Appraisal of surgical treatment of 47 cases of patellofemoral instability.
BACKGROUND
Patellofemoral instability is a common knee disease. Its etiology is complex and variable, with many components making different contributions in each individual, resulting in several distinct clinical presentations. Our goal was to analyze the results of surgical treatment in our hospital over a period of 10 years.


METHODS
We analyzed 55 knees of 47 patients who underwent surgery for patellofemoral instability and were classified into 2 main groups: proximal realignment and combined proximal and distal realignment. Three other groups were analyzed according to the duration of preoperative symptoms: less than 1 year (group I); 1 to 10 years (group II); and more than 10 years (group III).


RESULTS
There were 62% good results overall, with 78% good results in groups I and II. Group III had 81% bad results, showing that a late diagnosis of advanced disease results in a poor prognosis. In addition to late diagnosis, bad results were usually associated with incorrect diagnosis or choice of surgical technique. There was no significant difference between isolated proximal realignment and combined proximal and distal realignment in groups I or II, but in group III, the combined technique yielded better results.


CONCLUSIONS
Our results indicate that patellofemoral instability should be addressed in its early stages. Patients with long-lasting symptoms or more severe disease seem to achieve better results with combined techniques.


CONCLUSIONS
Proximal and distal realignments produce better results than isolated proximal realignment in patients with joint degeneration or with greater duration of disease. The realignment surgery does not produce good results in patients with advanced disease.
Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo.
Roberto Freire da Mota e
RF
Albuquerque
Alexandre Pagotto
AP
Pacheco
Arnaldo José
AJ
Hernandez
Marco Martins
MM
Amatuzzi
José Ricardo
JR
Pécora
Alexandre Estevão Vamos
AE
Kokron
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome