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Two Year Outcomes of Southwick-Fulkerson Osteotomy

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

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Two Year Outcomes of Southwick-Fulkerson Osteotomy

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

  2. Problem Repeat patellar dislocators

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

  4. Patellar tracking correction Pre-Operative Post-Operative

  5. Southwick-Fulkerson Osteotomy Anteriomedialization of the tibial tubercle 1 2 3 4

  6. Tibial Tubercle-Trochlear Groove Distance

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

  8. Intraoperative Stimulation Femoral Nerve Catheter Quadriceps Contraction Provides Active Movement

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

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

  11. Results

  12. Patients

  13. Clinical Results

  14. J-Sign

  15. Patient Satisfaction

  16. Recovery Times Crutch Use 35.7 days (2-90)

  17. Recovery Times Brace Use 51 days (21-240)

  18. Recovery Times Return to Driving 35.6 days (5-180)

  19. Recovery Times Full Recovery 190 days (42-547)

  20. MPFL Type

  21. Apprehension

  22. Age

  23. 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

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

  25. “Normal” Scores

  26. Pre/Post KOOS

  27. 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)

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

  29. 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.

  30. Thank YouQuestions?

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