Хроническая нестабильность надколенника
Травматология и ортопедия
Дата публикации: марта 9, 2016
Ключевые слова
нестабильность надколенника
остеотомия бугристости
высокое положение надколенника
patella instability
tibial tuberosity osteotomy
high patella's location.
остеотомия бугристости
высокое положение надколенника
patella instability
tibial tuberosity osteotomy
high patella's location.
Как цитировать
Жиженкова Т., Даниляк В., Ключевский В., Молодов М., Волков А. Хроническая нестабильность надколенника // Кремлевская медицина. Клинический вестник. 2016. Т. № 4.
Аннотация
Цель работы – улучшить результаты лечения пациентов с хронической нестабильностью в пателлофеморальном суставе путем дифференцированного подхода к оперативным вмешательствам с учетом причин ее возникновения. Проанализированы результаты лечения 11 пациентов с рецидивирующим вывихом надколенника (12 стабилизи- рующих операций, у одного больного с двух сторон). Показания к оперативному вмешательству устанавливались на основании данных клинического и рентгенологического обследования. В предоперационном периоде с помощью ком- пьютерной и магнитно-резонансной томографии исследовались параметры пространственных взаимоотношений над- коленника, большеберцовой бугристости и бедренной борозды, определялись соответствующие индексы и коэффици- енты, углы инклинации и степень мыщелковой дисплазии. Основными причинами хронической нестабильности надколенника явились: его высокое расположение, увеличе- ние расстояния между бугристостью большеберцовой кости и межмыщелковой бороздой, ее дисплазия, а также их со- четания. Обоснован дифференцированный подход к применению того или иного способа оперативного вмешатель- ства с целью восстановления трекинга надколенника с учетом этиологии его нестабильности.Purpose: To improve results of treating patients with chronic instability in the patella-femoral joint using a differential approach to surgical manipulations taking into consideration the cause of pathology. Results of treatment of 11 patients with recurrent dislocation of the patella (12 stabilizing surgeries; in one patient - bilateral) have been analyzed. Indications for surgery were made using clinical and X-ray findings. In the pre-operative period CT and MRI examinations evaluated parameters of spatial relationship between the patella, tibial tuberosity and femoral sulcus. The corresponding indexes and coefficients, inclination angles and the degree of condylar dysplasia were evaluated as well. Main causes for chronic instability were: high location, larger distance between tibial tuberosity and femoral sulcus, dysplasia and their combination. A differential approach to surgical techniques taking into consideration the etiology of instability so as to restore patella's tracking has been proposed.Литература
С.В. Предикторы привычного вывиха надколенника.
Материалы Всероссийской научно-практической конфе-
ренции с международным участием «Современные аспек-
ты травматологии, ортопедии и реконструктивной хи-
рургии». АГМА. 2014: 21-22.
2. Arendt E.A., Moeller A., Agel J. Clinical outcomes of
medial patellofemoral ligament repair in recurrent (chronic)
lateral patella dislocations. Knee Surg. Sports Traumatol.
Arthrosc. 2011; 19 (11): 1909-1914.
3. Cerciello S., Lustig S., Costanzo G., Neyret P. Medial
retinaculum reefing for the treatment for patellar instability.
Knee Surg. Sports Traumatol. Arthrosc. 2014; 22 (10): 2505-
2512.
4. Dejour D., Le Coultre B. Osteotomies in patello-femoral
instabilities. Sports Med. Arthrosc. 2007; 15 (1): 39-46.
5. Dejour H., Walch G., Neyret P., Adeleine P. Dysplasia
of the femoral trochlea. Rev. Chir. Orthop. Reparatrice Appar.
Mot. 1990; 76 (1): 45-54.
6. Dejour H., Walch G., Nove-Josserand L., Guier C.
Factors of patellar instability: an anatomic radiographic study.
Knee Surg. Sports Traumatol. Arthrosc. 1994; 2 (1): 19-26.
7. Fithian D.C., Paxton E.W., Stone M.L. et al.
Epidemiology and natural history of acute patella dislocation.
Am. J. Sport Med. 2004; 32 (5): 1114 – 1121.
8. Greenfield M.A., Insall J.N., Case G.C., Kelly M.A.
Instrumentation of the patellar osteotomy in total knee
arthroplasty. The relationship of patellar thickness and lateral
retinacular release. Am. J. Knee Surg. 1996; 9 (3): 129-131.
