Chirurgie de l’instabilité patellaire avec patella alta chez le patient d’âge moyen. Résultats cliniques - 31/03/18
Patello femoral reconstruction for patellar instability with patella alta in middle-aged patients. Clinical outcomes
, Y. Okamoto, T. Murakami, K. Nakagawa, N. Okuno, H. Wakama, M. NeoAbstract |
Introduction |
Although several surgical treatments for patellar instability with patella alta have been reported, the clinical outcomes and optimal surgical procedures for patellar instability with patella alta in middle-aged patients are still controversial. We hypothesized that optimal surgical procedures for patellar instability with patella alta in middle-aged patients may induce good clinical outcomes with better patellofemoral geometry.
Materials and methods |
Twelve middle-aged patients with a mean age of 44 years (range: 40–55 years), who presented with patellar instability and patella alta, were treated with a combination of several surgeries, such as medial patellofemoral ligament (MPFL) reconstruction, trochleoplasty, lateral release, and three-dimensional transfer of the tibial tuberosity, based on a surgical algorithm. Patellar position and clinical outcomes were evaluated postoperatively. The mean follow-up time was 41.5 months (range: 24–72 months).
Results |
Patellar position altered from 1.31 (1.21–1.53) preoperatively to 0.88 (0.69–1.06) postoperatively on the Caton-Deschamps Index (p<0.01). The tibial tuberosity-trochlear groove (TT-TG) distance altered from 21.8mm (20.1–25.8mm) to 10.3mm (5.1–14.7mm), and patellar tilt ranged from 28.1°(21–40°) to 14.6°(5–28°), respectively (p<0.01). Clinical outcomes on the Lysholm and Kujala scales improved from 43.1 and 38.4 to 86.7 and 78.3, respectively, at final follow-up (p<0.01). Surgical treatment that included trochleoplasty resulted in better outcomes than other surgical combinations without trochleoplasty (p<0.05). Sulcus angle and post-operative patellar tilt improved more in those who underwent trochleoplasty than in those who did not (p<0.05).
Discussion |
Surgical treatment for patellar instability with patella alta in middle-aged patients resulted in improved clinical outcomes. In particular, a combination surgery including trochleoplasty resulted in the greatest improvement in case of severe trochlear dysplasia.
Level of evidence |
IV. Retrospective case series study.
Le texte complet de cet article est disponible en PDF.Keywords : Patellar instability, Patella alta, Middle age, Trochleoplasty
| ☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 104 - N° 2
P. 154 - avril 2018 Retour au numéro
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