Yu sabi dat? Risk factors ɛn tritmɛnt fɔ patellofemoral jɔyn instability in pikin dɛn .

Patellofemoral instability (PFI) inklud wan siriכs sik, we de frכm mild malaise to obvious dislocation of patella (LPD). LPD na tin we nɔ bɔku, wit 50 kes dɛn na ɛvri 100,000 pikin dɛn. Di fɔs dislɔkeshɔn kin apin bitwin 15 ɛn 19 ia. LPD na sik we de pwɛl, ɛn di dislɔkeshɔn rit afta kɔnsavativ tritmɛnt ɔ fizik tritmɛnt na lɛk 70%. Rikonstrכkshכn fכ di mεdial patεlofεmoral ligament na di mכst we dεn kin yuz sכja tritmεnt. Bɔt, lɛk 16% pan di sik pipul dɛn gɛt kɔmplikeshɔn, inklud ri-dislɔkeshɔn. Apat frɔm dat, wan kwata pan di pasɛnt dɛn nid fɔ fala-fala ɔpreshɔn na di ɔda knee jɔyn we dɛn nɔ de trit ɔspitul wan. di lכng tεm risk fכ progrεsiv kכtilaj injuri εn OA afta LPD na 6 tεm hכy pas di wan afta di fכs dislכkeshn, we de mek plεnti yכŋ pasεn dεm de fכs OA risk insay dεn 30s εn 40s. Lak fɔ ɔndastand PFI na wan pan di men tin dɛn we de ambɔg fɔ mek dɛn gɛt bak di kɔnsistɛns fɔ nɔmal patɛlɔfɛmɔral jɔyn.

Risk Factor .

di risk fכktכ dεm fכ PFI kin divayd insay tu kategori: anatomical abnormaliti εn alayns abnכmaliti. di fεmoral trochlear displasia na di mכst imכtant anatomical abnכmaliti, εn di alayns abnכmaliti inklud patellar εleveshכn, patellar rol εn subluxation. Patelofemoral difכm de kכz bay bayomεkanikal chenj dεm we kכz fכ injuri fכ di mεdial stεbyulayza, inkrεs pan Q angle, antεvεshכn fכ di fכs fכs εn lateralization fכ patellar tεndon insεshכn. Di risk factor dɛm fɔ PFI de sɔmariz na Fig 1.

• Di femoral trochlea displasia .

• Angle fɔ inklin transvas pulli .

• Facet asymmetry of pulley .

• Pulley dip .

• Abnɔmal alaynɛshɔn .

• Ay Patɛla .

• Di distans frɔm Tibia to Trochlear Groove (TT-TG) bin go ɔp

• Inkris q angle .

• Femoral Anteversion .

  
  

Di kwaliti dɛn we de sho aw dɛn de chɛk di imej .

Di MRI tin dɛm wae dɛn fɛn pan PFI kin difrɛn wit di kayn we aw di sik kin tranga ɛn aw i kin krɛse. di mild PFI kes dεm kin kכl patellar dyskinesia, we dεn kכl εdima fכ di כp εn lateral sayd dεm fכ di Hoffa fεt pad (dεn kin kכl am bak patelofemoral fat impak). di patelofemoral fεt impak de kכlכs to כda risk fכktכ dεm fכ PFI, inklud di fεmoral kכndil displasia, patellar ayt, inkrεs pan TT-TG distans, lateral patellar tilt εn subluxation. di patellar diskinesia we dεn bin de du fכ lכng tεm de mek di katilej injuri εn di εli dijεnεshכn fכ di lateral patelofemoral joint.

Akyu dislɔkeshɔn fɔ Patɛl (APLD) na di mɔs siriɔs fɔm fɔ PFI. The X-ray plain film shows the discovery of acute injuries, which may include joint effusion, occasional lipid level of fatty arthropathy, fracture of medial patella osteochondral, lateral tilt/subluxation of patella (Figure 8A), and deep lateral sulcus sign caused by impaction injury of lateral femoral condylar cartilage. di spεsifi k MRI manifesכn dεm fכ akyu LPD inklud mεdial stεbyulayza injuri (we dεn si insay 96%), lateral patellar tilt כ subluxation, osteochondral injuri εn jכint efyushכn (Figure 2B, C). in mכst kes, di patεla de spontan riset afta di fכs dislכkeshn.

I go rich 70% pan di sik pipul dɛn go gɛt dislɔkeshɔn we de kam bak ɛn kam bak, ɛn di dislɔkeshɔn we de kam bak kin apin. insay dis kes, MRI kin sho krכnik tea fכ di mεdial stεbyulayza, di mεdial patellar difכmiti, di ossifikeshכn fכ di mεdial patεla, di patellar-femoral fεt impak, di kכtilaj injuri εn di dijεnεshכn fכ di lateral patelofemoral jכint (Figure 3).

