Chu chu i hria em? Naupangte patellofemoral joint instability enkawl dan tur leh enkawl dan tur .

Patellofemoral Instability (PFI) ah hian natna hrang hrang a awm a, malaise na lo tak atanga obvious dislocation of patella (LPD) thlengin a awm a. LPD hi a tam hle a, naupang 100,000 zelah case 50 vel an awm. Dislocation hmasa ber hi kum 15 leh 19 inkar vel a ni tlangpui. LPD hi natna tichak lo tak a ni a, conservative treatment emaw physical therapy emaw hnua dislocation rate chu 70% vel a ni. Medial patellofemoral ligament siam thar leh hi surgery hmanga enkawlna hman lar ber a ni. Mahse, damlo 16% velin harsatna an nei a, 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 progressive cartilage injury leh OA awm theihna hun rei tak chhunga a hlauhawmna chu a tir lama dislocation hnuah aiin a let 6-in a sang zawk a, hei hian damlo naupang tam tak chu kum 30 leh 40 inkar OA risk a hmachhawn tir a ni. PFI chungchanga hriatthiamna zau tak neih loh hi normal patellofemoral joint-a inmilna siamhatna kawnga daltu ber pakhat a ni.

Risk factor a ni a .

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 lateralization of patellar tendon insertion avanga biomechanical changes awm vang a ni. PFI risk factors te chu Figure 1-ah hian tarlan a ni.

• Femoral Trochlea Dysplasia 2019 a ni.

• Angle of inclination chu transverse pulley a ni.

• Pulley-a facet asymmetry .

• Pulley thuk zawng .

• A inmil lo .

• Patella sang tak a ni.

• Tibia atanga Trochlear Groove (TT-TG) thlenga hlat zawng chu a sang hle a ni.

• Q angle tihpun a ni.

• Femoral anteversion 1000 a ni.

  
  

Imaging examination neih dan tur .

PFI a MRI hmuhchhuah hi natna nasat leh natna rei tak a awm dan azirin a inang lo. PFI natna vei te hi patellar dyskinesia hmanga hriat theih a ni a, chu chu hoffa fat pad (patellofemoral fat impact tia hriat bawk) chunglam leh lateral side edema hmanga hriat theih 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 tihpun, lateral patellar tilt leh subluxation te pawh a tel. Hun rei tak chhunga patellar dyskensia lo awm tawh chuan cartilage hliam a thlen a, lateral patellofemoral joint chu a hmaa a lo chhe tawh bawk.

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

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

Enkawl dan tur .

1. Surgical ni lo enkawlna:

• Acute patellar dislocations tam zawk hi transient a ni a, a takin reset a ni ang. A châng chuan, damlo, chhûngte, ṭhiante, coach emaw, trainer emaw chuan patella chu a hmunah kut hmangin an reset ṭhin. Damlo chu patellar dislocation avanga emergency department-a a kal chuan conscious sedation pek a ni ang. Closed reduction of patella chu kephah zauh zauh zauh a ni. Reset zawh chuan clinically chuan khup ruh chu hliam dang a awm leh awm loh enfiah 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) chhunga fixation hian acute attack hnua natna leh initial tissue damna a control thei a ni. Hemi hun chhung hian crutches hian a rit phurh chu a phur thei a ni. Chumi hnuah chuan patella stabilizing brackets chu activities atan hman a ni a, physical therapy hmangin movement, strength leh limb control te siam that leh a ni.

• Damlote chuan an beih hmasak ber atanga thla 3 vel hnuah exercise an la leh tlangpui thin. Chu bakah, stent vuah hi duhthlan tur a ni.

2. Surgery hmanga enkawlna: 1.1.

• Damlo 30% aia tam zingah chuan patellar dislocation hmasa ber chu khup ruh inzawmna tam tak nen a inzawm a ni. Chutiang a nih chuan MRI tih a ngai a, osteochondral fracture a awm leh awm loh hriat a ngai a ni. Heng ruh tliakte awmna hmun tam ber chu medial patella emaw lateral femoral condyle emaw a ni a, intra-articular fracture awmnaah chuan surgery hmanga enkawl a tha tlangpui.

