ABSTRACT
Objective To compare the efficacy of tibial tuberosity osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) with simple TTO in treatment of recurrent patella dislocation associated with patella alta.Methods From July 2010 to December 2015,50 patients with recurrent patella dislocation and patella alta were included in this study.There were 15 males and 35 females with an average age of 20.6 years.These patients received surgical treatment and their clinical data were collected and retrospectively analyzed by case-control study.According to surgical methods,patients were divided into TTO group (32 cases) and MPFLR + TTO group (18 cases).The differences between preoperative status and postoperative status were evaluated by knee function scores including Tegner,international knee documentation committee (IKDC),Kujala scores,knee injury and osteoarthritis outcome score (KOOS).Patellar stability was checked at the last follow-up visit.Results The TTO group and MPFLR + TTO group were followed up for (50.9 ± 17.8) months and (22.3± 10.1)months,respectively.Two patients occurred recurrent dislocation in TTO group,who showed positive in both extrapolation test and extrapolation apprehension test at 0°flexions of knee.All patients in MPFLR + TTO group did not occur recurrent dislocation,who showed negative in both extrapolation test and extrapolation apprehension test at 0° flexions of knee.There was no significant difference between preoperative and postoperative results in TTO group in Tegner score (P ＞ 0.05),KOOS scores in pain and daily life activities subdomains (P ＞ 0.05),while differences in the rest of scores were statistically significant (P ＜ 0.05).Compared with TFO group,the differences of all scores were statistically significant (P ＜ 0.05) and KOOS scores in the pain and daily life activities subdomains were significantly improved postoperatively in MPFLR + TTO group P ＜0.05).Conclusions For patients with recurrent patellar dislocation associated with patella alta,both surgical methods are found to be effective.Postoperative improvements in pain and daily life activities are less obvious in TTO.While postoperative improvements in pain and daily life activities in MPFLR + TTO are superior to those of TTO.
ABSTRACT
<p><b>OBJECTIVE</b>To observe autograft of femoral head for acetabular reconstruction in total hip arthroplasty(THA)without shortening femoral osteotomy for developmental dysplasia of the hip (DDH) with complicated deformity.</p><p><b>METHODS</b>A case series of 18 Crowe type-III-IV DDH patients (19 hips) with osteoarthritis between December 2004 and October 2010 was reported. There were 2 male and 16 female patients. Mean age was 34.3 years (19-44 years) and limb shortening 4.5 cm (3.0-6.2 cm), and preoperative Harris score was 40 ± 17. All cases were accomplished through posterolateral approach by the same surgeon and underwent the procedure of acetabular reconstruction using a bulk femoral head autograft and periarticular soft tissue releases(dissection of the entire articular capsule, scar tissues and osteophytes), but had no procedure of shortening by subtrochanteric transverse osteotomy. Design data through paired t-test compared the preoperative and postoperative Harris scores, also the radiographic observation, in order to asses the clinical efficacy of acetabular reconstruction, while observing the length of limb lengthening, complications and function.</p><p><b>RESULTS</b>Graft coverage of cases in the group were 16%-47% (mean, 26%), with 17 mm of the socket uncovered during operative evaluation. All patients were followed-up for 14-56 months (mean, 34.6 months). The lengthening of the affected limb was 2.9-4.6 cm (mean, (3.6 ± 0.7)cm). The limb-length discrepancy was 0-1.2 cm (mean, (0.6 ± 0.3)cm) after THA. The offset of the affected limbs was 26.4-34.3 cm(mean, (30.5 ± 1.6)cm). The postoperation radiography showed good position of the prosthetic components and coverage of the socket after bone graft was full. All patients had no static contraction abnormality of muscle in the affected limb. Three patients with numbness in lateral leg after the procedure recovered completely in one months. No other complication was observed except heterotopic ossification in 1 case. At the last follow-up examination, Harris hip score was 86 ± 11. There was statistical significance compared with the preoperative score (t = 5.86, P < 0.01) , and no revision was needed in all patients.</p><p><b>CONCLUSION</b>Autograft of femoral head for acetabular reconstruction in THA without shortening femoral osteotomy for developmental dysplasia of the hip (DDH) is an effective procedure to reconstruct acetabulum and improve the socket bone coverage.</p>