Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques.
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.
Paulos
Lonnie
L
Andrews-Paulos Research & Education Institute, Gulf Breeze, Florida 32561, USA. lonniepaulos@sbcglobal.net
Swanson
Stephen C
SC
Stoddard
Gregory J
GJ
Barber-Westin
Sue
S
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