Functional and Clinical Outcomes After Modified Fulkerson Osteotomy for Patellar Maltracking

Abstract

Patellar maltracking syndrome (PMS) is characterized by abnormal patellar motion, leading to anterior knee pain, instability, and patellofemoral joint degeneration. Often associated factors are patella alta, trochlear dysplasia, increased quadriceps angle, and vastus medialis oblique weakness. When conservative management, including physical therapy and McConnell taping fails, surgical intervention is required. This retrospective study, performed at the University Clinic for Surgical Diseases ‘St. Naum Ohridski’ – Skopje, North Macedonia, evaluates the clinical efficacy of modified Fulkerson tibial tubercle osteotomy in 30 patients with PMS. Diagnosis was based on clinical assessment and radiographic imaging. The preoperative Kujala Score ranged from 46 to 63 (mean 54.5, average 56), while the preoperative KOOS score ranged from 24 to 57 (mean 40.5, average 41.55), indicating moderate functional impairment. Depending on cartilage wear, either medialization or anteromedialization was performed through tibial tubercle osteotomy. Postoperatively, the patients were put on a partial weight – bearing for six weeks. Afterwards, strict rehabilitation program was followed to restore muscle strength, flexibility and patellar tracking. The postoperative outcomes showed a significant clinical improvement. Kujala scores range from 74 to 91 (mean 82.5, average 84) and KOOS score range from 50 to 85 (mean 67.7, average 62.62). Statistical analysis showed significant clinical improvement regarding pain and function (p<0.001). Four patients experienced mild lateral knee pain which was successfully treated conservatively. There were not reported any cases of deep vein thrombosis, infection or fractures. The downside of this technique is the hardware removal which was required by eight patients after an average time of 2 years from the surgical intervention. This study claims that the modified Fulkerson osteotomy is successful in the treatment of PMS, when the conservative treatment fails. Significant clinical improvements in pain, function, and stability are achieved through this technique while maintaining a low complication rate.