Mahmut KARAMEHMETOĞLU, Yusuf ÖZTÜRKMEN, İbrahim AZBOY, Mustafa CANİKLİOĞLU

Kronik patellofemoral dizilim bozukluğu tedavisinde Fulkerson osteotomisinin yeri

Amaç: Kronik patellofemoral dizilim bozukluğu olan olgularda uygulanan Fulkerson osteotomisi ve sonuçları değerlendirildi. Çalışma planı: On sekiz hastanın (10 kadın, 8 erkek; ort. yaş 28.6; dağılım 21-42) 21 dizine tibia tüberkülünün anteromediale transferi (Fulkerson osteotomisi) yapıldı. Ameliyat öncesi ve sonrası tüm hastaların 45° fleksiyonda tanjansiyel grafilerinde patellofemoral uyum açısı, lateral patellofemoral açı ve patellofemoral indeks ölçüldü. Bilgisayarlı tomografide 12 dizde lateral patellar tilt, dört dizde lateral patellar subluksasyon, beş dizde her iki türde dizilim bozukluğu belirlendi. Cerrahi girişim öncesinde artroskopik değerlendirme yapıldı. Tüm dizlerde patella eklem yüzeyindeki osteoartroz ileri derecedeydi (Outerbridge tip III-IV). Ortalama 10.5 mm (dağılım 7-15 mm) anteriorizasyon yapıldı. Yedi olguda ayrıca vastus medialis kası ilerletmesi uygulandı. Objektif değerlendirme ameliyat öncesi ve sonrasında Fulkerson ve ark.nın ölçütlerine göre yapıldı. Ortalama izlem süresi 28 ay (dağılım 20-60 ay) idi. Sonuçlar: Fulkerson ve ark.nın ölçütlerine göre, 18 dizde (%85.7) mükemmel, çok iyi veya iyi sonuç alındı. İki dizde (%9.5) orta, bir dizde (%4.8) kötü sonuç elde edildi. Ameliyat sonrası ağn ve instabilite skorlarında anlamlı düzelme saptandı (p

Anahtar Kelimeler:

Osteoartrit, diz, Kemik dizilim bozukluğu, Diz çıkığı, Ameliyat sonrası komplikasyonlar, Tedavi sonucu, Hareket açıklığı, eklem, Tendon transferi, Femur

Fulkerson osteotomy for the treatment of chronic patellofemoral malalignment

Objectives: We evaluated the results of Fulkerson osteotomy in patients with chronic patellofemoral malalignment. Methods: Fulkerson osteotomy (anteromedial tibial tubercle transfer) was performed in 21 knees of 18 patients (10 females, 8 males; mean age 28.6 years; range 21 to 42 years). The patellofemoral congruence angle, lateral patellofemoral angle, and patellofemoral index were measured pre- and postoperatively on tangential radiograms obtained at 45° knee flexion. Malalignment patterns were determined by computed tomography as lateral tilt (n=12), lateral patellar subluxation (n=4), and both (n=5). All the patients underwent arthroscopic examination preoperatively and all had severe osteoarthrosis in the patellar articular surfaces (Outerbridge type III-IV). The mean anteriorization was 10.5 mm (range 7 to 15 mm). The vastus medialis oblique muscle was advanced in seven knees. The patients were assessed according to the criteria of Fulkerson et al. pre- and postoperatively. The mean follow-up was 28 months (range 20 to 60 months). Results: According to the criteria of Fulkerson et al., the results were excellent, very good, or good in 18 knees (85.7%), fair in two knees (9.5%), and poor in one knee (4.8%). Pain and instability scores showed significant improvement (p<0.05). On final radiographic assessment, the mean patellofemoral congruence angle and patellofemoral index were -6.8 (range -26° to 10°) and 1.4 (range 0.8 to 1.6), respectively (p<0.05). The lateral patellofemoral angle had a lateral orientation in all the knees. Complications included tibial tubercle avulsion (n=1), deep vein thrombosis (n=1), and slight knee flexion contractures (n=4). Wound-related problems, compartment syndrome, peroneal nerve palsy, or proximal tibial fracture were not encountered. Conclusion: Successful results are obtained by Fulkerson osteotomy in the treatment of chronic patellofemoral malalignment with severe articular degeneration (Outerbridge type IIIIV) particularly in the lateral and distal regions of the patella.

Keywords:

Osteoarthritis, Knee, Bone Malalignment, Knee Dislocation, Postoperative Complications, Treatment Outcome, Range of Motion, Articular, Tendon Transfer, Femur,

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