Chu chu i hria em? Naupangte patellofemoral joint instability awm theihna tur risk factors leh enkawlna

Patellofemoral instability (PFI) hian natna hrang hrang a huam a, malaise na lo atanga patella dislocation langsar (LPD) thlengin a huam a ni. LPD hi a tam hle a, naupang 100,000 zingah 50 vel an awm. Dislocation hmasa ber hi kum 15 leh 19 inkar a ni tlangpui. LPD hi natna chak lo tak a ni a, conservative treatment emaw physical therapy emaw hnua dislocation rate hi 70% vel a ni. Medial patellofemoral ligament siam thar leh hi surgery hmanga enkawlna hman lar ber a ni. Mahse, damlo 16% vel chuan harsatna an nei a, chutah chuan re-dislocation pawh a tel. Tin, damlo hmun li aanga hmun khat chuan khup ruh dang, surgery hmanga enkawl loh chu follow-up surgery an mamawh bawk. LPD hnua hun rei tak chhunga progressive cartilage injury leh OA risk chu initial dislocation hnua risk aiin a let 6 in a sang zawk a, hei hian damlo naupang tam tak chu kum 30 leh 40s velah OA risk a hmachhawn tir thin. PFI chungchang hriatthiamna kimchang tak neih loh hi patellofemoral joint pangngaia a awm dan pangngaia awm leh theihna tura daltu lian ber pakhat a ni.

RISK FACTOR a ni

PFI risk factors hi chi hnih ah then theih a ni a, chungte chu anatomical abnormality leh alignment abnormality te an ni. Femoral trochlear dysplasia hi anatomical abnormality pawimawh ber a ni a, alignment abnormality ah hian patellar elevation, patellar roll leh subluxation te a tel a ni. Patellofemoral deformity hi medial stabilizer hliam, Q angle tihpun, femur anteversion leh patellar tendon insertion lateralization avanga biomechanical changes avanga lo awm a ni. PFI risk factors te chu Figure 1-ah hian tarlan a ni.

• femoral trochlea natna (femoral trochlea dysplasia) a awm thin

• angle a innghahna chu transverse pulley a ni

• facet asymmetry a awm a, chu chu pulley a ni

• pulley thuk tak a ni

• alignment pangngai lo (abnormal alignment) a awm

• patella sang tak a ni

• tibia atanga trochlear groove (tt-tg) thlenga hlat zawng chu a sang chho ta a ni

• q angle tihpun

• femoral anteversion a ni

  
  

IMAGING EXAMINATION THIL TIH DAN

MRI atanga PFI hmuhchhuah hi natna nasat dan leh a rei tawh dan azirin a inang lo. PFI case na lo tak takte chu patellar dyskinesia a ni thei a, hei hi Hoffa fat pad (patellofemoral fat impact tia hriat bawk) chunglam leh a sir lam edema a ni. Patellofemoral fat impact hi PFI risk factor dangte nen a inzawm tlat a, chung zingah chuan femoral condyle dysplasia, patellar height, TT-TG distance sang, lateral patellar tilt leh subluxation te pawh a tel. Hun rei tak chhunga patellar dyskinesia awm hian cartilage hliam a thlen a, lateral patellofemoral joint a ti chhe hma hle.

Acute dislocation of patella (APLD) hi PFI natna hlauhawm ber a ni. X-ray plain film-ah hian acute injury hmuhchhuah a ni a, chu chu joint effusion, a chang chuan lipid level of fatty arthropathy, medial patella osteochondral fracture, lateral tilt/subluxation of patella (Figure 8A), leh lateral femoral condylar cartilage impaction injury avanga deep lateral sulcus sign te a ni thei. Acute LPD MRI-a a lan dan bikte chu medial stabilizer injury (96%-a hmuh), lateral patellar tilt emaw subluxation, osteochondral injury leh joint effusion te a ni (Figure 2B, C). A tam zawkah chuan patella hi a dislocation hmasa ber hnuah a takin a reset leh thin.

