Operative Techniques in Sports Medicine最新文献

Imaging of the patellofemoral joint (PFJ) is essential for evaluating patellofemoral pathology and injury. In addition to a detailed history and physical examination, PFJ imaging should be used to better understand the relationship between osseous and soft tissue structures, further confirm a diagnosis, and to create an individualized treatment plan for each patient. This chapter reviews the relevant radiographic and advanced imaging studies utilized in the work-up and treatment of patients with patellofemoral disorders.

Valgus lower extremity alignment with excessive femoral anteversion and tibial external torsion (Miserable Malalignment Syndrome) results in patellar maltracking. Sagittal plane deformities (rotational alignment) should be quantified along with typical frontal plane alignment. Femoral and tibial rotation can be assessed with both physical examination and radiographic studies. Derotational osteotomies of both the femur and the tibia can then be used for correction. In this chapter, we attempt to provide guidelines for assessing lower extremity rotation and an understanding of normal femoral and tibial rotational values. We then provide examples of corrective femoral osteotomies and tibial rotational osteotomies.

Patellofemoral cartilage injuries present a complex challenge due to the unique anatomy and biomechanics of the joint. The daily activities involving the knee, such as weight-bearing, stair ambulation, and squatting, impose high loads on the joint, increasing the risk of cartilage overload and subsequent cartilage injury. Additionally, several anatomical abnormalities, including patellar malalignment, patella alta, and trochlear dysplasia, can influence the behavior of the patellofemoral joint, leading to instability and further elevating the risk of cartilage injuries. Surgical management of patellofemoral cartilage injuries remains a topic of modern debate. The effectiveness and suitability of different techniques depend on individual indications and the characteristics of the cartilage defect. This chapter explores the use of cartilage repair and restoration techniques for patellofemoral cartilage defects. Here, we discuss aspects of the surgical techniques, their outcomes, and provide insights into when staging arthroscopy or concomitant stability surgery should be considered.

Patellar instability in patients with a dysplastic trochlea can be challenging to treat without addressing the trochlea directly. Trochleoplasty allows the surgeon to target a root osseous cause of instability and is an effective treatment option in well-selected patients. This chapter explores the variations in trochleoplasty techniques and offers an overview of recently published data associated with this surgery.

Tibial tubercle osteotomies (TTOs) are a versatile procedure that can be used to treat several conditions due to its ability to manipulate both extensor mechanism tracking and patellofemoral joint contact forces. This permits a wide array cut geometries that can be titrated to the individualized needs of each patient. Most common is the anteromedializing (AMZ) TTO, which has been a workhorse procedure for realigning extensor mechanism tracking. The patella can also be distalized, which becomes indicated when pathological patella alta is present.

When treating patellar instability, a successful outcome depends on the clinician's understanding of the destabilizing factors. These risk factors are often additive, and if significant enough they can collectively breach a given stability threshold. Three-dimensional models provide a useful perspective of the joint morphology, curvature, and congruency which can be particularly helpful for developing an optimal plan for restoring balanced tracking.

To decide when to perform a TTO, the decision centers on how well a TTO provides a solution to a tracking or articular loading problem, compared with the added morbidity that accompanies an osteotomy. Details regarding tubercle anteriorization, medialization and distalization are discussed, along with technical considerations and surgical technique.