Minimally Invasive Proximal Patella Realignment (SS-63)

ABSTRACTS The sport ability improved in all cases. The Tegnar sport level was 6.9 and 7.0 respectively before the first dislocation and after surgery. X-ray examination found that the patella congruence angle improved from 27.7°⫾ 7.9° to 1.4° ⫾ 8.1°(P⬍0.01), and the lateral patella angle improved from –1.1° ⫾ 7.4° to 11.8°⫾ 4.9°(P⬍0.01) in average. Conclusion: It is effective to treat recurrent patella dislocation by way of simultaneous arthroscopic patella retinaculum adjustment and Fulkerson’s osteotomy, to prevent recurrence, alleviate symptoms, and restore knee function. Minimally Invasive Proximal Patella Realignment (SS-63). Frank Thomas, MD, John Fulkerson, MD Objective: Our goal was to evaluate outcomes following an all arthroscopic or “mini-open” proximal patella realignment and correlate these with arthroscopic and radiographic findings. Methods: 32 patients (39 knees) with an average age of 25 (range 13-51) underwent a minimally-invasive proximal patella realignment more than 2 years prior to follow-up. Five diagnostic groups were discovered: recurrent dislocations, recurrent subluxation, single dislocation, chondral lesions/ELPS (excessive lateral pressure syndrome), and a combination of chondral lesions with instability. A subsequent realignment operation or lack of improvement constituted a “failure.” Modified Lysholm and Tegner scores were obtained. Outcomes were correlated with the location and extent of chondral lesions documented during arthroscopy. Preoperative radiographs were evaluated to define the Blackburne-Peele index, the sulcus angle, and the congruence angle as well as look for degenerative changes. Relative risks were calculated, and statistical significance was determined using the Chi Square method, with a P value ⬍0.05. Results: With an average follow-up of 44 months (range 24-68 months), 20 of 36 knees (56%) were considered to have a successful result. There were no intraoperative or postoperative complications. Amongst the successful outcomes, the average modified Lysholm score was 82 (range 59-95) and the average Tegner score was 4.5 (range 2-9). 80% (4 out of 5) of patients with a combination of medial patella and trochlea articular lesions failed to improve (relative risk⫽2.1, P⫽0.0744). One (8%) in the success group and eight (62%) of the failures showed radiographic evidence of degenerative changes (relative risk 3.0, P⫽0.0039). Only one of seven knees with patellofemoral degenerative changes did well (RR 2.3, P⫽0.0271).The average congruence angle in the success group was 32.2 degrees (range 8-48) and 44

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degrees (range 32-70) in the failures. The sulcus angle and Blackburne-Peele index were not found to be different between the groups. Of the five diagnostic groups, only 25% (2 of 8 knees) of those being treated for chondral lesions as part of the preoperative diagnosis had a successful outcome (RR⫽2.2, P⫽0.0406). Conclusions: Degenerative changes on x-ray or a combined medial patellar facet and trochlear articular lesion adversely affect the outcome following less-invasive realignment of the patella. When used to treat patellar instability in the absence of these factors, limited open or arthroscopic realignment yields very satisfying results. A lower congruence angle may improve the chance of success. The Use of Poli-Hydrogel Cylindrical Implants to Treat Deep Chondral Defects of the Knee (SS-64). Marco Maiotti, MD, Carlo Massoni, MD, Francesco Allegra, MD Currently there are no definite guidelines and data about the use of synthetic implants to treat deep chondral defects of the knee and in this prospective cohort study we present the clinical and radiological outcomes for a study group of patients who underwent poli-hydrogel cylinders implantations for traumatic femoral chondral defects at mean follow-up of 24 months. Study group data were compared with control group and statistically analyzed. Satisfactory short-term outcomes reported in our study suggest that this technique may represent an effective resurfacing procedure for isolated traumatic chondral defects of the knee in mid-aged people. Purpose: The aim of the present study was to evaluate the clinical outcome of poli-hydrogel cylinders implantations (PHCIs) for isolated chondral defects of the knee. Type of Study: Prospective cohort study. Methods: Eighteen patients (10 males/8 females) with an average age of 56 years (range 47-64) who had a single traumatic chondral defects on the femoral condyle (Outerbridge grade IV ⬍2cm), underwent arthroscopic surgery and PHCIs. Exclusionary criteria: multiple defects, large defects (⬎2cm), unstable knee, meniscal injuries, axial deformities and advanced osteoarthritis. Clinical functional evaluation was carried out according to Lysholm II and Tegner scale. A control group of fifteen patients matched on the basis of sex, age and chondral damage treated by arthroscopic debridement was identified. Statistical analysis was done using t-student test. MRIs were taken preoperatively as well as 12 and 24 months post-operatively.