Hello all, I have been reading here for a long time, this is my first post and am seeking some opinions.
I have a 50 y/o female with B CMP Grade III - Grade IV. Pt has had B knees scoped and has had several series of Synvisc / Supartz injections on B knees. R knee MRI impression reads: Postsurgical changes with truncation of the posterior horn of the MM. Chondromalacia patella Grade III - Grade IV. The articular cartilage of the medial and lateral knee comparments appear relatively well preserved. MD recently recommended a Fulkersons Osteotomy. I have seen a few of these over the years and most pts have struggled after this surgery.
How are your outcomes for pts with a Fulkersons Ostoeotomy? Would you recommend this surgery or would you have reservations about recommending this surgery?
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I have not seen any great success postcards for this. I have run into 2 that subsequently went on to full replacements that created some difficulty due to the angulation. I suspect that some of that maybe worth having the patient raise with the surgeon before they consent.
Thanks for the input bonez, that was the general feeling I had. You bring up an excellent point with the change in mechanics (from the Fulkersons) affecting the ability of the surgeon to perform a high quality replacement later on.
The pt has seen several ortho's and every opinion is that she is not a candidate for replacement. She is willing to have a TKR, but her articular cartilege does not show enough degeration to justify a TKR otherwise I imagine one of the ortho's would have been more then willing to perform surgery.
The pts that I saw that I can remember that had this surgery were younger (20's -30's) dealing with PFS and were not progressing towards a replacement, so again thank you.
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I've seen 2 in my life. Outcomes were decent, both were bilateral (one at a time) but they were in my clinic for 6 months. No FWB for 12 weeks! The quads were shot for a very long time creating some major instability issues. I remember it took one a few weeks to eek out a independent ECCENTRIC SLR. And they were both younger female in their 30's. A Fulkerson for a 50's y/o female? Yikes. Get ready for a long one. Does the patient have a positive J-sign, patella apprehension and how is her patella mobility? How does taping and/or medialization of the patella help the patient? How is the quad?
The main problem I have with these types of surgeries is that it ususally is a product of back physical therapy management. Most of the time for these severe chronic PFPS patients were are seeing them for 6 weeks getting them some better, having them regress and then folding in for the surgery. Chronic PFPS needs months of management. Once I get my PFPS patient rolling I just keep tabs on them for the next 4 months with a visit 2QW to QM to see progress. I would never recommend a realignment procedure based on what I have seen unless the patient had at least 6 months of "good" rehab.
We have been working on quad strength for 2 months, pt came to us very deconditioned, was tolerating very limited (10-15 min) of therex initally. Now up to 45 - 50 min of therex with focus on quad/VMO strengthening.
Recently began medial glide taping which has significantly decreased her pain with community ambulation and stairs.
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