9. Kramer J., White L.M., Recht M.P. MR imaging of the
extensor mechanism. Semin. Musculoskelet. Radiol. 2009; 13
(4): 384–401.
10. Lewallen L., McIntosh A., Dahm D. First-Time
Patellofemoral Dislocation: Risk Factors for Recurrent
Instability. J. Knee Surg. 2015.
11. Magnussen R.A. Tibial tubercle osteotomy in association
with MPFL reconstruction: When is it really needed?
Orthopaedics Today Eur. 2015; 3: 49–51.
12. Magnussen R.A., Simone V.D., Lustig S., Neyret P.
Treatment of patella alta in patients with episodic patellar
dislocation: a systematic review. Knee Surg. Sports Traumatol.,
Arthrosc. 2014; 10: 2545-2550.
13. Matsushita T., Kuroda R., Oka S. et al. Clinical
outcomes of medial patellofemoral ligament reconstruction in
patients with an increased tibial tuberosity-trochlear groove
distance. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22 (10):
2438-2444.
14. Munch J., Sullivan J., Stein B.S. Tibial tubercleto-trochlear
groove distance:Is it the best tool for the job?
Orthopaedics Today Eur. 2015; 1: 54–59.
15. Nelitz M., Wehner T., Steiner M. et al. The effects
of femoral external derotational osteotomy on frontal plane
alignment. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22:
2788-2794.
16. Thaunat M., Erasmus P.J. Recurrent patellar dislocation
after medial patellofemoral ligament reconstruction. Knee Surg.
Sports Traumatol. Arthrosc. 2008; 16 (1): 40-43.
17. Wagner D., Pfalzer F., Hingelbaum S. et al. The influence
of risk factors on clinical outcomes following anatomical medial
patellofemoral ligament (MPFL) reconstruction using the
gracilis tendon. Knee Surg. Sports Traumatol. Arthrosc. 2013;
21 (2): 318-324.
18. Ward S.R., Terk M.R., Powers C.M. Patella alta:
association with patellofemoral alignment and changes in
contact area during weight-bearing. J. Bone J. Surg. Am. 2007;
89 (8): 1749–1755.
19. Biedert R.M., Bachmann M. Anterior-posterior
trochlear measurements of normal and dysplastic trochlea by
axial magnetic resonance imaging. Knee Surg. Sports Traumatol.
Arthrosc. 2009; 17: 1225–1230.
20. Mayer C., Magnussen R.A., Servien E. et al. Patellar
tendon tenodesis in association with tibial tubercle distalization
for the treatment of episodic patellar dislocation with patella
alta. J. Sports Med. 2012; 40 (2): 346-351.
21. Trillat A., Dejour H., Couette A. Diagnosis and
treatment of recurrentdislocations of the patella. Chir. Orthop.
Reparatrice Appar. Mot. 1964; 50: 813-824.
22. Fulkerson J.P. Anteromedialtibial tubercle transfer
without bone graft. J. Sports Med. 1990; 18: 490-497.
23. Colvin А.С., West R.V. Patellar Instability. J. Bone J.
Surg. 2008; 90 (12): 2751-2762.
24. Faruqui S., Bollier M., Wolf B., Amendola N. Outcomes
after Trochleoplasty. J. Iowa Orthop. 2012; 32: 196–206.
Материалы Всероссийской научно-практической конфе-
ренции с международным участием «Современные аспек-
ты травматологии, ортопедии и реконструктивной хи-
рургии». АГМА. 2014: 21-22.
2. Arendt E.A., Moeller A., Agel J. Clinical outcomes of
medial patellofemoral ligament repair in recurrent (chronic)
lateral patella dislocations. Knee Surg. Sports Traumatol.
Arthrosc. 2011; 19 (11): 1909-1914.
3. Cerciello S., Lustig S., Costanzo G., Neyret P. Medial
retinaculum reefing for the treatment for patellar instability.
Knee Surg. Sports Traumatol. Arthrosc. 2014; 22 (10): 2505-
2512.
4. Dejour D., Le Coultre B. Osteotomies in patello-femoral
instabilities. Sports Med. Arthrosc. 2007; 15 (1): 39-46.
