Two Year Outcomes of

Southwick-Fulkerson Osteotomy

Two Year Outcomes of

Southwick-Fulkerson Osteotomy.

Chloe Mellecker

John P. Albright MD

Department of Orthopaedic Surgery

ProblemProblem

Repeat patellar dislocators

Patient PopulationPatient Population

Patellar dislocations or instability Bony attachment

Patellar tendon Soft tissue attachment

Quadriceps tendon Medial Patellofemoral

Ligament (MPFL) Lateral Patellofemoral

Ligament (LPFL)

Patellar tracking correctionPatellar tracking correction

Pre-Operative

Post-Operative

Southwick-Fulkerson OsteotomySouthwick-Fulkerson Osteotomy

Anteriomedialization of the tibial tubercle

123

4

Tibial Tubercle-Trochlear Groove DistanceTibial Tubercle-Trochlear Groove Distance

MPFL Repair/ReconstructionMPFL Repair/Reconstruction

Torn with dislocation Repair (re-tighten) Reconstruction

Intraoperative StimulationIntraoperative Stimulation Femoral Nerve Catheter Quadriceps Contraction

Provides Active Movement

HypothesisHypothesis Patients who receive…

1) Southwick-Fulkerson Osteotomy

2) MPFL reconstruction or repair

3) Femoral nerve stimulation guidance

…will have decreased recovery times and

improved final outcomes.

AssessmentAssessment Survey

Knee Osteoarthritis Outcome Score International Knee Documentation Committee Score General Recovery Questions

Physical Exam J Sign Apprehension Subsequent

Dislocations

ResultsResults

Return Rate 31/37 (83.8%)

Average Follow-up 3.72 (2-5.95)

PatientsPatients

n (%) Avg Age (Range)

Men 9 (29%) 25.77 (16.38)

Women 22 (71%) 23.36 (14-47)

Total 31 (100%) 24.06 (14-47)

MPFL Procedure

n (%)

Repair 16 (51.6%)

Reconstruction 15 (48.4%)

Total 31 (100%)

Clinical ResultsClinical Results

n (%)

Subsequent Dislocations

1 (3.2%)

Apprehension 4 (12.9%)

Crepitus 22 (71%)

J-SignJ-Sign

n (%)

None 14 (45.2%)

Slight 8 (25.8%)

S-Sign 8 (25.8%)

Obvious 1 (3.2%)

Patient SatisfactionPatient Satisfaction

n (%)

Surgery “Successful”

29 (93.5%)

Would Repeat 29 (93.5%)

Reached Pre-Operative Goals

24 (77.4%)

Recovery TimesRecovery Times

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Recovery TimesRecovery Times

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Recovery TimesRecovery Times

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Recovery TimesRecovery Times

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MPFL TypeMPFL TypeRepair 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)

ApprehensionApprehension

(+) (-)

MPFL Repair 4 12

MPFL Reconstruction

0 15

Apprehension KOOS Symptom

Positive 38.393

Negative 54.497

Difference 16.104

(p=.0284)

AgeAge

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 TimeDiscussion: 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: OutcomesDiscussion: Outcomes

Successful reconstruction is difficult to achieve Redislocation rate high Danger of overconstraint with MPFL

reconstruction (Tom, Colvin)

“Normal” Scores“Normal” Scores

Study Group My Knee

Pain 80.67 100

Symptom 52.64 60.71

ADL 84.85 100

Sport 60.35 95

QOL 64.6 81.25

IKDC 68.4 95.4

Pre/Post KOOSPre/Post KOOS

Pre-Operative (Avg)

Post-Operative (Avg)

Symptom 55.67 52.41

Pain 55.69 79.9

ADL 62.53 85.34

Sport 27.66 61.61

QOL 36.64 64.11

Discussion: Definition of Successful OutcomesDiscussion: 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 RatesDiscussion: Success Rates

Historical standard MPFL Repair 83% MPFL Reconstruction 93% Distal Realignment 86% Current Study 96.8%

Revised stricter standard 80.6% Success

ConclusionConclusion

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 YouQuestions?Thank YouQuestions?