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Treatment of Fulkerson Procedure
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Treatment of Fulkerson Procedure - February 3, 2006 3:35:00 AM
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evo8grl
Posts: 6
Joined: May 29, 2005
From: Maine
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I can not find much information about the Fulkerson Procedure and rehab. I know that it is a distal re-alignment so the patella can track properly. Does anyone have experience treating this? I have had one doctor tell me only closed-chain exercises, while another gave no recommendations. I know that I should not be doing LAQ's and SAQ's to avoid putting too much stress through the tendon. Any suggestions on good exercises?
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Re: Treatment of Fulkerson Procedure - February 3, 2006 4:10:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Much like the lateral release procedure, this was once widely done but now considered by most to be little more than ritual mutiliation.
However, with the correct patient selection, I'm sure it could be beneficial in theory.
Depending on the time out of surgery, I would first get full passive extension. I would do a lot of proprioceptive work, and add resistance through the range of motion (open or closed chain) slowly. It's easy to aggravate the surgical site with PREs too early. I have found loaded SLRs and proprioceptive stuff the best early on, and progress slowly into the strength. I agree that closed chain stuff is the way to go.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Treatment of Fulkerson Procedure - February 3, 2006 5:03:00 PM
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eam
Posts: 290
Joined: February 5, 2004
From: New York, NY 10028
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I recently discharged a patient with a similiar procedure along with a lateral release. (a recipe for disaster in my mind!).
Her leg was blown up like a grapefruit when I first saw here-after that was under control, I actually used mostly closed chain exercises with her-focus on the obvious deficits. This patient was very hypermobile and needed alot of strengthening in her pelvis as well as her quads. I spent a vast amount of time on her glut medius.
Good luck!
Erica
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Re: Treatment of Fulkerson Procedure - February 7, 2006 5:39:00 AM
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mcap56
Posts: 617
Joined: October 26, 2002
From: New York, NY
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We treated someone who had the procedure performed by Fulkerson. This patient was non weightbearing, for at least 4 weeks. After that the protocol was very conservative. You really need to work in close conjunction with the surgeon on this one. I am not saying it makes sense or that their protocol is superior. But, it is a big procedure and everything is uncharted territory. If you follow protocol, at least you have that cover.
Met her at a party a few years later. Knee hadn't improved over prior status.
mcap
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Re: Treatment of Fulkerson Procedure - February 7, 2006 6:35:00 AM
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jimptdpt
Posts: 29
Joined: December 1, 2003
From: Medway, Ma, usa
Status: offline
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I saw a couple of these years ago. We used to call them tibial tubracle transfers. They will remove the tubracle and reposition it, holding it in place using a screw. They will be non or min weightbearing for a while. Like Jason said extension is everything.
One of the doctors was telling me a horror story of one of his tibial tubracle transfers, that was non weightbearing. He allowed the patient to go swimming, but still non weightbearing. Te patient decided to jump on the diving board. The screw worked as a awl and split the tibia.
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