Damlo 70% thlengin recurrent dislocation an nei ang a, chronic recurrent dislocation pawh a awm thei bawk. Chutiang a nih chuan MRI hian medial stabilizer-a chronic tear, medial patellar deformity, medial patella ossification, patellar-femoral fat impact, cartilage hliam leh lateral patellofemoral joint degeneration te a lantir thei a ni (Figure 3).

ENKAWLNA THIL AWM DAN

1. Surgery nei lo enkawlna: 1.1.

• Acute patellar dislocation tam zawk hi chu transient a ni a, spontaneous reset a ni ang. A châng chuan damlo, chhungte, ṭhiante, coach emaw trainer emaw chuan a hmunah patella chu manual-in an reset ṭhin. Damlo chu patellar dislocation avanga emergency department-ah a kal chuan conscious sedation pek a ni ang. Patella closed reduction hi ke zawi zawia tihzauh a ni. Reset hnuah khup ruh chu hliam dang a awm leh awm loh clinically check thin ang che.

• Patella dislocation hmasa ber atana standard treatment chu non-surgical treatment a ni a, splint emaw knee joint fixator-a hun rei lote (kar 2-4) fixation hian acute attack hnua natna leh tissue damna hmasa ber a control thei a ni. Hemi chhung hian kekawrte hian a rit phurh phalsak an ni. Chumi hnuah chuan patella stabilizing brackets chu activity atan hman a ni a, physical therapy hmangin movement, strength leh limb control siam that leh a ni.

• Damlote hian an attack hmasa ber atanga thla 3 vel hnuah exercise an tan leh tlangpui. Chu bakah, stent vuah hi duhthlan tur a ni.

2. Surgery hmanga enkawl dan:

• Damlo 30% aia tamah chuan patellar dislocation hmasa ber hi khup ruh (knee joint effusion) tam tak nen a inzawm a ni. Chutiang a nih chuan osteochondral fracture a awm leh awm loh hriat nan MRI tih a ngai a ni. Heng fracture awmna hmun tam ber chu medial patella emaw lateral femoral condyle emaw a ni a, intra-articular fracture a awm chuan surgical treatment neih a tha tlangpui.

• Operation chhung hian osteochondral fracture piece te chu a fracture piece lian tham leh cartilage quality a zirin lakchhuah emaw fix emaw a ni. Osteochondral fracture lian zawng ≥ 15 mm a nih chuan excision ai chuan fracture fixation ngaihtuah a ni. He fixation hi open method hmanga metal screw, bioabsorbable pin emaw suture hmanga tih a ni.

• Fracture enkawlnaah chuan patella chu a ruala surgical stabilization trend chu medial repair emaw MPFL reconstruction hmangin a thleng thei a ni. Fracture fixation atan metal screw hman a nih chuan nakin lawkah surgery dang hmanga lakchhuah a ngai mai thei.

• Patellar stabilization hmanraw tha ber chungchangah hian ngaihdan hrang hrang pahnih a awm a. A hmasa ber chu isolated MPFL reconstruction tih a ni. MPFL hi patella lateral subluxation-a constraint factor ber a nih avangin a siam thar lehna hian patella tan stability mamawh a pe ang. MPFL siam tharna hi quadriceps tendon autograft, hamstring tendon autograft emaw allograft hmanga tih a ni tlangpui. Patellar stability siamhatna tura isolated MPFL reconstruction hlawhtlinna rate chu 95% aia tam a ni a, hei hi graft thlan nen hian engmah inzawmna a nei lo. MPFL siam thar lehna avanga harsatna awm tam ber chu khup ruh (knee joint stiffness), patellar fracture leh patellar instability lo awm leh thin te hi a ni.

• A pahnihna hian patellar instability risk factors te a solve a, MPFL reconstruction te pawh a solve bawk. Hetiang method hmang hian patellar instability awm thei anatomical risk factors te chu X-ray film leh CT/MRI hmangin an chhut a, chung zingah chuan trochlear dysplasia, patellar height sang leh TT-TG distance te pawh a tel a ni. A hriat chian hnuah chuan risk factor thenkhat emaw, a zawng zawng emaw chu operation hmangin siamthat a ni ang.

