Fulkerson Osteotomy Effect on Knee Joint Position Sense, Gait Kinematics, and Functional Level

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Patellofemoral joint chondral lesions (PFCLs) are common in young adults, with no established treatment consensus.
• Treatment options for PFCLs include surgery, nonoperative management, or a combination of both.
• This study investigates the efficacy of Fulkerson osteotomy combined with rehabilitation versus rehabilitation alone for PFCLs.

Purpose of the Study:

• To compare outcomes of Fulkerson osteotomy plus physical therapy versus physical therapy alone in patients with PFCLs.
• To determine if unilateral Fulkerson osteotomy surgery yields superior results compared to nonoperative treatment.
• To evaluate the impact of surgical intervention on gait kinematics, joint position sense, and functional knee assessment.

Main Methods:

• Prospective cohort study with a case-control design, including 20 patients in each group (Fulkerson osteotomy vs. nonoperative).
• Follow-up duration averaged 13 months for both groups.
• Assessment included gait analysis (Zebris FDM-T), knee joint position sense (DrGoniometer Application), and functional tests (single-leg hop, single-leg squat, Kujala score).

Main Results:

• Fulkerson osteotomy group showed significant improvements in gait parameters (step length, cadence, stance/swing phase percentages) and knee joint position sense at 60° flexion.
• Patients undergoing nonoperative treatment exhibited persistent impairments in joint position sense.
• Kujala scores were significantly higher in the Fulkerson osteotomy group (89.79) compared to the nonoperative group (80.10).

Conclusions:

• Fulkerson osteotomy surgery leads to superior gait kinematics and improved knee joint position sense at 60° flexion in PFCL patients.
• The surgery also resulted in better subjective functional outcomes, as indicated by higher Kujala scores.
• No significant differences were found in single-leg hop or squat tests between the surgical and nonoperative groups.