.0221) KOOS Sport (p=.0221) KOOS QOL (p=.1183) IKDC (p=.0168)

Apprehension (+)(-) MPFL Repair412 MPFL Reconstruction 015

ApprehensionKOOS Symptom Positive Negative Difference (p=.0284)

Age KOOS Symptom (p=.0576) KOOS Pain (p=.0358) KOOS ADL (p=.004) KOOS Sport (p=.0018) KOOS QOL (p=.006) IKDC (p=.002)

Discussion: Recovery Time ] Procedure known for long recovery ] Crutch use 6-8 weeks (Cosgarea) ] Sports 9-12 months (Barber) ] Our patients experienced decreased recovery times ] Driving ] ADL

Discussion: Outcomes ] Successful reconstruction is difficult to achieve ] Redislocation rate high ] Danger of overconstraint with MPFL reconstruction (Tom, Colvin)

“Normal” Scores Study GroupMy Knee Pain Symptom ADL Sport QOL IKDC

Pre/Post KOOS Pre-Operative (Avg) Post- Operative (Avg) Symptom Pain ADL Sport QOL

Discussion: Definition of Successful Outcomes ] Historically ] Re-dislocation ] Re-operation ] Revised ] Tracking ] Apprehension ] Apprehension sign of severe malalignment (Karamehmetoglu) ] 25% of successful Southwick dovetails apprehensive (Gibbons)

Discussion: Success Rates ] Historical standard ] MPFL Repair 83% ] MPFL Reconstruction 93% ] Distal Realignment 86% ] Current Study 96.8% ] Revised stricter standard ] 80.6% Success

Conclusion ] Femoral nerve stimulation effective answer for how far to transfer tubercle and placement of MPFL reconstruction. ] Recovery time is decreased in this procedure. ] MPFL reconstruction eliminates persistence of apprehension which improves outcome scores.

Thank You Questions?