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DOI: 10.1055/a-2113-1750
Patellaosteotomie kombiniert mit modifizierter Trochleaplastik und Tuberositasmedialisierung als Therapie der permanenten Patellaluxation in Beugung
Treatment of Permanent Patellar Dislocation in Flexion by Patellar Osteotomy Combined with Modified Trochleoplasty and Tibial Tubercle MedialisationZusammenfassung
Patellaluxationen in Flexion stellen die schwerste Form der patellofemoralen Dysbalance dar. Sie treten bei jeder Beugung auf, und die meisten bisherigen operativen Therapieversuche zeigten sich frustran. In einem neuen therapeutischen Ansatz wird die konkave Rückfläche der Patella, die auf dem hypoplastischen lateralen Kondylus wie auf Schienen nach lateral gleitet, in den Fokus gerückt. Die operative Therapie besteht aus einer Kombination aus lateral erweiternder Retinakuloplastik, Trochleaplastik, Patellaosteotomie, Tuberositasversetzung und MPFL-Plastik. In dem hier als OP-Video präsentierten Fall konnte bei einer 13-jährigen Patientin mit permanenter Patellaluxation in Beugung auf beiden Seiten ein physiologischer Patellalauf ohne Luxationstendenz bei schmerzfreien Kniegelenken erreicht werden.
Patellaluxationen in Flexion sind die schwerste Form der patellofemoralen Dysbalance. Die hier gezeigte operative Therapie besteht aus lateral erweiternder Retinakuloplastik, Trochleaplastik, Patellaosteotomie, Tuberositasversetzung und MPFL-Plastik, hiermit konnte ein physiologischer Patellalauf ohne Luxationstendenz erreicht werden.
Abstract
Patellar dislocations in flexion, which occurs permanently with every movement, is the most serious manifestation of patellofemoral malalignment. Surgical approaches to correct this problem have been mostly unsuccessful. In a new therapeutic approach, the concave posterior surface of the patella, which slides on the hypoplastic lateral condyle as if guided by splints, is seen as the main pathology. The appropriate surgical strategy is trochleoplasty, combined with closed wedge patellar osteotomy, tuberosity medialisation, procedure for lengthening lateral retinaculum and MPFL plasty with the quadriceps tendon. In the case of a 13-year-old female patient presented here, this procedure leads to permanent stability in a symptom-free knee joint on both sides.
Schlüsselwörter
Patellaluxation - Patellaosteotomie - Trochleaplastik - patellofemorale InstabilitätPublication History
Received: 15 March 2023
Accepted after revision: 16 June 2023
Article published online:
21 August 2023
© 2023. Thieme. All rights reserved.
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Literatur
- 1 Dejour H, Walch G, Neyret P. et al. [Dysplasia of the femoral trochlea]. Rev Chir Orthop Reparatrice Appar Mot 1990; 76: 45-54 (PMID: 2140459)
- 2 Dickschas J, Ferner F, Lutter C. et al. Patellofemoral dysbalance and genua valga: outcome after femoral varisation osteotomies. Arch Orthop Trauma Surg 2018; 138: 19-25 DOI: 10.1007/s00402-017-2822-8. (PMID: 29079908)
- 3 Dickschas J, Harrer J, Reuter B. et al. Torsional osteotomies of the femur. J Orthop Res 2015; 33: 318-324 DOI: 10.1002/jor.22758. (PMID: 25399673)
- 4 Dickschas J, Tassika A, Lutter C. et al. Torsional osteotomies of the tibia in patellofemoral dysbalance. Arch Orthop Trauma Surg 2017; 137: 179-185 DOI: 10.1007/s00402-016-2599-1. (PMID: 28004177)
- 5 Chen J, Wu C, Ye Z. et al. Tibial Tuberosity-Trochlear Groove Distance and Its Components in Patients with and without Episodic Patellar Dislocation: A Study of 781 Knees. J Bone Joint Surg Am 2022; 104: 504-511 DOI: 10.2106/JBJS.21.00656. (PMID: 34851325)
- 6 Schmeling A, Frings J, Akoto R. et al. [Patellar dislocation: Causes and treatment]. Unfallchirurg 2020; 123: 969-983 DOI: 10.1007/s00113-020-00912-5. (PMID: 33201266)
- 7 Tan SHS, Ngiam EHK, Lim JY. et al. Surgical Management of Patella Alta in Patellofemoral Instability: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9: 2325967121999642 DOI: 10.1177/2325967121999642. (PMID: 33997063)
- 8 Frings J, Freudenthaler F, Krause M. et al. Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique. Strategies Trauma Limb Reconstr 2020; 15: 184-192 DOI: 10.5005/jp-journals-10080-1501. (PMID: 34025801)
- 9 Giovannetti de Sanctis E, Dejour DH. Patellar medial closing-wedge osteotomy in patello-femoral instability: Indications and outcomes. J Orthop 2022; 32: 156-159 DOI: 10.1016/j.jor.2022.06.005. (PMID: 35769286)
- 10 Kumar S, Sonanis SV. Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop 2018; 15: 168-172 DOI: 10.1016/j.jor.2018.01.022. (PMID: 29657461)
- 11 von Knoch F, Böhm T, Bürgi ML. et al. Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 2006; 88: 1331-1335 DOI: 10.1302/0301-620X.88B10.17834. (PMID: 17012423)
- 12 Pagenstert G, Wolf N, Bachmann M. et al. Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome. Arthroscopy 2012; 28: 788-797 DOI: 10.1016/j.arthro.2011.11.004. (PMID: 22301361)
- 13 Fink C, Veselko M, Herbort M. et al. MPFL reconstruction using a quadriceps tendon graft: part 2: operative technique and short term clinical results. Knee 2014; 21: 1175-1179 DOI: 10.1016/j.knee.2014.05.006. (PMID: 24927675)
- 14 Hinckel BB, Baumann CA, Arendt EA. et al. Quadriceps Tendon Lengthening for Obligatory (Habitual) Patellar Dislocation in Flexion. Arthrosc Tech 2022; 11: e1589-e1595 DOI: 10.1016/j.eats.2022.05.003. (PMID: 36185121)
- 15 Koch PP, Fuchs B, Meyer DC. et al. Closing wedge patellar osteotomy in combination with trochleoplasty. Acta Orthop Belg 2011; 77: 116-121 (PMID: 21473457)