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Fulkersons Osteotomy

 
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Fulkersons Osteotomy - February 25, 2011 11:17:34 AM   
seanjr

 

Posts: 3
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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?

Thank you for your help. 
Post #: 1
RE: Fulkersons Osteotomy - February 25, 2011 12:52:34 PM   
bonez

 

Posts: 701
Joined: August 29, 2007
Status: offline
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.

(in reply to seanjr)
Post #: 2
RE: Fulkersons Osteotomy - February 25, 2011 1:36:15 PM   
seanjr

 

Posts: 3
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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.


(in reply to bonez)
Post #: 3
RE: Fulkersons Osteotomy - February 27, 2011 11:13:54 AM   
VagusX

 

Posts: 339
Joined: March 27, 2003
From: Savannah, GA, USA
Status: offline
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.

(in reply to seanjr)
Post #: 4
RE: Fulkersons Osteotomy - February 28, 2011 2:19:42 PM   
seanjr

 

Posts: 3
Status: offline
Thank you VagusX.

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.


(in reply to VagusX)
Post #: 5
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