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

Patellofemoral joint chondral lesions (PFCLs) are one of the most common chronic knee problems in all populations in young adults. Despite their high frequency, there is still no consensus about treatment options. All PFCL grades can be treated with surgery, nonoperative treatment, or both.

The purpose of this study was to compare patients with PFCLs who underwent Fulkerson osteotomy surgery followed by physical therapy and rehabilitation with those patients who only received physical therapy and rehabilitation. It was hypothesized that patients who underwent unilateral Fulkerson osteotomy surgery would have superior results compared with patients who only received nonoperative treatment.

Cohort study; Level of evidence, 3.

This was a prospective study with a case-control design and included 20 patients who underwent Fulkerson osteotomy and 20 patients with PFCL who were managed nonoperatively. The follow-up period was a median of 13.25 months (range, 12.03-14.71 months) for patients who underwent Fulkerson osteotomy and 12.85 months (range, 12-14.37 months) for patients who were treated nonoperatively. Knee joint position sense and gait kinematics were assessed using the DrGoniometer Application and Zebris FDM-T device. The functional level was determined using the single-leg hop test, the single-leg squat test, and the Kujala subjective knee evaluation form.

When comparing gait kinematics of the affected sides between patients who underwent Fulkerson osteotomy and those who received nonoperative treatment (physical therapy and rehabilitation only), differences were observed in step length, cadence, stance phase percentage, and swing phase percentage (P < .05). In knee joint position sense of the affected sides at 60° target angle, patients who underwent Fulkerson osteotomy had significant improvements after surgery (P < .05), whereas patients who were managed nonoperatively showed continued impairment both before and after treatment (P < .05). No significant differences were observed in single-leg hop and single-leg squat test results between the 2 groups (P > .05). Kujala scores were significantly higher in the Fulkerson osteotomy group (89.79 ± 12.67 vs 80.10 ± 13.20, respectively) (P < .05).

Patients who underwent Fulkerson osteotomy had superior gait kinematics, joint position sense at 60° of flexion, and Kujala scores. No significant changes were observed in terms of the joint position sense at 15°, 45°, and 90° of flexion, the single-leg hop test, and the single-leg squat test compared with those who received nonoperative treatment.