INTRODUCTION: The aim of In this study was to verify the relationship among clinical indicators of patellofemoral pain syndrome (PFPS) and the results of modifying radiological investigation. Previous research suggests that there is a poor association between them. Therefore we have employed a technique for the functional evaluation of PFPS based on measuring the stiffness of the knee joint during passive flexion (biorheometry). METHOD: The correlation between clinical examination and a standardized Lysholm score, radiological and biorheometric measures was investigated in the 28 knee joints of 14 subjects exhibiting clinical features of PFPS. A modified axial radiological projection of the patellofemoral articulation in 90° of flexion provided the parameters quantifying the anatomical - morphological arrangement of the patellofemoral joint. The biorheometric properties of the knee were evaluated using a custom made measuring apparatus during passive flexion and extension of the knee. RESULTS: Our results confirm that the link between the clinical findings and the X-ray imaging examinations was not evident. On the contrary, the biorheometric examination proved to correlate well with the clinical symptoms of PFPS. Parameters were identified which can characterize the biorheograms of people suffering PFPS. CONCLUSIONS: Analysis of the relationship among the clinical, radiological and biorheometric examinations leads to the recommendation that biorheometric examination is an effective method for the objective assessment of PFPS.
- MeSH
- kolenní kloub diagnostické zobrazování MeSH
- koleno MeSH
- lidé MeSH
- patelofemorální kloub * diagnostické zobrazování MeSH
- patelofemorální syndrom * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The preoperative planning in habitual dislocation of the patella should take into account all pathologies and the procedure should address all abnormalities. One of them might be also the rotational deformity of the femur. The purpose of this prospective study was to confirm the hypothesis that the only correction of pathological femoral anteversion by derotational intertrochanteric osteotomy (in the absence of another pathology) or the correction of femoral anteversion with simultaneous reconstruction of the patellofemoral joint provide adequate stability for the patellofemoral joint, with respect to the elimination of the risk of recurrent dislocation of the patella. MATERIAL AND METHODS In the course of 15 years, 17 patients (20 knee joints) with habitual dislocation of the patella were included in the study, in whom the CT scan also confirmed the femoral anteversion of 35° and greater. The group was female-dominant, often with BMI > 30. The mean age was 26 years. In 4 cases only derotational intertrochanteric osteotomy was performed, in 16 patients the osteotomy was followed by the stabilization of the patella in the knee region (always individually in dependence on the diagnosed pathology), of whom in 2 cases as the second step procedure because of thrombophilic disorders detected earlier. Immediately after the surgery, or at 6 weeks postoperatively (depending on the knee procedure done), individual rehabilitation was commenced. Partial weight bearing was recommended for the period of 3 months after the surgery. The mean follow-up period was 39 months (minimum of 36 months). RESULTS In one case a failure of osteosynthesis was observed and revision osteosynthesis with an intramedullary nail was performed. In all the other cases, primary healing of the osteotomy was achieved. The other complications were less significant (1 case of asymptomatic deep vein thrombosis of the lower limb, evacuation of subcutaneous haematoma in 1 case, 3 cases of the knee stiffness solved by manipulation under general anaesthesia at 6 weeks after surgery). Recurrent patellar dislocation was not observed in any of the patients. No pain in the upper thigh was reported by patients during the last follow-up control (at least 3 years postoperatively). Three female patients reported an isolated feeling of patellar instability. DISCUSSION There are very few studies focusing on the femoral derotational osteotomy for habitual dislocation of the patella in world literature. If any at all, they concern supracondylar and not intertrochanteric femoral osteotomy and the groups of patients were smaller than the group evaluated by us. CONCLUSIONS Preoperative planning for habitual dislocation of the patella should definitely reflect all pathologies. Therefore, the femoral derotational osteotomy should certainly be mastered by the orthopaedic surgeon, though it is a larger and more exacting procedure than patellar stabilizations in the knee region. Indications for this type of osteotomy should include anteversion greater than 30°, or 35°. The derotational intertrochanteric osteotomy alone or its combination with the stabilization of the patella in the knee region brings reliable results with no risk of recurrent dislocation. Key words: patella, habitual dislocation, femur, anteversion, derotational osteotomy.
