Return to Work Following Tibial Tubercle Osteotomy for Patellofemoral Osteoarthritis and Pain.

PURPOSE: To evaluate the ability of patients to return to work following anteromedialization (AMZ) tibial tubercle osteotomy (TTO) due to isolated patellofemoral osteoarthritis or pain. METHODS: Consecutive patients undergoing AMZ TTO were reviewed retrospectively at a minimum of 1 year postoperatively. Patients completed a subjective work questionnaire, a visual analog scale for pain, as well as a Kujala questionnaire and satisfaction questionnaire. RESULTS: Fifty-seven patients (61 knees; average age: 32.7 ± 9.6 years) were contacted at an average follow-up of 4.86 ± 2.84 years postoperatively. The preoperative Kujala score improved from 55.7 ± 17.8 to 84.6 ± 15.8 at final follow-up (P < 0.001). Thirty-seven patients (64.9%) were employed within 3 years prior to surgery and 34 patients (91.9%) were able to return to work by 2.8 ± 2.6 months postoperatively. However, only 27 patients (73.0%) of patients were able to return to the same level of occupational intensity. Patients who held sedentary, light-, medium-, or high-intensity occupations were able to return to work at a rate of 100.0%, 93.8%, 77.8%, and 100.0% by 2.2 months, 3.0 months, 3.1 months, and 4.0 months, postoperatively. No patients underwent revision TTO or conversion to arthroplasty by the time of final follow-up. CONCLUSION: In patients with focal patellofemoral osteoarthritis or pain, AMZ TTO provides a high rate of return to work (91.9%) by 2.8 ± 2.6 months postoperatively. Patients with higher intensity occupations may take longer to return to work than those with less physically demanding occupations. LEVEL OF EVIDENCE: III

ERRATUM: Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient

Due to a technical error, part of the surname of an author (i.e. Stein instead of Shubin Stein) was omitted in the original published version of this paper [Orthop Rev (Pavia). 2013;5:45-7. doi: 10.4081/or.2013.e9]

Does Ligamentous Laxity Protect Against Chondral and Osteochondral Injuries in Patients With Patellofemoral Instability?

Background: Many patients undergoing medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability have chondral or osteochondral injuries requiring treatment. Hypothesis: In patients undergoing MPFL reconstruction for patellofemoral instability, those with ligamentous laxity (LAX) would be less likely to have chondral or osteochondral defects requiring surgical intervention compared with those with no laxity (NLX). Study Design: Cohort study; Level of evidence, 2. Methods: Included were 171 patients with patellofemoral instability (32 men, 139 women; mean age, 22 years [range, 11-57 years]) who underwent MPFL reconstruction between 2005 and 2015. Patients with a Beighton-Horan score ≥5 were considered LAX (n = 96), while patients with scores(n = 75). Preoperative magnetic resonance images were evaluated to determine the presence, size, and location of chondral or osteochondral injury as well as the grade according to the Outerbridge classification. Documented anatomic measurements included tibial tubercle-trochlear groove (TT-TG) distance, Caton-Deschamps Index (CDI) for patellar height, and the Dejour classification for trochlear dysplasia. Results: Of the 171 patients, 58 (34%) required a surgical intervention for a chondral or osteochondral defect: chondroplasty (29/58; 50%), particulated juvenile cartilage implantation (18/58; 31%), microfracture (16/58; 28%), osteochondral fracture fixation (2/58; 3.4%), and osteochondral allograft (2/58; 3.4%). While there was no statistical difference in the proportion of patellar chondral or osteochondral injuries between patients with NLX (58%) versus LAX (67%) ( Conclusion: For patients who sustained patellar or femoral chondral or osteochondral injuries, compared with their counterparts with NLX, patients with LAX were less likely to have severe (grade 3 or 4) injuries requiring surgical intervention