ObjectivesTo assess the effectiveness of a modified tibial tubercle osteotomy
as a treatment for arthroscopically diagnosed chondromalacia patellae.MethodsA total of 47 consecutive patients (51 knees) with arthroscopically
proven chondromalacia, who had failed conservative management, underwent
a modified Fulkerson tibial tubercle osteotomy. The mean age was
34.4 years (19.6 to 52.2). Pre-operatively, none of the patients
exhibited signs of patellar maltracking or instability in association
with their anterior knee pain. The minimum follow-up for the study
was five years (mean 72.6 months (62 to 118)), with only one patient
lost to follow-up.ResultsA total of 50 knees were reviewed. At final follow-up, the Kujala
knee score improved from 39.2 (12 to 63) pre-operatively to 57.7
(16 to 89) post-operatively (p < 0.001). The visual analogue
pain score improved from 7.8 (4 to 10) pre-operatively to 5.0 (0
to 10) post-operatively. Overall patient satisfaction with good
or excellent results was 72%. Patients with the lowest pre-operative
Kujala score benefitted the most. Older patients benefited less
than younger ones. The outcome was independent of the grade of chondromalacia.
Six patients required screw removal. There were no major complications.ConclusionsWe conclude that this modification of the Fulkerson procedure
is a safe and useful operation to treat anterior knee pain in well
aligned patellofemoral joints due to chondromalacia patellae in
adults, when conservative measures have failed.
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