Document Detail

Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques.
MedLine Citation:
PMID:  19491333     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although patients considered "successful" at longer-term follow-up no longer exhibited patellar instability, those with more severe malalignment issues had other, gradually worsening symptoms such as activity-related pain, crepitation, swelling with activities, and pain with weather changes. HYPOTHESIS: Improvement of patellar tracking by correction of the tubercle-sulcus angle and related ligament deficiencies will result in good to excellent results, regardless of the technique employed. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-five patients with dislocating patellae and significant lower leg deformity were treated; 12 patients (group 1) underwent a derotational high tibial osteotomy and 13 patients (group 2) underwent an Elmslie-Trillat-Fulkerson proximal-distal realignment. All were prospectively evaluated a minimum of 24 months postoperatively with a physical examination, validated outcome questionnaires, radiographs, and computerized axial tomography scans. Postoperative 3-dimensional bilateral gait analyses were performed on all subjects walking on a 3-dimensional force treadmill to measure stance kinematics, foot progression angle, knee flexion, knee valgus-varus, hip flexion, and patella angle. Contralateral limbs with similar preoperative alignment were used as controls. RESULTS: Group 1 patients significantly improved over their preoperative status in all primary subjective and functional outcome parameters, and were significantly better than group 2 patients. Group 2 patients improved, but not to the degree of group 1 patients. Gait analysis revealed group 1 patients had more symmetrical gait patterns, with less variability and less compensatory gait changes, than group 2 patients. CONCLUSION: The original hypothesis proved to be incorrect. The simultaneous correction of ligament imbalance, excessive tubercle-sulcus angle, and lower limb torsional deformity produced significantly better results than conventional proximal-distal realignment.
Lonnie Paulos; Stephen C Swanson; Gregory J Stoddard; Sue Barber-Westin
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-06-02
Journal Detail:
Title:  The American journal of sports medicine     Volume:  37     ISSN:  1552-3365     ISO Abbreviation:  Am J Sports Med     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-01     Completed Date:  2009-10-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609541     Medline TA:  Am J Sports Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1288-300     Citation Subset:  IM    
Andrews-Paulos Research & Education Institute, Gulf Breeze, Florida 32561, USA.
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MeSH Terms
Bone Malalignment / surgery*
Gait / physiology
Joint Instability / surgery*
Orthopedic Procedures / methods*
Patellar Dislocation / physiopathology,  surgery*
Prospective Studies
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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