Patellofemoral Di̇zi̇li̇m Bozukluğunda Ti̇bi̇al Tüberkül Anteromedi̇ali̇zasyon (Fulkerson) Cerrahi̇si̇ni̇n Orta Dönem Sonuçlari (original) (raw)
Related papers
Patellar height after high tibial osteotomy. Int Orthop
International Orthopaedics
We analysed two series of patients affected by unicompartmental arthrosis or axial malalignment of the knee treated with two different techniques of high tibial osteotomy. Forty-seven knees were treated with a closing wedge osteotomy (CWO) and 40 with an opening wedge osteotomy (OWO). The two groups were comparable with respect to age, gender and deformity. For each patient the patellar height was measured by Caton's method before surgery, and at the latest assessment (at least 1 year after operation). The correction rate for the two series was analysed to assess any possible correlation between the variation of the patellar height and the degree of correction of the knee axis. We concluded that a high tibial osteotomy modifies the patellar height and that this depends on the technique employed. Patellar 'lowering' occurred more often with OWO than with CWO and the latter also produced a high degree of patellar elevation. Résumé Nous avons analysé deux groupes de patients souffrant d'arthrose unicompartimentale ou de déformation angulaire du genou, traités par deux différentes techniques d'ostéotomie tibiale haute: 47 cas ont été traités par une ostéotomie externe de soustraction et 40 par une ostéotomie interne d'addition. Les deux groupes étaient comparables pour la distribution de l'age, du sexe et de la déformation. La hauteur patellaire a été mesurée avant l'opération et à la dernière visite (jamais avant le délai d'un an après l'opération) selon la méthode de Caton. Nous avons évalué entre les deux différents groupes s'il y avait une corrélation de la hauteur patellaire avec la valeur de la correction de l'axe du genou. L'étude démontre que l'ostéotomie tibiale haute modifie la hauteur patellaire selon la technique chirurgicale employée. La réduction de la hauteur patellaire est plus fréquente après une ostéotomie interne d'addition. Après l'ostéotomie externe de soustraction nous avons observé un grand pourcentage d'élévation patellaire.
Statements Concerning the Patellofemoral Joint
Orthopedics and Sports Medicine Open Access Journal, 2020
This is different statements in respect to understanding and treating patients having patellofemoral problems. The statements are based upon scientific data and clinical experience and they reflect the authors opinion. The statements are specifically selected in relation to specific topics with little consensus and/or frequent misunderstandings. Subjects like first time patella dislocations, trochlea anatomy, tibia tubercle trochlea groove distance (TTTG), patella alta, medial patellofemoral ligament reconstructions, trochlear dysplasia, trochleoplasty, anterior knee pain and Hoffa fat pad impingement, will briefly be commented on.
Galeazzi’s modified technique for recurrent patella dislocation in skeletally immature patients
Journal of Orthopaedic Science, 2012
Background A large number of surgical techniques have been proposed for the treatment of recurrent patellar dislocation in adolescents, one of the most famous being Galeazzi's semitendinosus tenodesis as modified by Baker. The aim of this study was to verify the mid-term results of this technique, the effectiveness of restoring the patellofemoral congruency, by both static and dynamic computed tomography (CT), and to determine whether the preoperative type of patellofemoral relationship affects the results. Methods The study included 14 patients (16 knees), with a mean age of 11.6 years, Tanner stage B3, with at least two to three episodes of patellar dislocation. The patients underwent surgery using Baker's modification of Galeazzi's technique. All 14 patients were evaluated preoperatively and at least 4 years afterward by static and dynamic CT. Clinical evaluation at follow-up was performed using the criteria described by Crosby and Insall. Results Clinical results at follow-up were excellent in 62.5% and good in 37.5%. As preoperative evaluation showed a high patella in 7 out of 16 knees, two groups were considered: A, high patella; B, not high patella. The data obtained with static CT show that the patella reached a satisfactory congruence in all knees. The data obtained with dynamic CT showed different results between group A and B. A preoperative high patella remains high with quadriceps contraction and again shows the change of tilt and subluxation. In group B, the data obtained with dynamic CT are comparable with those obtained with static CT. Conclusions This technique produces good mid-term clinical results. However, the dynamic CT showed that in those patients with high patellas, semitendinosus tenodesis alone is not enough to stabilize the patella.
