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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 . 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 1 2 3 4
MPFL Repair/Reconstruction Torn with dislocation Repair (re-tighten) Reconstruction
Intraoperative Stimulation Femoral Nerve Catheter Quadriceps Contraction Provides Active Movement
Hypothesis Patients who receive… Southwick-Fulkerson Osteotomy MPFL reconstruction or repair 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
Recovery Times Crutch Use 35.7 days (2-90)
Recovery Times Brace Use 51 days (21-240)
Recovery Times Return to Driving 35.6 days (5-180)
Recovery Times Full Recovery 190 days (42-547)
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)
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.