5. Dejour H., Walch G., Neyret P., Adeleine P. Dysplasia
of the femoral trochlea. Rev. Chir. Orthop. Reparatrice Appar.
Mot. 1990; 76 (1): 45-54.
6. Dejour H., Walch G., Nove-Josserand L., Guier C.
Factors of patellar instability: an anatomic radiographic study.
Knee Surg. Sports Traumatol. Arthrosc. 1994; 2 (1): 19-26.
7. Fithian D.C., Paxton E.W., Stone M.L. et al.
Epidemiology and natural history of acute patella dislocation.
Am. J. Sport Med. 2004; 32 (5): 1114 – 1121.
8. Greenfield M.A., Insall J.N., Case G.C., Kelly M.A.
Instrumentation of the patellar osteotomy in total knee
arthroplasty. The relationship of patellar thickness and lateral
retinacular release. Am. J. Knee Surg. 1996; 9 (3): 129-131.
9. Kramer J., White L.M., Recht M.P. MR imaging of the
extensor mechanism. Semin. Musculoskelet. Radiol. 2009; 13
(4): 384–401.
10. Lewallen L., McIntosh A., Dahm D. First-Time
Patellofemoral Dislocation: Risk Factors for Recurrent
Instability. J. Knee Surg. 2015.
11. Magnussen R.A. Tibial tubercle osteotomy in association
with MPFL reconstruction: When is it really needed?
Orthopaedics Today Eur. 2015; 3: 49–51.
12. Magnussen R.A., Simone V.D., Lustig S., Neyret P.
Treatment of patella alta in patients with episodic patellar
dislocation: a systematic review. Knee Surg. Sports Traumatol.,
Arthrosc. 2014; 10: 2545-2550.
13. Matsushita T., Kuroda R., Oka S. et al. Clinical
outcomes of medial patellofemoral ligament reconstruction in
patients with an increased tibial tuberosity-trochlear groove
distance. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22 (10):
2438-2444.
14. Munch J., Sullivan J., Stein B.S. Tibial tubercleto-trochlear
groove distance:Is it the best tool for the job?
Orthopaedics Today Eur. 2015; 1: 54–59.
15. Nelitz M., Wehner T., Steiner M. et al. The effects
of femoral external derotational osteotomy on frontal plane
alignment. Knee Surg. Sports Traumatol. Arthrosc. 2014; 22:
2788-2794.
16. Thaunat M., Erasmus P.J. Recurrent patellar dislocation
after medial patellofemoral ligament reconstruction. Knee Surg.
Sports Traumatol. Arthrosc. 2008; 16 (1): 40-43.
17. Wagner D., Pfalzer F., Hingelbaum S. et al. The influence
of risk factors on clinical outcomes following anatomical medial
patellofemoral ligament (MPFL) reconstruction using the
gracilis tendon. Knee Surg. Sports Traumatol. Arthrosc. 2013;
21 (2): 318-324.
18. Ward S.R., Terk M.R., Powers C.M. Patella alta:
association with patellofemoral alignment and changes in
contact area during weight-bearing. J. Bone J. Surg. Am. 2007;
89 (8): 1749–1755.
19. Biedert R.M., Bachmann M. Anterior-posterior
trochlear measurements of normal and dysplastic trochlea by
axial magnetic resonance imaging. Knee Surg. Sports Traumatol.
Arthrosc. 2009; 17: 1225–1230.
20. Mayer C., Magnussen R.A., Servien E. et al. Patellar
tendon tenodesis in association with tibial tubercle distalization
for the treatment of episodic patellar dislocation with patella
alta. J. Sports Med. 2012; 40 (2): 346-351.
21. Trillat A., Dejour H., Couette A. Diagnosis and
treatment of recurrentdislocations of the patella. Chir. Orthop.
Reparatrice Appar. Mot. 1964; 50: 813-824.
22. Fulkerson J.P. Anteromedialtibial tubercle transfer
without bone graft. J. Sports Med. 1990; 18: 490-497.
23. Colvin А.С., West R.V. Patellar Instability. J. Bone J.
Surg. 2008; 90 (12): 2751-2762.
24. Faruqui S., Bollier M., Wolf B., Amendola N. Outcomes
after Trochleoplasty. J. Iowa Orthop. 2012; 32: 196–206.