Tritmɛnt dɛn .

1. Tritmɛnt we nɔ gɛt ɔpreshɔn:

• mכst akyu patelar dislכkeshn dεm na transiεnt εn go bi spontan riset. Sɔntɛnde, di sik pipul dɛn, di famili mɛmba dɛn, di padi dɛn, di kɔch ɔ di trena dɛn go riset di patɛla na di say we dɛn de. If di sikman go na di imejensi dipatmɛnt bikɔs ɔf patellar dislɔkeshɔn, dɛn go gi am kɔnshɛns sɛdishɔn. di klos ridכkshכn fכ di patla de apin bay we dεn de strεch di leg dεm sכmtεm. Wans yu riset, klinikli chɛk di knee joint fɔ ɔda injuri dɛm.

• di standad tritmεnt fכ di fכs dislכkeshn fכ patεla na nכn-sכj tritmεnt, εn sכt tεm (2-4 wik) fikseshכn in splint כ kכn jכint fiksata kin kכntrכl pen εn initial tisu hεlin afta akyu atak. Insay dis tɛm, dɛn kin alaw kruk fɔ bia di wet. Afta dat, dɛn kin yuz patɛla stebul brakɛt fɔ aktiviti dɛn, ɛn dɛn kin du fizik tɛrapi fɔ mek dɛn ebul fɔ muv, trɛnk ɛn kɔntrol di limb dɛn bak.

• Di sik pipul dɛn kin bigin bak fɔ du ɛksɛrcise lɛk 3 mɔnt afta dɛn dɔn atak dɛn fɔs. Apat frɔm dat, fɔ wɛr stent na opshɔnal.

2. Sɔj tritmɛnt:

• insay mכr dan 30% pan di sik pipul dεm, di fכs patelar dislכkeshn de riliyt to wan big amoun fכ di kכn jכint efyushכn. insay dis kes, i nid fכ du MRI fכ no if osteochondral fraktכs de. di say we dεn frakshכn ya kin kכmכn na di mεdial patεla כ lateral fεmoral kכndil, εn dεn kin rεkכmand sכja tritmεnt we di intra-artikul fraktכs dεm de.

• We dɛn de du di ɔpreshɔn, dɛn kin pul ɔstiochondral fraktrɔs pis ɔ fiks am akɔdin to di sayz we di fraktrɔs pis dɛn gɛt ɛn di kwaliti fɔ di katilej. we di sayz fכ di osteochondral fraktכs na ≥ 15 mm, dεn kin kכnsidr frakshכn fikseshכn insted fכ kכmכt. dis fikseshכn de bi bay wan opin mεtכd we de yuz mεtal skru, bayoabsorbable pin כ sutura.

• insay di tritmεnt fכ fraktכs, di trεnd fכ simultaneכs sכja stεbilizayshכn fכ patεla de achyv bay mεdial ripa כ MPFL rεkכnstrכkshכn. If dɛn yuz mɛtal skru fɔ fiks fraktrɔs, dɛn kin gɛt fɔ pul dɛn bay ɔda ɔspitul prosidur dɛn tumara bambay.

• Tu skul dɛn de fɔ tink bɔt di bɛst we fɔ mek patellar stebul. Di fɔs we na fɔ du aysolɛt MPFL rikostrɔkshɔn. MPFL na di men kכnstrεkshכn fכktכ fכ lateral sablukseshכn fכ patεla, so in rεkכnstrכkshכn go gi di nid stεbiliti fכ Patεla. MPFL rikostrɔkshɔn kin ɔltɛm bi bay kwadrisɛps tɛndon ɔtograft, hamstring tɛndon ɔtograft ɔ allograft. di sakses rεt fכ isolεt MPFL rεkכnstrכkshכn fכ rεstכr patellar stεbiliti na ova 95%, we nכ gεt natin fכ du wit di chכys fכ graft. di kכmכn komplikashכn dεm fכ MPFL rεkכnstrכkshכn na di kכn jכyn stiffnεs, patellar fraktכs εn rεkכrεnt patellar instability.

• Di sɛkɔn we de sɔlv di risk factor dɛm fɔ patellar instability, ɛn MPFL rikostrɔkshɔn. in dis mεtכd, di anatomical risk fכktכ dεm fכ patellar instability dεn de ditarεmin pan X-ray film εn CT/MRI, inklud trochlear displasia, inkrεs patellar ayt εn TT-TG distans. We dɛn dɔn disayd, sɔm ɔ ɔl di tin dɛn we kin mek pɔsin gɛt prɔblɛm go kɔrɛkt bay we dɛn du di ɔpreshɔn.

