| Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques. | |
| | |
MedLine Citation:
|
PMID: 19491333 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
Lonnie Paulos; Stephen C Swanson; Gregory J Stoddard; Sue Barber-Westin |
Related Documents
:
|
19439143 - Radiographic evaluation of hallux valgus treated with opening wedge osteotomy. 615803 - Cecal changes following appendectomy. 1529743 - Stability over time of character assessment using a psychodynamic instrument and person... |
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 |
Affiliation:
|
Andrews-Paulos Research & Education Institute, Gulf Breeze, Florida 32561, USA. lonniepaulos@sbcglobal.net |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Bone Malalignment / surgery* Female Gait / physiology Humans Joint Instability / surgery* Male 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
Previous Document: When rejection sensitivity matters: regulating dependence within daily interactions with family and ...
Next Document: Limited sampling strategies for the estimation of sirolimus daily exposure in kidney transplant reci...