management of episodic patella dislocationrhumatologie-bichat.com/poly grenoble 2011 genou/26...
TRANSCRIPT
Philippe NeyretElvire Servien
Management of Episodic patella dislocation
University of Lyon
Grenoble 2011
Interrogatoire
• Craquement• H +
EXAMEN
•H+ Ponction ?
EXAMEN
TROCHLEAR DYSPLASIATROCHLEAR DYSPLASIA
• Crossing sign
• Trochlear bumpH. Dejour, G Walch, Ph NeyretTrochlea dysplasia, Rev Chir Orthop 1990, 76 : 45-54
crossing
• Trochlear dysplasia
>145°
Crossing sign
EPD Control group
96% 3%
Trochlear bump
>3mm
EPD Control group
3.2mm -0.8mm+-2.4 +-2.9
Principal Factors
3
�Patellar height
�TT-TG
�Patellar tilt Threshold
Secondary Factors
4
•F. Antetorsion•G. Recurvatum•G. Valgum•Female No Threshold
P
A
T
Caton & Deschamps Index
AT/AP
1. Patella alta >1.2
T
1.0
H. Dejour
2. TT-TG >20mm
10mm
H. Dejour
19.621.7
31mm
3. Patellar Tilt >20°
15°Quadriceps DysplasiaTrochlear Dysplasia
?
Treatm
ent Surgical
� True dislocation� Young patient� Preop.planning� 1factor 1 procedure
RESULTS � N= 130 (174 knees) 1988-1999
� FU: 2y-13y N=110Subjective IKDC: 77.2 (45.9-95.4)
Very Satisf. or Satif.: 94%Post-op dislocation: 4.5%
E. Servien, T Ait Si Selmi, Ph Neyret : Subjective evaluation of surgical treatment for patellar instabilityRev Chir Orthop, 2004, 90, 137-142
TROCHLEA DYSPLASIATROCHLEA DYSPLASIA?
Discussion
MPFLMPFL ?
Distal transferDistal transfer?
The trochleaDiscussion
X-Ray
CT-Scan3D CT-Scan
• Normal Trochlea
crossing
• Trochlear dysplasia
>145°°°°
X-Rays
No previous dislocation
Several previous dislocations
Don FithianMPFL
Reconstruction
• TTd is the same in the control and EPD groups
• Mean patellar tendon length is longer in the EPD group than in the control group
Ph. Neyret, A.H.N. Robinson, …, P. ChambatPatellar tendon length – the factor in patellar instability ? The Knee 2002
Patella alta
TTd
Ph. Neyret, A.H.N. Robinson, …, P. ChambatPatellar tendon length – the factor in patellar instability ? The Knee 2002
Patella alta
Philippe NeyretElvire Servien
T
Merci
University of Lyon