- MeSH
- dospělí MeSH
- femur diagnostické zobrazování chirurgie MeSH
- kolenní kloub MeSH
- lidé MeSH
- osteotomie MeSH
- patela * MeSH
- patelofemorální kloub * diagnostické zobrazování chirurgie MeSH
- prospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Charakterizovat a popsat morfologický obraz nejčastějších příčin retropatelárních bolestivých stavů a uvést doporučené fyzioterapeutické postupy. Metodika: Nejčastější nozologické jednotky postižení FP kloubu jsme dokumentovali na souboru pacientů vyšetřených na pracovišti magnetické rezonance Medihope, DC Olomouc. Pacienti byli vyšetřeni magnetickou rezonancí Signa HDxT 1,5 T (GE Healthcare, Milwaukee, USA) s použitím cívky HD 1,5T knee coil ve standardním protokolu vyšetření kolenního kloubu se zvláštním důrazem na axiální a sagitální sekvenci k zobrazení femoropatelárního kloubu. V přehledném sdělení prezentujeme MR nálezy nejčastějších příčin bolestivých stavů ventrálního kompartmentu kolenního kloubu, kterými jsou dysplazie pately s inkongruencí artikulačních ploch femoropatelárního kloubu, projevy primární nebo sekundární artrózy, komplex změn při chondropatiích pately a funkční změny u laterálního kompresivního syndromu pately. Závěr: Příčinou retropatelární bolestivosti kolenního kloubu může být inkongruence patelárních artikulačních ploch a ploch femorálního sulku, dále chondropatie femoropatelárního kloubu v důsledku traumat, instability nebo přetížení kloubu. Magnetická rezonance je přínosnou zobrazovací metodou k morfologické diferenciaci bolestivých stavů ventrálního kompartmentu kolenního kloubu. Při terapii bolestivých stavů femoropatelárního kloubu se uplatňují cílené fyzioterapeutické postupy. Fyzioterapie působí nejen symptomaticky v rámci tlumení bolesti, ale působí i cíleně na svalové a kloubní struktury, čímž umožní normalizaci stavu.
Aim: To characterize and describe the morphological image of the most common causes of painful retropatellar conditions and indicate the recommended physiotherapy. Methods: We documented the most frequent nosological units of FP joint impairments in a group of patients examined in the Medihope magnetic resonance center of the Military Hospital in Olomouc. The patients were examined with MRI Signa HDxT 1.5 T (GE Healthcare, Milwaukee, USA) using an HD 1.5T knee coil in the standard protocol for the examination of the knee joint, with a special emphasis on axial and sagittal sequence to display the patellofemoral joint. In this review, the authors present MR findings of the most common causes of painful conditions of the ventral compartment of the knee joint, which are dysplasia of the patella with incongruence of the articular surfaces of the patellofemoral joint, symptoms of primary or secondary arthritis, a complex of changes in the chondromalacia patellae and functional changes in the lateral patella compression syndrome. Conclusion: The cause of retro patellar pain of the knee joint may be incongruence of the patellar articular surfaces of the patella and the surfaces of the femoral sulcus, chondropathy of the patellofemoral joint as a result of trauma, instability or overloading the joint. Magnetic resonance imaging is a valuable imaging method for the morphological differentiation of painful conditions of the ventral compartment of the knee. In the therapy of painful conditions of the patellofemoral joint, targeted physiotherapeutic procedures are applied. Physiotherapy has not only symptomatic effects in pain relief, but also specific effects on the muscle and joint structures, which allows the normalization of their condition.
- Klíčová slova
- retropatelární bolest,
- MeSH
- artróza kolenních kloubů diagnóza etiologie MeSH
- bolest etiologie MeSH
- diferenciální diagnóza MeSH
- fyzioterapie (techniky) MeSH
- kloubní chrupavka anatomie a histologie diagnostické zobrazování patologie MeSH
- lidé MeSH
- luxace pately diagnóza etiologie terapie MeSH
- nemoci chrupavky diagnóza patofyziologie terapie MeSH
- patela anatomie a histologie diagnostické zobrazování patologie MeSH
- patelofemorální kloub * diagnostické zobrazování patofyziologie patologie MeSH
- Check Tag
- lidé MeSH
Patelofemorální kloub u dítěte může být postižen onemocněním vrozeným, traumatem, nebo získanou vývojovou patologií. Vrozené poruchy patelofemorálního kloubu vznikají na podkladě vrozené vady, abnormality nebo anatomické variace. Získané poruchy postihují často děti předškolního věku a dospívající. Jedná se zejména o traumata nebo jejich následky. Volba nejvhodnější terapie dané patologie se odvíjí od klinického projevu postižení. Uplatňuje se jak léčba chirurgická, tak konzervativní. Podobnost příznaků jednotlivých patologických stavů může vést k nesprávné diagnostice. Významné postavení v léčbě zastává v současné době miniinvazivní operativa. Problematika patelofemorálního kloubu u dítěte by měla být vždy řešena ve specializovaném centru zaměřeném na dětskou ortopedii a traumatologii.
Patello-femoral joint in paediatric patients can be affected by various inherited, traumatic or acquired conditions. Congenital pathologies usually relate to inherited abnormality or anatomic variations. The acquired or pathology usually develops in early school age and later in adolescence. The optimal treatment options depends on the clinical presentation and type of pathology and involves both conservative and surgical therapy. The main role in surgical management represents mini- invasive approach to treatment. The patella-femoral problems should be addressed in specialized centers dealing with paediatric orthopaedics and traumatology.
- MeSH
- dědičná osteoonychodysplazie diagnóza patologie terapie MeSH
- dítě * MeSH
- fraktury kostí diagnóza etiologie terapie MeSH
- kolenní kloub diagnostické zobrazování patologie MeSH
- lidé MeSH
- luxace pately diagnóza etiologie terapie MeSH
- patela diagnostické zobrazování patologie MeSH
- patelofemorální kloub * diagnostické zobrazování patologie MeSH
- poranění z opakovaného přetěžování diagnóza etiologie terapie MeSH
- syndrom MeSH
- synoviální membrána patologie MeSH
- vrozené vady MeSH
- Check Tag
- dítě * MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