SMAR Patellofemoral Instability Editorial Volume 25, Issue 2
Sports Medicine and Arthroscopy Review, 2017
I t is once again my great pleasure to serve as Guest Editor for the Patellofemoral Instability issue of Sports Medicine and Arthroscopy Review. Much in the world has changed in the 10 years since we published Volume 15, Issue 2, in June of 2007. Navigating the clinical spectrum of patellofemoral disorders still remains one of the greatest challenges facing sports medicine specialists. Although the majority of patellofemoral problems are successfully treated nonoperatively, a subset of patients with recurrent patellar instability who undergo stabilization surgery are among our most grateful patients. The articles in this issue were written specifically to assist clinicians in helping those patients. Although anatomy is timeless, our interpretation of the relationship between structures evolves as we change our perspective on how we look at anatomic structures. In the first paper, Tanaka demonstrates through careful dissection that the "medial patellofemoral ligament" may be more accurately described as "medial patellofemoral complex" as the proximal fibers often attach directly to the quadriceps tendon. Subsequent authors describe technological advances in computational analysis and imaging that have led to improved understanding of the multitude of anatomic and physiologic factors contributing to instability. The subtleties of the clinical examination remain a challenge for clinicians who evaluate the wide range of athletes and nonathletes of all ages who present with diverse clinical pictures. Dixit and Deu describe how nonoperative treatment remains appropriate for the majority of first-time dislocators. D'Amore and colleagues offer their recommendations on when, where, and how far to move the tibial tuberosity in patients with instability and malalignment. In their paper on complications of tibial tuberosity osteotomy, Johnson and colleagues review the potential for adverse outcomes and offer insight into how to prevent hardware and bone-healing complications. Interest in trochlear osteotomy has gradually increased in the United States in the last 10 years. The paper by Diduch's group describes indications for this procedure that will help the reader consider this relatively rare approach to stabilization in athletes with severe trochlear dysplasia. We are most fortunate to have a paper by Andrish on treatment for skeletally immature patients, an update from the paper he wrote in this journal 10 years ago. No issue committed to a surgical topic is complete without a paper dedicated to postoperative rehabilitation, as every experienced surgeon knows that a good surgical effort can lead to an excellent surgical result in the hands of an outstanding physical therapist. I am greatly appreciative of the efforts of the students, physicians, therapists, and engineers who committed their time and energy to make this outstanding issue possible. I would like to take this opportunity to thank the editors of this journal, Ken DeHaven, Dilworth Cannon, and Greg Fanelli, for their longstanding commitment and leadership. On the Cover: The femoral origin of the medial patellofemoral ligament is depicted to be in a sulcus found between the adductor tubercle and the medial femoral epicondyle. Sports Med Arthrosc Rev. 2017;25:100-104.
European Journal of Orthopaedic Surgery and Traumatology, 2005
Treatment of patella infera and arthrofibrosis after total knee replacement (TKR) remains an unsolved problem. Different options have been proposed: patellectomy, proximal transposition of tibial tuberosity, distalization of the femoral component, arthroscopic and open debridment of intraarticular fibrosis. Individual predisposition, mechanical irritation due to technical errors and an aggressive rehabilitation program have been all related as predisposing or causative factors. We present one patient with patella baja and arthrofibrosis with progressive retraction of patellar tendon treated with open arthrolysis and resection of the distal third of the patella in order to lengthen the tendon and prosthetic resurfacing of the remaining two proximal thirds of the patella. Insall-Salvati, Blackburne and Caton indexes were measured from post-operative X-rays after primary surgery to assess that the cause was not an initial component malposition, before and after our revision procedure. Le traitement des patella baja et des capsulites après arthroplastie totale de genou reste un problème non résolu. Différentes solutions ont été proposées : patellectomie, transposition proximale de la tubérosité tibiale antérieure, distalisation du composant fémoral, arthroscopie et débridement intraarticulaire. Prédisposition individuelle, erreurs techniques à l’origine d’irritations mécaniques, rééducation aggressive sont les facteurs prédisposants ou responsables mis en cause. Nous présentons le cas d’un patient présentant une patella baja avec retraction capsulaire et retraction progressive du tendon patellaire, que nous avons traitée par arthrolyse chirurgicale, résection du tiers distal de la patella de manière à allonger le tendon, et resurfaçage prothétique des deux tiers proximaux de la patella. Les index d’Insall-Salvati, de Blackburne et de Caton ont été mesurés sur les clichés post-opératoires initiaux, ainsi que sur les radiographies pré et post révision.