• Trochlear dysplasia hi trochleoplasty hmanga chinfel a ni a, chutah chuan trochlear groove chu a thuk zawk a ni (Figure 12A). Trochlear plasty hi United States-ah chuan a lar vak lo a, a chhan chu articular cartilage invasion a nih vang a ni a, theoretically chuan nakin lawkah ischemic necrosis emaw arthritis emaw a awm theihna a awm bawk.

• Patella san zawng emaw, patella san zawng tihpun emaw chu distal tibial tubercle hmangin a chinfel theih. TT-TG hlat zawng tihpun nan medial emaw anteromedial tibial tubercle emaw tih a ni (Figure 12B). Tibial tuberosity osteotomy avanga harsatna awm thei te chu nonunion, hardware na, tuberosity tihtlem hloh leh fracture te a ni.

• Lateral retina tension atan chuan lateral retinal release tih a ni a, hei hian patella tilt tihpun a lantir a ni. Lateral release avanga harsatna awmte chu patella-a persistent swelling leh iatrogenic medial instability te a ni.

• Ruh puitling lo damlote tan chuan operation thenkhat chu epiphysis vangin contraindicated emaw modified emaw a ni.

• MFPL-a femoral attachment point hi distal femur epiphysis hnuai chiahah a awm a. Chuvangin, ruh puitling lo damlote MPFL reconstruction chu femoral tunnel him taka drilling a nih theih nan fluoroscopy kaihhruaina khauh tak hnuaiah neih a ngai a ni.

• Distal femur injury hian deformity a thlen thei a, chu chu surgical correction a ngai thei a, a ngai lo thei bawk. Chutiang bawkin proximal tibial protrusion hliam hian deformity a thlen thei a, a bik takin medial knee-ah a awm thei bawk. Chuvangin, open proximal tibial protrusion nei damlo tan chuan tibial tuberosity osteotomy hi khap a ni.

• Chu ai chuan patellar tendon chu medial-ah a pumin emaw, a then emaw a inthlak thei a ni. Patellar tendon pawn lam chanve chu medial side-ah an sawn chuan he operation hi Roux-Goldthwait operation an ti a (Figure 12C).

• Surgery nei zawng zawngte chu coronary limbs leh rotating limbs inrem danah patellar instability awm leh awm loh endik vek tur a ni. Genu valgus tihpun, femoral anteversion tam lutuk leh external tibial torsion tihpun te hi patellar instability thlentu a ni.

• Ruh puitling lo nei damlote tan chuan genu valgus nena inzawmna siam hunah an thanlenna kaihruaitu ngaihtuah tur a ni. Epiphyseal screw emaw tension band plate emaw hian femoral epiphysis distal end medial side chu a span thei a, zawi zawiin siamthat theih a ni. Ruh puitling nei damlote chu coronary emaw rotational deformity emaw siamthat nan osteotomy neih a ngai a ni. Genu valgus correction indication chu > 10 degree a ni a, rotational dislocation correction indication chu 20 degree aia tam a ni.

• Naupang (< kum 10) te hian patellar instability pattern complex tak tak an tawk ang a, chung zingah chuan fixed emaw habitual patellar dislocation emaw pawh a tel ang. Syndrome engemaw zat Down syndrome, nail-patellar syndrome, Kabuki syndrome leh Rubinstein Taybi syndrome te hi patellar instability atanga siam an ni.

• MPFL isolated reconstruction hi heng pattern buaithlak tak takte chinfel nan hian a tawk lo tih hriat a pawimawh a, a chhan chu primary pathology hi laterally-ah a awm a, a chang chuan quadriceps femoris mechanism a tawi a, hei hian heng harsatnate chinfel nan hian wide lateral release leh quadriceps femoris plasty a mamawh a ni.

• Quadriceps femoris plasty-ah chuan quadriceps femoris mechanism chu reoriented leh/or rei tak a ni. Ngaihsak loh emaw, enkawl tlai emaw a nih chuan, heng thil nghet lo buaithlak tak takte hi nakin lawkah kan tawng thei a ni.

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