PATELLOFEMORAL DİZİLİM BOZUKLUĞUNDA TİBİAL TÜBERKÜL ANTEROMEDİALİZASYON (FULKERSON) CERRAHİSİNİN ORTA DÖNEM SONUÇLARI

Öz

Amaç: Patellofemoral dizilim bozukluğu instabilite, diz önü ağrısı, kondropati ve artroz için bilinen bir risk faktörüdür. Tibial tüberkülün lateral yerleşimli olduğu, ağrı ve/veya instabilite şikayeti olan patellofemoral dizilim bozukluğu tibial tüberkül osteotomisi ile etkin bir şekilde tedavi edilebilir. Gereç ve Yöntem: Biz çalışmamızda patellofemoral dizilim bozukluğu olup kliniğimizde Fulkerson osteotomisi yapılmış olan 45 Hastanın toplam 50 dizinin uzun dönem sonuçlarını sunmaktayız. Ortalama takip zamanı 116,9 aydır (60-204). Bulgular: Bizim kohortumuzda tüm radyolojik parametrelerde preoperatif değerlere göre anlamlı gelişme görülmüştür. Hastalarımızın çeşitli fonksiyonel ve ağrı skorlamalarına göre yaşam kaliteleri postoperatif anlamlı olarak artmıştır. Sonuç: Sonuç olarak, Fukerson osteotomisi patellofemoral dizilim bozukluğu zemininde lateral patellar instabilite ve/veya patellofemoral kondroz/artrozu olan hastalarda tedavide başarılı bir yöntemdir. Dikkatli hasta seçiminin sonucu etkileyen en önemli faktör olduğuna inanıyoruz.

Anahtar Kelimeler

• Patellofemoral dizilim bozukluğu,Tibial tüberkül anteromedializasyonu,Fulkerson osteotomisi

MIDTERM OUTCOMES OF TIBIAL TUBERCLE ANTEROMEDIALISATION (FULKERSON PROCEDURE) FOR PATELLOFEMORAL MALALIGNMENT

Öz

Objective: Patellofemoral malalignment is a known risk factor for instability, anterior knee pain, chondropathy and arthrosis. Patellofemoral malaligment with a laterally positioned tibial tubercle that results in symptoms of pain and/or instability can be effectively managed with a tibial tubercle osteotomy. Material and Method: We present long term results of 50 knees of 45 patients with patellofemoral malalignment treated with Fulkerson osteotomy at our institution. Results: The mean follow-up time was 116,9 months (60-204). Significant improvement was observed at all of the radiographic parameters when compared with the preoperative values of our cohort. We found that patients’ postoperative quality of life increased significantly according to various pain and functional scales. Conclusion: In conclusion, Fulkerson osteotomy is successful in the treatment of patients with lateral patellar instability and/ or patellofemoral chondrosis/artrosis owing to patellofemoral malalignment. We believe that careful patient selection is the most important factor determining the overall outcome.

Anahtar Kelimeler

• Patellofemoral malalignment,Tibial tubercle anteromedialisation,Fulkerson osteotomy

Kaynakça

1. 1. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002;30(3):447-56.
2. 2. Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T. The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop Relat Res 1978;(134):158-67.
3. 3. Insall J, Bullough PG, Burstein AH. Proximal” tube” realignment of the patella for chondromalacia patellae. Clin Orthop Relat Res 1979;(144):63-9.
4. 4. Nomura E, Inoue M. Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthrosc J Arthrosc Relat Surg 2003;19(5):1-9.
5. 5. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 1983;(177):176-81.
6. 6. Cox JS. Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment. Am J Sports Med 1982;10(5):303-10.
7. 7. Radin EL. The Maquet procedure--anterior displacement of the tibial tubercle. Indications, contraindications, and precautions. Clin Orthop Relat Res 1986;(213):241-8.
8. 8. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 1997;25(4):533-7.

9. 9. Carofino BC, Fulkerson JP. Anteromedialization of the tibial tubercle for patellofemoral arthritis in patients> 50 years. J Knee Surg 2008;21(02):101-5.
10. 10. Biedert RM. Patellofemoral disorders: diagnosis and treatment. John Wiley & Sons; 2005.
11. 11. Molina A, Ballester J, Martin C, Munoz I, Vazquez J, Torres J. Biomechanical effects of different surgical procedures on the extensor mechanism of the patellofemoral joint. Clin Orthop Relat Res 1995;(320):168-75.
12. 12. Ferguson JAB. Elevation of the insertion of the patellar ligament for patellofemoral pain. J Bone Joint Surg Am 1982;64(5):766-71.
13. 13. Fulkerson JP, Becker GJ, Meaney JA, Miranda M, Folcik MA. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med 1990;18(5):490-7.
14. 14. Morshuis WJ, Pavlov PW. Anteromedialization of the tibial tuberosity in the treatment of patellofemoral pain and malalignment. Clin Orthop Relat Res 1990;(255):242-50.
15. 15. Wang C-J, Chen L-M, Chen H-H. Patellonfemoral Disorders Treated by Distal Realignment. J Orthop Surg Taiwan 1999;16(1):61-8.
16. 16. Karamehmetoglu M, Ozturkmen Y, Azboy I, Caniklioglu M. Fulkerson osteotomy for the treatment of chronic patellofemoral malalignment. Acta Orthop Traumatol Turc 2007;41(1):21-30.
17. 17. Tjoumakaris FP, Forsythe B, Bradley JP. Patellofemoral instability in athletes: treatment via modified Fulkerson osteotomy and lateral release. Am J Sports Med. 2010;38(5):992-9.
18. 18. Dantas P, Nunes C, Moreira J, Amaral LB. Anteromedialisation of the tibial tubercle for patellar instability. Int Orthop 2005;29(6):390-1.
19. 19. Pritsch T, Haim A, Arbel R, Snir N, Shasha N, Dekel S. Tailored tibial tubercle transfer for patellofemoral malalignment: analysis of clinical outcomes. Knee Surgery, Sport Traumatol Arthrosc 2007;15(8):994-1002.