Yu no dat? Risk factor dεm εn tritmεnt fכ patellofemoral joyn instability in pikin dεm

Patellofemoral instability (PFI) inklud wan siriכs sik dεm, we de kכmכt frכm mild malaise to obvious dislocation of patella (LPD). LPD na kɔmɔn tin, wit 50 kes dɛm pan ɛvri 100,000 pikin dɛm. di fכs dislokeshכn kin apin bitwin 15 εn 19 ia. LPD na sik we de mek pɔsin nɔ ebul fɔ waka, ɛn di dislɔkeshɔn rɛt afta kɔnsavayv tritmɛnt ɔ fizik tɛrapi kin rich 70%. rεkכnstrכkshכn fכ di mεdial patellofemoral ligament na di mכst we dεn de yuz כspitul. Bɔt, lɛk 16% pan di sik pipul dɛn gɛt kɔmplikeshɔn, inklud fɔ ri-dislɔkeshɔn. Apat frɔm dat, wan kwata pan di sik pipul dɛn nid fɔ fala ɔpreshɔn pan di ɔda ni jɔyn we dɛn nɔ de trit wit ɔpreshɔn. di lכng tεm risk fכ progrεsiv kכtilaj injuri εn OA afta LPD na 6 tεm hכy pas di wan afta di fכs dislכkeshכn, we de mek bכku yכng pasεnshכn dεm de fεs OA risk we dεn ol 30 εn 40. di lכk כndastandin fכ PFI na wan pan di men tin dεm fכ mek di nכmal patellofemoral jכint kכnsistεns bak.

RISK FƐKTƆR

di risk fכ PFI kin sheb to tu kεtכgrεf: anatomical abnכmaliti εn alaynsmεnt abnכmaliti. di fεmoral trochlear dysplasia na di mכst imכtant anatomical abnכmaliti, εn di alayns abnכmaliti inklud di patellar elevetion, patellar roll εn subluxation. di patellofemoral difכmiti de kכz bay bayomεkanikal chenj dεm we kכz fכ injuri fכ di mεdial stεbyulayz, inkrεs pan di Q angle, antevεshכn fכ di fεmur εn lateralization fכ di patεla tεndon insεshכn. Di risk factor dɛm fɔ PFI dɛn sɔmariz na Fig 1.

• di fεmoral troklia displasia

• angle we di transvas pul de inklin

• facet asimɛtri fɔ pul

• pul dip dip

• abnɔmal alaynɛshɔn

• ay patɛl

• di distans frכm tibia to trochlear groove (tt-tg) inkrεs

• inkrisayz q angle

• di fεmoral antevεrshכn

  
  

KARAKTERISTIK DƐN WE DE FƆ IMAGIN EKSAMINƐSHƆN

Di tin dɛm we dɛn kin fɛn pan PFI na MRI kin difrɛn wit di kayn we aw di sik kin siriɔs ɛn aw i kin te. di mild PFI kes dεm kin bi patellar dyskinesia, we dεn kכl εdima na di כp εn lateral sayd dεm na di Hoffa fεt pad (dεn kכl am bak patellofemoral fεt impak). di patellofemoral fεt impak de kכlכsכl wit כda risk fכ PFI, we inklud fεmoral kכndyul displasia, patεla ayt, inkrεs pan TT-TG distans, latεral patεla tilt εn sablכksεshכn. di patellar dyskinesia we de te de mek di kכtilaj injuri εn di lateral patellofemoral jכint de dεjεnεreshכn kwik kwik wan.

akyu dislokeshכn fכ patεla (APLD) na di mכst siriכs fכm fכ PFI. di εks-ray plen film sho di diskכvri fכ akyu injuri, we kin inklud jכyn efyushכn, wan wan lipid lεvεl fכ fεt atropati, frakshכn fכ mεdial patεla כsteochondral, lateral tilt/subluxation fכ patεla (Figure 8A), εn dip lateral sכlkכs sayn we kכz bay impakshכn injuri fכ di lateral fεmoral kכndil kכtilaj. di spεsifi k MRI manifestεshכn dεm fכ akyu LPD inklud mεdial stεbyulayz injuri (dεn si am na 96%), lateral patellar tilt כ subluxation, כsteochondral injuri εn joyn efyushכn (Figure 2B, C). bכku tεm, di patεla de rεset insεf afta di fכs dislכkeshכn.

כp to 70% pan di sik pipul dεm go gεt dislokeshכn we de kam bak, εn krεse we de kam bak kin apin. insay dis kes, MRI kin sho krכnik tεar fכ di mεdial stεbyulayz, mεdial patεla difכmiti, כsifikεshכn fכ di mεdial patεla, patεla-fεmoral fεt impak, kכtilaj injuri εn dijεnεreshכn fכ di lateral patεlofemoral jכint (Figure 3).

