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Fulkerson osteotomy successfully addresses most common cause of pediatric knee pain

Fulkerson osteotomy successfully addresses most common cause of pediatric knee pain

In 1983, the Fulkerson osteotomy was created to surgically address the most common cause of knee pain in active people of all ages – patellofemoral (kneecap) instability. Fast forward to 2020: Shriners Hospitals for Children — Greenville’s T. Whitney Gibson, D.O., has now successfully completed over 50 of these life-improving operations, applying his pediatric orthopaedic expertise to the youngest patients who are able to benefit from the procedure.

“A child must first reach skeletal maturity before they are a candidate for the Fulkerson osteotomy,” explained Dr. Gibson. “After that milestone, if there is an excessive lateral pull of the patella greater than 20 degrees with knee in extension (straight out) or 10 degrees with knee in flexion (bent) – we consider that an abnormal Q-angle, which can be corrected using this technique. Using the Fulkerson method, we cut the tibial tubercle, which connects the patellar tendon that runs on the bottom of the kneecap to the tibia (shinbone). We then are able to move it upward and medially.”

This condition is more common among girls, Dr. Gibson notes, due to the female body’s wider pelvis. This results in a higher potential for elevated lateral tension affecting the patella. For either sex, the growth plate must be fully closed in order to perform the Fulkerson osteotomy.

“One thing that sets the Greenville Shriners Hospital apart is our motion analysis center,” said Dr. Gibson. “We are able to study the gait of each individual patient, which offers incredibly insightful information to determine if the Fulkerson method is the best approach for that specific individual.”

Rehabilitation, available under the same roof as outpatient and surgical appointments, is part of the hospital’s multidisciplinary approach to care, and is an instrumental part of the recovery process. Physical therapy begins before and resumes soon after the operation, and continues for eight weeks to three months. 

Most patients are able to enjoy all activities again six to eight months following the Fulkerson osteotomy operation.