The patella thinning osteotomy
International Orthopaedics, 1992
The authors describe an original procedure, the patella thinning osteotomy, as an alternative to advancement of the tibial tuberosity or patellectomy in cases of severe anterior knee pain. They present an experimental study on cadaveric knees prior to a clinical trial. This study on 13 knee specimens, using Fujifilm Prescale barosensitive film, shows that thinning of the patella by 7 mm diminishes to a significant degree the patellofemoral contact areas from 16.07% at 60° of flexion to 27.90% at 30° of flexion. Patellofemoral joint reacting forces, measured in 12 knees, also diminish in both medial and lateral surfaces at 30°, 60° and 90° of flexion, the level of statistical significance being over 0.05, except for the lateral surface at 60° of flexion. This technique decompresses the patellofemoral joint, and produces the biological effects found after other osteotomies. Les auteurs présentent une technique originale d'amincissement de la rotule, comme alternative à la patellectomie ou à l'avancement de la tubérosité tibiale antérieure chez les malades présentant des douleurs sévères de la face antérieure du genou. Une étude expérimentale, menée sur 13 genoux provenant de membres amputés, a permis de montrer, à l'aide du papier barosensible Fujifilm Prescale, qu'un amincissement de la rotule de 7 mm entraîne une importante diminution de la surface de contact fémoro-patellaire, de 16.07% à 60° de flexion à 27,9% à 30°. Les pressions enregistrées dans 12 cas (une fois la mesure n'a pas été possible) ont diminué aprés l'ostéotomie d'amincissement, aussi bien sur la facette interne de la rotule que sur l'externe à 30°, 60° et 90° de flexion. Le degré de signification statistique est remarquablement élevé, sauf pour les mesures réalisées sur la facette externe à 60° de flexion. Cette technique ajoute donc une décompression aux bénéfices biologiques de toutes les ostéotomies.
Kocatepe Tıp Dergisi
Bu çalışmada Ön çapraz bağ (ÖÇB)'ı sağlam ve ÖÇB'si kopuk olan hastalar arasındaki patellar yükseklik ve tibial tüberkül troklear oluk mesafesi (TT-TGd) arasındaki farkların değerlendirilmesi amaçlanmıştır. GEREÇ VE YÖNTEM: 18-40 yaşları arasında toplam 2019 hasta (1015 ÖÇB kopuk ve 1004 ÖÇB sağlam) çalışmaya dahil edildi. Patellar yükseklik ölçümünü belirlemek için Insall Salvati indeksi (ISI) kullanıldı. TT-TGd, aksiyel manyetik rezonans görüntüleri ile ölçüldü. İki ortopedi cerrahı, gözlemci içi ve gözlemciler arası güvenilirliği değerlendirmek için bağımsız olarak iki hafta ara ile 50 hastanın görüntüsünü inceledi. Ortalama patellar yükseklik ve TT-TGd ölçümleri ÖÇB'si kopuk olan hasta grubu ve sağlam ÖÇB'si olan kontrol grubu ile karşılaştırıldı. BULGULAR: Gözlemci içi ve gözlemciler arası uyum her iki ölçüm için de mükemmeldi (tüm ölçümler için p=0.001 ve k> 0.850). Patellar yükseklik ve TT-TGd, ÖÇB kopuk olan hastalarda kontrol grubuna göre anlamlı olarak daha yüksekti (sırasıyla 1.09 ± 0.37 ile 1.06 ± 0.56, p<0.001, 10.0 ± 3.3'e karşı 8.5 ± 3.0, p<0.001). ISI kadınlarda erkeklere göre anlamlı olarak daha yüksekti (1.13'e karşı 1.07, p<0.001). TT-TGd açısından cinsiyetler arasında anlamlı fark yoktu (9.5'e 9.3, p=0.792). SONUÇ: ÖÇB'si kopuk olan hastalarda patella yüksekliği ve TT-TGd anlamlı olarak artmış olmasına rağmen, bu farklılıklar normal aralıkta oldukları için klinik olarak önemli değildir.