Fulkerson Osteotomy Procedure by Dr. Ted Young, MD
The Fulkerson Osteotomy procedure was originally described in 1983 by J.P. Fulkerson who used the technique to allow for restoration of the extensor mechanism in the knee, without the use of a bone graft, by moving the tibial tubercle anteromedially. The technique allows for proper alignment at the knee with reduction of the patellofemoral contact forces.
Patellofemoral (knee cap) instability is the most common cause of knee pain in active people, both young and old. When there is instability in the patella (knee cap), it can cause pain, limitations in tolerance to activities, and dislocation or subluxation (when the knee cap slips out and back in on its own) at the joint.
Patients who have had patellar dislocations to the lateral side (outside), typically result in a medial patellofemoral ligament (MPFL) injury. The MPFL is reported to provide up to 60% of the resistance to lateral translation of the patella with normal activities. Without appropriate integrity of the MPFL, recurrent instability and pain is likely possible. In patients who have one incident of traumatic patellar dislocation, conservative treatment or a MPFL reconstruction, alone, may be sufficient courses of treatment. But, in cases of multiple episodes of instability, correction of the patellofemoral alignment is necessary.
When subluxations become recurrent, the cause of instability is addressed and/or the pain is consistent with patellofemoral instability, and all other conservative options have been exhausted, a Fulkerson procedure may be the best treatment option.
There are many technical terms and measurements that go into determining if a patient is a good candidate for a Fulkerson procedure. Your doctor would recommend you to get an MRI to determine if your anatomy and symptoms match up to create the ideal surgical treatment option. If your doctor uses technical terms such as you having lateralization (when the knee cap has a shift to the outside of the knee joint) of the tibial tubercle with an increased tubercle to trochlear groove distance, a large Q-angle and/or a MPFL tear, considering the Fulkerson procedure may be a good conversation to have with them, in order to establish proper alignment and minimize recurrent instability.
Recovery from this procedure is long and challenging. In order to be a good candidate for this procedure, you must have to have the anatomy and symptoms that warrant it, but you also need to make sure you are mentally tough for the demanding and challenging recovery process. The rehabilitation, following the procedure, is long, challenging and requires self-discipline. Each doctor will have some variations to the rehabilitation protocol, but generally, the patient is immobilized in a knee brace for the first 6 weeks and weight bearing on the leg may be limited during this time. During physical therapy, range of motion of the knee will be restricted within a specific range, set by the doctor, and the therapist may have to push the range to achieve the desired motion.
Rehabilitation is progressive and guided based on tissue integrity and proper healing time. Prior to considering surgery, you need to make sure you have a good support system and that you are mentally and physically dedicated to the rehabilitation process.
The return to full activities ranges 6-12 months, with continuous effort and progression.
If you think you are a candidate for the Fulkerson Osteotomy procedure, or would like more information regarding your symptoms, contact an orthopedic surgeon who is skilled in this procedure. Please call JOI-2000.
Dr. Young is board certified by the American Board of Orthopaedic Surgery. He practices at the JOI Beaches Clinic. Dr. Young is a member of the Baptist Center for Joint Replacement team at Baptist Beaches.
Ferrari M.B., Sanchez G., Kennedy N.I., Osteotomy of the Tibial Tubercle for Anteromedialization. Arthrosc Tech. 2017; 6(4): e1341-e1346