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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2020, Number 6

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Acta Ortop Mex 2020; 34 (6)

Treatment of objective patellar instability. Results after five years of follow-up

Alfano F, Spreafico W, Del SJ

Language: Spanish
References: 39
Page: 403-411
PDF size: 403.12 Kb.


ABSTRACT

Objective: To present the different surgical procedures in the treatment of objective femoropateral instability, including osteotomy of anterior tibial tuberosity and femoral trocleoplasty. Material and methods: With a prospective 5-year follow-up design that included 21 patients (21 knees) treated for relapsing patellar dislocation between March 2010 and August 2014, treated surgically using 2 different techniques depending on the type of basic structural instability. To determine this, the Caton-Deschamps X-Ray Index (for the evaluation of the patellar height) and tomographic parameters were analyzed to assess the troclear configuration and distance from the anterior tibial tuberosity to the femoral trochlea (TT-TG) in the overlapping of images in the axial plane. Results: We have had satisfactory results both with the transfer of the anterior tibial tuberosity and with the trocleoplasty. In both procedures, a reconstruction of the medial patelo-femoral ligament (LPFM) was performed. Conclusion: Recurrence of instability is very rare after these procedures and is more likely to result from undiagnosed or underestimated associated abnormalities. Precise preoperative planning is required to determine the patellar height, location of the anterior tibial tuberosity, and troclear configuration for satisfactory results.


REFERENCES

  1. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004; 32(5): 1114-21.

  2. Dejour H, Walch G, Neyret P, Adeleine P. La dysplasie de la trochlée fémorale. Rev Chir Orthop Reparatrice Appar Mot.. 1990; 76(1): 45-54.

  3. Dejour H, Walch G, Nove Josserand L, Guier CH. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994; 2(1): 19-26.

  4. 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: 317-25.

  5. Caton J. Méthode de mesure de la hauteur de la rotule. Acta Orthop Belg. 1989; 55: 385-6.

  6. Bernageau J, Goutallier D. Examen radiologique de l'articulation fémoro-patellaire. In: L'actualité rhumatologique, de Seze et Coll. Expansion Scientifique Francaise, Paris, 1984, 105-10.

  7. Goutallier D, Bernageau J, Lecudonnec B. Mesure de l'écart tubérosité tibiale antérieure-gorge de la trochlée (TA. GT). Technique Résultats Intérets. Rev Chir Orthop. 1978; 64: 423-8.

  8. Pors WRR, Fulkerson JP. Distal realignment of the patella femoral joint. Indications, effects, results and recommendations. Orthop Clin North Am. 1992; 23: 631-43.

  9. Shabshin N, Schneitzer ME, Morrison WB, Parker L. MRI Criteria for patella alta and baja. Skelet Radiol. 2004; 33(8): 445-50.

  10. Trillat A, Dejour H, Couette A. Diagnostic et traitement des subluxations récidivantes de la rotule. Rev Chir Orthop Reparatrice Appar Mot. 1964; 50: 813-24.

  11. Masse Y. Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot. 1978; 64(1): 3-17.

  12. Rogers BA, Thornton-Bott P, Cannon SR, Briggs TW. Interobserver variation in the measurement of patellar height after total knee arthroplasty. J Bone Joint Surg Br. 2006; 88(4): 484-8.

  13. Tavernier T, Dejour D. Knee imaging: what is the best modality. J Radiol. 2001; 82(3 Pt 2): 387-8.

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

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

  16. Dejour D, Saggin P. The sulcus deepening trochleoplasty-the Lyon's procedure. Int Orthop. 2010; 34(2): 311-6.

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

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

  19. Zaffagnini S, Previtali D, Tamborini S, Pagliazzi G, Filardo G, Candrian C. Recurrent patellar dislocations: trochleoplasty improves the results of medial patellofemoral ligament surgery only in severe trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. 2019; 27(11): 3599-613.

  20. Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, et al. Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc. 2014; 22(11): 2591-8.

  21. 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; 41(5): 1005-12.

  22. McNamara I, Bua N, Smith TO, Ali K, Donell ST. Deepening trochleoplasty with a thick osteochondral flap for patellar instability: clinical and functional outcomes at a mean 6-year follow-up. Am J Sports Med. 2015; 43: 2706-13.

  23. Balcarek P, Zimmermann F. Deepening trochleoplasty and medial patellofemoral ligament reconstruction normalize patellotrochlear congruence in severe trochlear dysplasia. Bone Joint J. 2019; 101-B(3): 325-30.

  24. Hiemstra LA, Peterson D, Youssef M, Soliman J, Banfield L, Ayeni OR. Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2019; 27(9): 2967-83.

  25. Ntagiopoulos PG, Byn P, Dejour D. Midterm results of comprehensive surgical reconstruction including sulcusdeepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med. 2013; 41(5): 998-1004.

  26. Donell ST, Joseph G, Hing CB, Marshall TJ. Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee. 2006; 13(4): 266-73.

  27. Rouanet T, Gougeon F, Fayard JM, Rémy F, Migaud H, Pasquier G. Sulcus deepening trochleoplasty for patellofemoral instability: a series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res. 2015; 1014: 443-7.

  28. Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc. 2005; 13(7): 529-33.

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

  30. Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P. 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; 97(8): 833-45.

  31. Laidlaw MS, Feeley SM, Ruland JR, Diduch DR. Sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar instability. Arthrosc Tech. 2018; 7(2): e113-23.

  32. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med. 1997; 25(4): 533-7.

  33. Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res. 2007; 463: 187-94.

  34. Henderson IJ, Lavigne P. Periosteal autologous chondrocyte implantation for patellar chondral defect in patients with normal and abnormal patellar tracking. Knee. 2006; 13(4): 274-9.

  35. Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res. 2005; 436: 30-9.

  36. Silvello L, Scarponi R, Guazzetti R, Bianchetti M, Fiore AM. Tibial tubercle advancement by the Maquet technique for patellofemoral arthritis or chondromalacia. Ital J Orthop Traumatol. 1987; 13(1): 37-44.

  37. Saltzman BM, Rao A, Erickson BJ, Cvetanovich GL, Levy D, Bach BR Jr, et al. Systematic review of 21 tibial tubercle osteotomy studies and more than 1000 knees: indications, clinical outcomes, complications, and reoperations. Am J Orthop (Belle Mead NJ). 2017; 46(6): E396-407.

  38. Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J 2nd, Bach BR Jr, et al. Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med. 2014; 42(8): 2006-17.

  39. Tigchelaar S, van Essen P, Bénard M, Koeter S, Wymenga A. A self-centring osteotomy of the tibial tubercle for patellar maltracking or instability: results with ten-years' follow-up. Bone Joint J. 2015; 97-B(3): 329-36.



EVIDENCE LEVEL

IV, reporte de casos.




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