Resultado de tratamiento quirúrgico de la luxación recidivante de rótula mediante la técnica de Campbell / Result of surgical treatment of recurrent patella dislocation using the Campbell technique

Resumen: Introducción: La luxación recidivante de rótula es una condición en la cual no se mantiene la congruencia de la superficie de la rótula en su desplazamiento sobre el surco intercondíleo del fémur en los movimientos de flexoextensión de la rodilla. Los objetivos del trabajo son: mostrar la distribución de pacientes con luxación recidivante de rótula según diferentes variables sociodemográficas y evaluar los resultados con el uso de la técnica de Campbell. Material y métodos: Se llevó a cabo un estudio observacional en pacientes con luxación recidivante de rótula, en el período de Diciembre de 2017 a Diciembre de 2019. La recolección de datos se realizó con la revisión de las historias clínicas. La muestra fue de 19 pacientes, para la evaluación de la técnica quirúrgica se utilizó el sistema propuesto por los autores. El procesamiento de la información incluyó el cálculo de medidas de resumen para variables cualitativas, frecuencias absolutas y porcentajes. Resultados: El sexo femenino y el grupo de edad de 15 a 30 años fueron los más frecuentes, la cicatrización fue mala en dos pacientes. Se obtuvieron buenos resultados en 84.3% de los pacientes operados. Conclusiones: Predominó el sexo femenino y el grupo de 15 a 30 años, la cicatrización fue mala en dos pacientes. Se obtuvieron buenos resultados en los pacientes operados. A pesar de que la mayoría de los autores recomiendan la reparación del ligamento patelofemoral medial como técnica de elección o la técnica de Insall, la técnica de Campbell arroja buenos resultados cuando se aplica a luxación recidivante de rótula que necesita realineación proximal del mecanismo extensor.

Abstract: Introduction: the recurrent dislocation of the patella is a condition in which the congruence of the surface of the patella is not maintained in its displacement on the intercondyleal groove of the femur in the flexo-extension movements of the knee. The objectives of the study are: to show the distribution of patients with recurrent dislocation of patella according to different socio-demographic variables and to evaluate the results with the use of campbell's technique. Material and methods: An observational study was conducted in patients with recurrent patella dislocation in the period from December 2017 December 2019. Data collection was carried out with the review of medical records. The sample was 19 patients, the evaluation of the surgical technique was used the system proposed by the authors. Information processing included the calculation of summary measures for qualitative variables, absolute frequencies and percentages. Results: The female sex and the age group of 15 to 30 years were the most frequent, healing was poor in two patients, good results were obtained in 84.3% of the operated patients. Conclusions: Predominance of the female sex and the group of 15 to 30 years, the healing was bad in two patients, good results were obtained in the operated patients. Although most authors recommend medial patello-femoral ligament repair as a technique of choice or the Insall technique, Campbell's technique yields good results when applied to recurrent patella dislocation that need proximal realignment of the extensor mechanism.

Surgical Technique for Distal Femur Varization Osteotomy / 대한정형외과학회잡지

A closing wedge distal femoral osteotomy is a procedure to reduce pain and delay the progression of degenerative arthritis of knee by moving the weight bearing line from the lateral compartment to the medial side while preserving the knee joint. Age, weight bearing line, and the degree of arthritis are the essential factors to be considered at the time of surgery. The indications for distal femoral osteotomy are as follows. All patients are aged less than 65 years old, normal medial compartment of the knee with normal patello femoral joint, valgus deformity with lateral degenerative arthritis, younger patients with lateral osteochondritis, congenital osteochondrosis, and recurrent patellar dislocation with genu valgum. The distal femoral osteotomy provides the advantages of rapid pain reduction and short rehabilitation in young and active patients and patients who are subjected to heavy loads on the knee.

The Evaluation of Femoral Trochlear Dysplasia Using Imaging Analysis System Based on Three-Dimension Computed Tomography / 中国运动医学杂志

