title: Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques.
abstract: BACKGROUND
  Although patients considered "successful" at longer-term follow-up no longer exhibited patellar instability, those with more severe malalignment issues had other, gradually worsening symptoms such as activity-related pain, crepitation, swelling with activities, and pain with weather changes.
  
  
  OBJECTIVE
  Improvement of patellar tracking by correction of the tubercle-sulcus angle and related ligament deficiencies will result in good to excellent results, regardless of the technique employed.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Twenty-five patients with dislocating patellae and significant lower leg deformity were treated; 12 patients (group 1) underwent a derotational high tibial osteotomy and 13 patients (group 2) underwent an Elmslie-Trillat-Fulkerson proximal-distal realignment. All were prospectively evaluated a minimum of 24 months postoperatively with a physical examination, validated outcome questionnaires, radiographs, and computerized axial tomography scans. Postoperative 3-dimensional bilateral gait analyses were performed on all subjects walking on a 3-dimensional force treadmill to measure stance kinematics, foot progression angle, knee flexion, knee valgus-varus, hip flexion, and patella angle. Contralateral limbs with similar preoperative alignment were used as controls.
  
  
  RESULTS
  Group 1 patients significantly improved over their preoperative status in all primary subjective and functional outcome parameters, and were significantly better than group 2 patients. Group 2 patients improved, but not to the degree of group 1 patients. Gait analysis revealed group 1 patients had more symmetrical gait patterns, with less variability and less compensatory gait changes, than group 2 patients.
  
  
  CONCLUSIONS
  The original hypothesis proved to be incorrect. The simultaneous correction of ligament imbalance, excessive tubercle-sulcus angle, and lower limb torsional deformity produced significantly better results than conventional proximal-distal realignment.
authors.affiliation: Andrews-Paulos Research & Education Institute, Gulf Breeze, Florida 32561, USA. lonniepaulos@sbcglobal.net
authors.forename: Lonnie
authors.initials: L
authors.lastname: Paulos
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Swanson
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Sue
authors.initials: S
authors.lastname: Barber-Westin
mesh_terms: D000293:Adolescent; D000328:Adult; D017760:Bone Malalignment / Q000601:surgery*; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D031222:Patellar Dislocation / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult