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Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation.
[trochlear dysplasia]
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
.
Diseases
Validation
Diseases presenting
"positive apprehension sign"
symptom
trochlear dysplasia
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