meniscus study

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

• Repeat patellar dislocators

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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
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Southwick-Fulkerson Osteotomy

• Anteriomedialization of the tibial tubercle

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Tibial Tubercle-Trochlear Groove Distance
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MPFL Repair/Reconstruction

• Torn with dislocation
• Repair (re-tighten)
• Reconstruction

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Intraoperative Stimulation

• Femoral Nerve Catheter

• Quadriceps Contraction Provides Active Movement

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Hypothesis

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

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Assessment

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

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Results
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Patients
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Clinical Results
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J-Sign
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Patient Satisfaction
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Recovery Times
Crutch Use 35.7 days (2-90)
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Recovery Times
Brace Use 51 days (21-240)
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Recovery Times
Return to Driving 35.6 days (5-180)
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Recovery Times
Full Recovery 190 days (42-547)
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MPFL Type
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Apprehension
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Age
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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)

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Normal Scores
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Pre/Post KOOS
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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.

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Thank YouQuestions?