Transcript meniscus study - Athletic Training at Iowa

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)

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Patellar tracking correction
Pre-Operative
Post-Operative
Southwick-Fulkerson Osteotomy

Anteriomedialization of the tibial tubercle
1
2
3
4
Tibial Tubercle-Trochlear Groove Distance
MPFL Repair/Reconstruction

Torn with dislocation
Repair (re-tighten)
Reconstruction


Intraoperative Stimulation

Femoral Nerve Catheter  Quadriceps Contraction
Provides Active Movement
Hypothesis
Patients who receive…
1)
2)
3)
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
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Physical Exam
J Sign
Apprehension
Subsequent
Dislocations
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

Results
Return Rate
31/37 (83.8%)
Average Follow-up
3.72 (2-5.95)
Patients
n (%)
Avg Age
(Range)
Men
9 (29%)
25.77
(16.38)
Women
22 (71%)
23.36 (1447)
Total
31 (100%)
24.06 (1447)
MPFL
Procedure
Repair
n (%)
16 (51.6%)
Reconstruction
15 (48.4%)
Total
31 (100%)
Clinical Results
n (%)
Subsequent
Dislocations
Apprehension
1 (3.2%)
4 (12.9%)
Crepitus
22 (71%)
J-Sign
n (%)
None
14 (45.2%)
Slight
8 (25.8%)
S-Sign
8 (25.8%)
Obvious
1 (3.2%)
Patient Satisfaction
n (%)
Surgery
“Successful”
29 (93.5%)
Would Repeat
29 (93.5%)
Reached
Pre-Operative Goals
24 (77.4%)
Recovery Times
100
90
80
70
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Recovery Times
300
250
200
150
100
50
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Recovery Times
200
180
160
140
120
100
80
60
40
20
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Recovery Times
600
500
400
300
200
100
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
MPFL Type
Repair
Reconstruction
Difference
(p-value)
KOOS
Symptom
47.991
57.143
-9.152
(p=.0666)
KOOS Pain
73.09
87.222
-14.13
(p=.0508)
KOOS ADL
78.217
92.941
-14.72
(p=.0221)
KOOS Sport
49.375
74.667
-25.29
(p=.0221)
KOOS QOL
57.422
71.25
-13.83
(p=.1183)
IKDC
59.158
78.273
-19.12
(p=.0168)
Apprehension
(+)
(-)
MPFL Repair
4
12
MPFL
Reconstruction
0
15
Apprehension
KOOS Symptom
Positive
38.393
Negative
54.497
Difference
16.104
(p=.0284)
Age
Age
KOOS Symptom
-.3447 (p=.0576)
KOOS Pain
-.3783 (p=.0358)
KOOS ADL
-.5026 (p=.004)
KOOS Sport
-.5376 (p=.0018)
KOOS QOL
-.4824 (p=.006)
IKDC
-.5342 (p=.002)
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
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Discussion: Outcomes

Successful reconstruction is difficult to
achieve
Redislocation rate high
Danger of overconstraint with MPFL
reconstruction (Tom, Colvin)


“Normal” Scores
Pain
Symptom
ADL
Sport
QOL
IKDC
Study Group
80.67
52.64
84.85
60.35
64.6
68.4
My Knee
100
60.71
100
95
81.25
95.4
Pre/Post KOOS
Symptom
Pain
Pre-Operative Post(Avg)
Operative
(Avg)
55.67
52.41
55.69
79.9
ADL
Sport
QOL
62.53
27.66
36.64
85.34
61.61
64.11
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)
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Discussion: Success Rates

Historical standard
MPFL Repair 83%
MPFL Reconstruction 93%
Distal Realignment 86%
Current Study 96.8%
Revised stricter standard
80.6% Success
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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.
Thank You
Questions?