Single or Combined Maquet III Osteotomy: Long Term Results

Abstract

INTRODUCTION: In 1963, based on biomechanics studies, Maquet proposed the advancement of the patellar tendon insertion as a mean of treating patellofemoral pain. The rationale for this procedure was a reduction in the patellofemoral compression force vector by changing the angular relationship between patella tendon and quadriceps tendon. One of the additional procedures, on a malalign knee, was performing a cupuliform osteotomy above the tibial tuberosity (COATT). OBJECTIVES: Evaluating, on a retrospective and comparative trial, the clinical and radiological long-term outcomes of the patients who underwent a single (M) or combined (MC) Maquet III osteotomy, in order to determine if this surgery as or not fulfilled its initially objectives. METHODS: All surgical records of the Service, between 1970 and 1991, were reviewed. We identify 116 cases registered as “M” or “MC” Maquet III osteotomy. A questionnaire as been prepared for collecting data. We evaluated the preoperative complaints, postoperative complications and range of motion recovery time, as well as the postoperative pain absence period. All patients underwent an objective assessment by the Visual Analog Scale (VAS) and the Kujala Patellofemoral Scoring System (KPFSS). A radiological assessment was also made in order to evaluate the arthrosis degree and compartment affected, the Bicondylo-Patellar Angle (BPA) and the Caton-Deschamps Index (CDI). Mann-Whitney, t-Student and Chi-Square tests were applied for statistical evaluation. p <0.05 was considered statistically significant. RESULTS: According to the study criteria, from the 116 selected patients we could review in our clinics 49 Maquet III osteotomies (n= 25 “M” group vs n=24 “MC” group) . On the “M” group, the average age at surgery was 37.6 ±12.0 years and the postoperative follow-up 27.1 ±3.15 years, versus 56,5 ±6,8 years at surgery and a 23,2 ±3,4 postoperative follow up years on the “MC” group. Prior range of motion was accomplished 4.8 ±3.5 months after surgery on the “M” group versus 6,7 ±3,5 months on the “MC” group (p=0,017). About complications, on the “M” group we have 16,0% (n=4) versus 16,6% (n=4) (p=0,763). The “M” group presented40% (n=10) patients who haven’t referred pain until nowadays versus 38,5% (n=5) (p=0,85), and the average period of of pain absence was 20.5 ±5.7 years on the “M” group versus 11,0 ±1,7 (p=0,001). At the COX score, 58,3% (n=14) of the “M” group had good to excellent outcomes versus 53,8% (n=7) (p=0,793). VAS at rest was 1.7 ±0.7, in activity 4.4±3.0 and KPFSS 61.9 ±22.3 points on the “M” group versus 1,1 ±0,3 (p=0,016), 4,3 ±2,0 (p=0,883) and 54,7 ± 16,9 (p=0,364) points on the “MC” group. Radiologically, BPA was 6.3 ±3.9° and CDI 0.9 ±0.1 on the “M” group versus 11,8 ±3,9 (p=0,000) and 0,9 ±0,2 (p=0,99) on the “MC” group. Nowadays, at the“M” group,58,3% (n=14) had a grade I/II of Kellgren&Lawrence at patellofemoral joint and 79,2.% (n=19) at the femorotibial joint versus 53,8% (n=7) (p=0,793) and 46,2% (n=6) (p=0,041). CONCLUSION: With a cut off follow-up period higher than 20 years, the Maquet III group presented58,3% of good to excellent outcomes with patients presenting a majority of low grade osteoarthritic knee. The COATT procedure hasn’t increased the postoperative complications nor worsen the funcional outcomes. On the other side, the femorotibial grade of arthritis was higher on this group