DI TRITMENT DƐN

1. Tritmɛnt we nɔto ɔpreshɔn:

• כl di akyu patεla dislכkeshכn dεm na fכ sכm tεm εn dεn go rεsεt dεm sכmtεm. Sɔntɛnde, di sik pipul dɛn, dɛn fambul dɛn, dɛn padi dɛn, kɔch ɔ trena dɛn go yuz dɛn an fɔ riset di patɛl na di say we dɛn de. If di pɔsin go na di imejensi dipatmɛnt bikɔs di patɛl dɔn dislɔkeshɔn, dɛn go gi am kɔnshɛns sɛdeshɔn. di kכlos rεdukshכn fכ di patεla de apin bay we dεn de strεch di lεg dεm sכmtεm. We yu dɔn riset, klinik wan chɛk di ni jɔyn fɔ ɔda injuri dɛn.

• di standad tritmεnt fכ di fכs dislokeshכn fכ di patεla na nכn-sכjεkshכnal tritmεnt, εn sכt tεm (2-4 wik) fכ fiks insay splint כ knee joyn fiksεta kin kכntro di pen εn di fכs tisu hεlin afta akyu atak. Insay dis tɛm, dɛn kin alaw stik fɔ bia di wet. afta dat, dεn de yuz patεla stεbyulayz braket fכ aktiviti dεm, εn dεn de du fכshal tεrapi fכ mek dεn muv bak, trεnk εn limb kכntrכl.

• Di sik pipul dɛn kin bigin fɔ du ɛksɛsayz bak lɛk 3 mɔnt afta di fɔs atak. Apat frɔm dat, fɔ wɛr stent na sɔntin we pɔsin kin disayd fɔ du.

2. Ɔspitul tritmɛnt:

• pan mכr dan 30% pan di sik pipul dεm, di fכs patεla dislכkeshכn de riliyt to bכku kכn jכint efyushכn. insay dis kes, i nid fכ du MRI fכ no if כsteochondral frakshכn de. di say we dεn kכmכn fכ dεn frakshכn dεm na di mεdial patεla כ lateral fεmoral kכndyul, εn dεn kin rεkomεnd כpεrayshכn tritmεnt we intra-atikul frakshכn dεm de.

• we dεn de du di כpεrayshכn, dεn de pul כ fiks di כsteochondral frakshכn pis dεm akɔdin to di sayz fכ di frakshכn pis dεm εn di kwaliti fכ di katilej. we di sayz fכ di כsteochondral frakshכn na ≥ 15 mm, dεn kin kכnsidr fכ frakshכn fikseshכn insted fכ εksizishכn. dis fikseshכn de kכmכt bay wan opin mεtכd we de yuz mεtal skru, bayoabsכbabl pin כ sutura.

• insay di tritmεnt fכ frakshכn, di tεnd fכ simultaneכs sכjεkshכn stεbilizεshכn fכ patεla de achy bay mεdial ripa כ MPFL rεkכnstrכkshכn. If dɛn yuz mɛtal skru fɔ fiks di fraktrɔs, dɛn kin gɛt fɔ pul dɛn bay ɔda ɔpreshɔn dɛn tumara bambay.

• tu skul dεm de fכ tink bכt di bεst mεtכd fכ patεla stεbyulεshכn. Di fɔs we na fɔ du isol MPFL rikostrɔkshɔn. MPFL na di men kכnstrכkshכn fכ di lateral sכblכkshכn fכ di patεla, so in rεkכnstrכkshכn go gi di stεbiliti we nid fכ di patεla. MPFL rεkכnstrכkshכn kin bi bay we dεn kin du kכdrisεps tεndon כtograft, hamstring tεndon כtograft כ allograft. di sakses rεt fכ isol MPFL rεkכnstrכkshכn fכ rεstכr patεla stεbiliti de ova 95%, we nכ gεt natin fכ du wit di chכys fכ graft. di mכst kכmכn komplikashכn dεm fכ MPFL rεkכnstrכkshכn na di kכn jכint stiffness, patellar frakshכn εn rikarεnt patellar instability.

• di sεkכn mεtכd de sכlv di risk fכktכ dεm fכ patellar instability, εn MPFL rεkכnstrכkshכn. insay dis mεtכd, dεn de ditarεmin di anatomical risk fכ di patεla instεbiliti pan εks-ray film εn CT/MRI, inklud trochlear dysplasia, inkrεs patellar ayt εn TT-TG distans. We dɛn dɔn no, sɔm ɔ ɔl di tin dɛn we kin mek pɔsin gɛt prɔblɛm, dɛn go kɔrɛkt am bay we dɛn du ɔpreshɔn.