Objective To evaluate the application of imaging analysis system based on three-dimension computed tomography (3D-CT)for the diagnosis of femoral trochlear dysplasia.Methods Between May 2013 and January 2014,30 patients were diagnosed as recurrent patella dislocation and received surgical treatment.All the patients received 3D-CT diagnosis of the knee joints preoperatively,and the data of 3D-CT were transferred to imaging analysis system with MIMICS software that would be used to get the trochlear dysplasia index.The patients were also received knee fluoroscopic detection.A true lateral view was also used for evaluation of the trochlear dysplasia as the classic method.The difference between the two methods was compared.And the sensitivity,specificity,positive and negative predictive value of the imaging analysis system were analyzed.Results The mean trochlear dysplasia index was 5.3 ± 1.8 mm (3.2 to 8.4 mm)using the classic fluoroscopic method,showing no significant difference from the result according to the imaging analysis system,5.2 ± 1.5 mm (3.5 to 8.1 mm).When the fluoroscopic method was set as the golden standard,the sensitivity,specificity,positive and negative predictive value of the imaging analysis system were 89.5％,81.8％,89.4％ and 82.0％ respectively.Conclusion The imaging analysis system based on 3D-CT of knee joints could provide acceptable results without good sensitivity and specificity,without significant differences from the classic fluoroscopic method.So it is a more safer and easier approach worthy of clinical implication.

Knee J-Sign in Recurrent Patella Dislocation: Incidence, Classification and Radiographic Characteristics / 中国运动医学杂志

Purpose To determine the incidence,degree and radiographic characteristics of knee Jsign in recurrent patella dislocation patients.Method It was a retrospective review of a consecutive series of 59 recurrent patella dislocation patients.The knee J-sign was classified into negative (-),positive one degree(mild,l+)and positive two degree(gross,2+)based on the severity of patellar lateral translation at the extreme extension of knees with quadriceps contracted actively.The computed tomography(CT)examination at 0° extension of the knee was performed to quantify the degree of patellar lateral translation and tilt,with three CT parameters measured and calculated in axial slices:patella bisect offset index (BOI),patella trochlear-groove (PTG) distance and patella lateral tilt (PLT) angle.Results In all the 59 patients,72.9％(43/59)showed positive J-sign,27.1％(16/59)of positive one degree(1+) and 45.8％(27/59)of positive two degree(2+).All the three CT parameters increased with the severity of Jsign(P＜0.05).Conclusion Among 59 recurrent patella dislocation patients,we have found 72.9％ of positive knee J-sign.The severity of J-sign has a positive correlation with the degree of patellar lateral translation and tilt.

Quantification of Patellar Maltracking Combined with J-Sign Using Computed Tomography / 中国运动医学杂志

Objective To quantify the patellar mal-tracking combined with J-sign using the computed tomography (CT).Method Fifty-three adult patients diagnosed as recurrent patellar dislocation (RPD) were chosen.According to their patellar tracking during knee active flexion and extension,they were divided into group A(with positive J-sign) and group B(with negative J-sign).The CT examinations were performed in all patients at 0°extension of the knee and the patella bisect offset index (BOI),patella troehlear-groove distance (PTG) and patella lateral tilt (PLT) were measured in the axial position and compared.The receiver operating characteristic analysis (ROC) curve was used to analyse the accuracy and stability of the three J-sign parameters.Results In all the 53 patients,thirty-seven(69.8％) knees were of positive J-sign,while the rest 16 were of negative J-sign.The mean values of CT parameters BOI,PTG and PLT in group A were significantly larger than those of group B.Moreover,the area under the curve for BOI,PTG and PLT were 0.906,0.883 and 0.833 respectively.The sensitivity and specificity of BOI were 83.3％ and 87.5％,while the predicting cut-off value was 97.5％.Conclusion In all the 53 recurrent patella instability patients,the morbidity of patella proximal mal-trackingis 69.8％.The CT parameter BOI can be used to quantify the J-Sign into positive and negative groups.

Bilateral Recurrent Patellar Dislocation: Review of 5 Patients / 대한정형외과학회잡지

From Nov. 1986 to May 1988, we experienced 5 patients of bilateral recurrent patellar dislocation and obtained the following results:1. The age at operation raaged from 17 to 25 years. Among 5 patients, four were female and one, male. 2. The age at the onset of symptom ranged from 7 to 16 years. 3. The common presenting symptoms were pain(5 knees), giving way(4), grating(4), swelling (3), and weakness(2). 4. The roentgenographic findings were lateral patella tilt(9 knees), lateral femoral condyle hypoplasia(6), patella alta(2), patella dysplasia(2), and accessory ossification center(2). 5. All knees were treated by Hughston technique:One patient(2 knees) was treated with proximal realignment only, and the others(7 knees) were with proximal and distal realignments. 6. Follow up period ranged from 1 to 2 years. And the excellent to good result was obtained from the patients treated with proximal and distal realignments(excellent in 4 knees, good in 2 knees), the fair result from the patient treated with proximal realignment only(2 knees), and the poor result from the patient slipped down at 6 weeks postoperatively(1 knee).