Treatment of Objective Patellofemoral Instability

  • Federico Alfano Hospital Español de Buenos Aires
DOI: https://doi.org/10.15417/431

Abstract

The aim of this study is to show the different surgical procedures for treating the objective patellar instability, including the different tibial tubercle osteotomies and the sulcus deepening trochleoplasty.  This study analyzed the Caton-Deschamps index used for assessment of patellar height, the distance from the tibial tubercle to the troclear groove (TT-TG) on CT Scan in the axial view, and the different trochlear and patellar morphotypes.  This study included 11 knees (11 patients) treated in an objective and documented patellofemoral instability.  We have had good results with both the transfer of the tibial tuberosity as the trochleoplasty.  A reconstruction of the medial patellofemoral ligament was performed in both procedures.  Recurrence of instability is very rare after these procedures and this is more likely to result from missed associated abnormalities.  Accurate preoperative planning of the patellar height and determining the location of the tibial tubercle and the trochlear and patellar morphotypes for satisfactory results are required.  However, as with any surgical procedure, both tibial tubercle  osteotomy and the sulcus deepening trochleoplasty are susceptible of complications. Key words: objective patellar instability, trochleoplasty, tibial tubercle osteotomies.

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References

Dejour H, Walch G, Neyret P, Adeleine P. La dysplasie de la trochlée fémorale. Rev Chir Orthop 1990; 76:45–54.

Dejour H, Walch G, Nove Josserand L, Guier CH. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2:19–26.

Caton J, Deschamp G, Chambat P, Lerat JL, Dejour H. Les rotules basses (Patellae inferae) A propos de 128 observations. Rev Chir Orthop 1982; 68:317–325.

Caton J. Méthode de mesure de la hauteur de la rotule. Acta Orthop Belg 1989; 55:385–386.

Bernageau J, Goutallier D. Examen radiologique de l’articulation fémoro-patellaire. In: L’actualité rhumatologique, de Seze et al. Expansion Scientifique Française, Paris, pp 105–110. 1984.

Goutallier D, Bernageau J, Lecudonnec B. Mesure de l’écart tubérosité tibiale antérieure-gorge de la trochlée (TA. GT). Technique Résultats Intérêts. Rev Chir Orthop 1978;64:423–428.

Pors WRR, Fulkerson JP. Distal realignment of the patella femoral joint. Indications, effects, results and recommendations. Orthop Clin North Am 1992; 23:631–643.

Shabshin N, Schneitzer ME, Morrison WB, Parker L. MRI Criteria for patella alta and Baja. Skelet Radio 2004; 33:445–450.

Trillat A, Dejour H, Couette A. Diagnostic et traitement des subluxations récidivantes de la rotule. Rev Chir Orthop 1964; 50:813–824.

Masse Y. Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot 1978; 64:3–17.

Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality Int Orthop. 2010 Feb;34(2):305-9.

Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007 May;35(5):801-4.

Dejour D, Saggin P. The sulcus deepening trochleoplasty—the Lyon’s procedure. Int Orthop 2010; 34(2):311–316.

Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 2007; 15(1):39–46.

Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med 2002; 21(3):499–519.

Dejour D, Byn P, Ntagiopoulos PG. The Lyon's sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. Int Orthop. 2013 Mar;37(3):433-9.

Thaunat M, et al. Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res. 2011 Dec;97(8):833-45.

Nelitz M, Dreyhaupt J, Lippacher S. Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J Sports Med. 2013 May;41(5):1005-12.

Published
2016-02-19
How to Cite
Alfano, F. (2016). Treatment of Objective Patellofemoral Instability. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(1), 35-41. https://doi.org/10.15417/431
Issue
Vol 81 No 1 (2016)
Section
Clinical Research

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