Survival and clinical results of a modified "crosse de hockey" procedure for chronic isolated patellofemoral joint osteoarthritis: mid-term follow-up

Hiroaki Kanazawa,Kazuo Kaneko,Yuichiro Maruyama,Minoru Yokoyama,Katsuo Shitoto

doi:10.1007/s10195-016-0428-5

Abstract

BackgroundThe optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA.Materials and methodsWe assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. The mean age was 57.6 years (range, 46–75 years) and mean follow-up was 90.1 months (range, 24–216 months). We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up.ResultsThe Kujala score (mean improvement of 46.7, P < 0.001) and the Fulkerson score (mean improvement of 19, P = 0.001) were significantly higher compared to preoperative values. Overall clinical results rated excellent in 24.3 %, very good in 21.6 %, good in 35.1 %, fair in 13.5 %, and poor in 5.4 % of knees. Patellar tilting (P = 0.015) and congruence angle (P = 0.018) significantly improved postoperatively. On the other hand, the Insall-Salvati index decreased at the time of follow-up, although it remained in the physiologic range. Postoperatively, consecutive disease progression in the tibiofemoral joint and patellofemoral joint osteoarthritis were 18.9 and 5.4 %, respectively. The operative complication rate was 5.4 % in this case series. These percentages were lower than those of alternative tibial tuberosity osteotomy techniques.ConclusionIn most patients with chronic isolated PFJ-OA, tibial tuberosity osteotomy by modified crosse de hockey is a reliable procedure that provides good/excellent mid-term clinical results.Level of evidenceLevel IV.

Highlights

PFJ arthritic changes begin with joint space narrowing at the lateral facet
Materials and methods The operative indications are painful patellofemoral joint osteoarthritis (PFJ-OA) resistant to conservative treatment for at least 4–6 months; radiographic tibiofemoral joint osteoarthritis (TFJ-OA) without symptoms or with clinically mild symptoms was included in this study
The findings of this study showed that the crosse de hockey procedure is useful for managing chronic isolated PFJ-OA from a clinical, radiographic point of view at the mid-term follow-up

Summary

Introduction

PFJ arthritic changes begin with joint space narrowing at the lateral facet. PFJ arthritic changes in isolation have been found in 13.6–24 % of women and in 11–15.4 % of men in two studies of subjects who were more than 55 and 60 years old, respectively. There are a variety of surgical procedure options, but the optimal treatment for isolated PFJ-OA is unclear. The optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA. Materials and methods We assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up.

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