• di trochlear displasia na trochleoplasty de sכlv, we di trochlear groove de dip (Figure 12a). Trochlear plasty nɔ rili pɔpul na Amɛrika bikɔs i involv fɔ invayd artikul katilej, ɛn tiorikali risk de fɔ fiuja ischemic necrosis ɔ at at.

• Patla ayt ɔ inkris pan patɛla ayt na in dɛn sɔlv bay distal tibial tuberkul. fכ mek dεn go inkrεs TT-TG distans, dεn de du mεdial כ anteromedial tibial tubercle (Figure 12b). di komplikashכn dεm fכ di tibial tuberosity osteotomy inklud nonunion, hadwae pen, lכs fכ ridyus tכbכs εn fraktכs.

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

• pan di sik pipul dεm we gεt bon dεm we nɔ machɔ, sɔm opareshɔn dεm dεn nɔ de du ɔ dɛn dɔn chenj dɛn bikɔs ɔf di epifis.

• di fεmoral atachmεnt pכynt fכ MFPL de jכs dכn di epifis fכ di distal fεmur. fכ dat, MPFL rεkכnstrכkshכn fכ di sik pipul dεm we gεt immature bon dεm fכ kכnεkt כnda strikt fluoroscopy gayd fכ mek sכh se dεn dכn sef dril fכ di fεmoral tכnel.

• distal fεmur injuri kin mek difכm, we kin nid כ nכ kin nid fכ kכrekt sכja. semweso, di injuri fכ di proksimal tibial protrushכn kin mek difכm, spεshal wan na di mεdial kכn. fכ dat, di osteotomy fכ di tibial tuberositi na fכ di pasεnshכn dεm we gεt opin proksimal tibial protrushכn.

• כn di kכntribyushכn, di patellar tεndon kin bi komplit כ pat pan displεs mεdial wan. we dεn tכn di כta haf pan di patellar tεndon to di mεdial sayd, dεn kכl dis opεrayshכn roux-goldthwait opεrayshכn (Figure 12c).

• Ɔl di pasɛnt dɛn we dɛn de du ɔpreshɔn fɔ ebul fɔ evaluate fɔ patellar instability in di arenjmɛnt fɔ korona limb ɛn rotating limbs. inkrεs jεnu valgus, εksyכs fεmoral antεvashכn εn inkrεs εkstεnshכnal tibial tכshכn na di risk fכs fכ patellar instability.

• Fɔ di wan dɛn we gɛt bon dɛn we nɔ machɔ, dɛn fɔ tink bɔt fɔ gayd dɛn we dɛn de dil wit Genu Valgus. di epifiz skru dεm כ tεnshכn bכnd plet dεm kin span di mεdial sayd fכ di distal εnd fכ di fεmoral epifis fכ kכrekt sכmtεm. Osteotomy nid fɔ kɔrɛkt pasɛnt dɛn we gɛt machɔ bon fɔ korona ɔ rɔta difɔmiti. Di kɔrɛkshɔn indikɛshɔn fɔ Genu Valgus na > 10 digri, ɛn di kɔrɛkshɔn indikɛshɔn fɔ roteshɔnal dislɔkeshɔn pas 20 digri.

• Pikin dεm (< 10 ia ol) go mit wit komplεks patεn dεm fכ patellar instability, we inklud fכs כ abit patellar dislכkeshn. Sɔm sindrom dɛm lɛk Down syndrome, nel-patellar syndrome, Kabuki syndrome ɛn Rubinstein Taybi syndrome na patellar instability.

• i impɔtant fɔ no se di aysolɛt rikostrɔkshɔn fɔ MPFL nɔ go du fɔ sɔlv dɛn kɔmplikɛt patɛns ya, bikɔs di praymari patɔlɔji de na di say we dɛn de, ɛn sɔm tɛm dɛn kin shɔt di mɛkanism fɔ kwadrisɛps femoris, we nid fɔ mek dɛn rilis am ɔlsay ɛn kwadrisɛps femoris plasti fɔ sɔlv dɛn prɔblɛm ya.

• Insay kwadriseps femoris plasty, kwadriseps femoris mɛkanizm de rioriɛnt ɛn/ɔ lɔng. If yu nɔr de tek kia ɔf yu nɔr de trit ɔr let, dɛn kin mit dɛn kɔmplikɛt nɔr stebul patɛns ya leta na layf.

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