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

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

• Patellar stabilization hman dan tha ber tur ngaihtuah school pahnih a awm a. A hmasa ber chu MPFL reconstruction isolated tih a ni. MPFL hi patella lateral subluxation-a constraint factor ber a nih avangin a reconstruction hian patella tan stability mamawh a pe dawn a ni. MPFL siamthatna hi quadriceps tendon autograft, hamstring tendon autograft emaw allograft emaw hmanga tih thin a ni. Patellar stability siamṭhatna tura isolated MPFL reconstruction hlawhtlinna rate chu 95% aia tam a ni a, hei hian graft thlan nen hian inzawmna a nei lo. MPFL siamthatna avanga harsatna awm tam ber chu knee joint stiffness, patellar fracture leh recurrent patellar instability te hi a ni.

• A pahnihna chuan patellar instability, leh MPFL reconstruction-a risk factors te chu a chinfel sak a ni. Hetiang method hmang hian x-ray film leh CT/MRI-ah te hian patellar instability anatomical risk factors te chu an teh a, chung zingah chuan trochlear dysplasia, patellar san zawng tihpun leh TT-TG distance te pawh a tel. Vawikhat an hriat chuan risk factor thenkhat emaw, a vai emaw chu surgery 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 tel a, theoretically chuan nakin lawka ischemic necrosis emaw arthritis emaw a thlen theihna a awm bawk.

• Patella san zawng emaw patella san zawng tihpunna chu distal tibial tubercle hmangin a chinfel theih. TT-TG distance tihsan nan medial emaw anteromedial tibial tubercle tih a ni (Figure 12b). Tibial tuberosity osteotomy-a harsatna awmte chu nonunion, hardware natna, tuberosity tihtlem leh ruh tliak te a ni.

• Lateral retina tension atan chuan lateral retinal release an ti a, hei hian patella tilt a pun dan a tarlang a ni. Lateral release-a harsatna awm thei zingah hian persistent swelling leh iatrogenic medial instability of patella te pawh a tel.

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

• MFPL-a femoral attachment point chu distal femur epiphysis hnuai chiahah a awm a. Chuvangin, ruh puitling lo nei damlote MPFL siam thar leh chu femoral tunnel him taka drilling neih theih nan fluoroscopy guidance khauh tak hnuaiah neih a ngai a ni.

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

• Chutih rualin, patellar tendon chu a pumin emaw, a then emaw chu medially-in a inthlak thei a ni. Patellar tendon pawn lam chanve chu medial side-ah a transfer chuan he operation hi roux-goldthwait operation an ti a (Figure 12C).

• Surgery nei zawng zawngte chu coronary limbs leh rotating limbs arrangement-a patellar instability awm leh awm loh endik vek tur a ni. Genu valgus tihpun, femoral anteversion tam lutuk leh pawn lam tibial torsion tihpun hi patellar instability awm theitu a ni.

• Ruh puitling lo nei tan chuan Genu Valgus nena inzawmna nei tur chuan guiding growth ngaihtuah tur a ni. Epiphyseal screw emaw tension band plate emaw hian zawi zawiin a siam that theih nan femoral epiphysis distal end medial side a span thei a ni. Coronary emaw rotational deformity emaw atana ruh puitling nei damlote siamthat nan osteotomy a ngai a ni. Genu valgus siamthatna tur indication chu > 10 degree a ni a, rotational dislocation siamthatna indication chu degree 20 aia tam a ni.

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

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

• Quadriceps femoris plasty-ah chuan quadriceps femoris mechanism chu reoriented leh/ emaw hun rei tak a ni. Neglect emaw, late treatment emaw a nih chuan, heng unstable pattern buaithlak tak takte hi a hnu lamah pawh an tawk thei ang.

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