• di trochlear dysplasia de sכlv bay trochleoplasty, we di trochlear groove de dip (Figure 12A). Trochlear plasty nɔr kin rili pɔpul na Amɛrika bikɔs i involv fɔ invayd di articular cartilage, ɛn tiori wan risk de fɔ fiuja ischemic necrosis ɔ arthritis.

• di patεla ayt כ inkrεs pan di patεla ayt de sכlv bay distal tibial tכba. fכ mek dεn inkrεs di TT-TG distans, dεn de du mεdial כ anteromedial tibial tכba (Figure 12B). di komplikashכn dεm we de fכ tibial tuberosity osteotomy inklud nכnunion, hadwae pen, lכs fכ di tuberosity rεdukshכn εn frakshכn.

• fכ di tεnshכn fכ di lateral rεtina, dεn de du di lateral rεtina rilis, we de sho di inkrεs pan di patεla tilt. di komplikashכn dεm we di lateral rilis de inklud inklud pεrsisεnt swel εn iatrogenic mεdial instεbiliti fכ patεla.

• pan di sik pipul dεm we gεt bon dεm we nכ machכ, sכm כpεrayshכn dεm nכ de kכntraindikεt כ modify biכs fכ di epiphysis.

• di fεmoral atachmεnt pכynt fכ MFPL de jכs dכn di epiphysis fכ di distal fεmur. So, MPFL rikostrɔkshɔn fɔ pasɛnt dɛn we nɔ machɔ bon dɛn fɔ du ɔnda strikt fluoroscopy gayd fɔ mek shɔ se dɛn drɔl di femoral tanɛl sef wan.

• di distal femur injuri kin mek di difכmiti, we kin nid כ nכ kin nid כpεrayshכn kכrekshכn. sεm kayn we, di injuri we di proksimal tibial protrushכn de gi kin mek i difכmiti, spεshal wan na di mεdial kכn. fכ dat, dεn fכbid כsteotomy fכ tibial tuberosity fכ pasεnshכn dεm we gεt opin proksimal tibial protrusion.

• di kכntribyushכn, di patεla tεndon kin kכmplit כ pat pan di mεdial. we di כta haf pan di patεla tεndon de tכn to di mεdial sayd, dεn kכl dis opεreshכn Roux-Goldthwait opεreshכn (Figure 12C).

• כl di sik pipul dεm we dεn de du כpεrayshכn fכ evaluate fכ patellar instability in di arenjmεnt fכ di korona limb dεm εn di limb dεm we de rכt. inkrεs genu valgus, εksyכsiv fεmoral antevεshכn εn inkrεs εksternal tibial tכrshכn na di risk fכ patεla instεbiliti.

• fכ di sik pipul dεm we gεt bon dεm we nכ machכ, dεn fכ tink bכt fכ gayd di growth we dεn de dil wit genu valgus. di epiphyseal skru dεm כ tεnshכn bכnd plet dεm kin span di mεdial sayd fכ di distal εnd fכ di fεmoral epiphysis fכ kכrekshכn sכmtεm. כstiotomy nid fכ kכrekt di sik pipul dεm we gεt machכ bon fכ korona כ rotashכnal difכmiti. di kכrekshכn indikεshכn fכ genu valgus na > 10 digri, εn di kכrekshכn indikεshכn fכ rotashכnal dislכkeshכn pas 20 digri.

• pikin dεm (< 10 ia ol) go mit kכmpleks patεn dεm fכ patεla instεbiliti, we inklud fiks כ habitual patεla dislכkeshכn. sεvεra sεndrכm dεm lεk Daun sεndrכm, nel-patellar sεndrכm, Kabuki sεndrכm εn Rubinstein Taybi sεndrכm de kכmכp fכ patεla instεbiliti.

• i imכtant fכ no se di isol rεkכnstrכkshכn fכ MPFL nכ inof fכ sכlv dεn komplikεt patεn dεm ya, biכs di praymar patכlayzm de na di lateral, εn sכmtεm di mεkanism fכ kwadriseps fεmoris de sכt, we nid fכ rilis waid lateral εn kwadriseps fεmoris plasti fכ sכlv dεn prכblεm ya.

• insay kwadriseps fεmoris plasti, kwadriseps fεmoris mεkanism de rioriεnt εn/כ lכng. If dɛn nɔ tek tɛm ɔ trit am let, dɛn kɔmplikɛt tin ya we nɔ kin stebul kin mit leta na layf.

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