Surgical Correction of Non-Traumatic Patella Maltracking: Midterm, Clinical Follow-up

Purpose: Mid-term clinical outcome study of Fulkerson distal realignment operation, with complementary combined or single-associated procedure, such as lateral release, medial plication, marrow stimulation technique (MST) - microfracture and MPFL reconstruction.

Methods: A prospective cohort study of 21 patients evaluated for 22 Fulkerson distal realignment operations and associated procedures. Mean follow-up time of 48 months (range, 24-156 months). Overall clinical outcome was reported by self-administered subjective International Knee Documentation Committee (IKDC) score and Tegner-Lysholm knee scoring scale.

Results: Preoperative, mean subjective IKDC score was 50.2 and Tegner-Lysholm score was 68.3. Postoperatively at a mean follow-up time of 48 month the mean score value was 72.6 and 80.5, respectively. (P<0.02) The associated procedures included four microfracture of the patella for full thickness cartilage lesion, seven lateral retinacular releases, and three medial capsular plications. One patient underwent MPFL reconstruction. One patient with Elhers-Danlos disease required excessive medialization of the tibia tuberosity. Three patients had surgery-related complications, one of which required hardware removal.

Conclusion: Surgical correction of non - traumatic patella mall- tracking with a Fulkerson distal realignment surgery combined with selective individualized associated procedures demonstrate an overall significant increase in subjective and functional clinical scores at medium term follow-up. Special attention should be addressed to associated pathologies secondary to patella maltracking or constitutional disorders and addressed accordingly.