ABSTRACT
PURPOSE: To correlate the location of the medial patellofemoral ligament femoral fixation site in knees suffering a chronic lateral patellar instability, by using radiographic references and by using the most important anatomic reference point (i.e. the adductor tubercle) identified by means of 3-dimensional (3D) surface reconstructions by computed tomography (CT) imaging. METHODS: Thirty consecutive knee 3D-CT examinations at 0º of knee extension were obtained from patients (20 females, 10 males; median age of 23.5 years; range, 14-48 years) treated for chronic lateral patellar instability with at least two documented patellar dislocations. For each knee, three virtual 7-mm-diameter femoral tunnels were created. One of the tunnels used an anatomic fixation landmark (anatomic fixation), while the other two used established radiologic methods. We calculated the percentage of the anatomic tunnel covered by the tunnel created according to the method described by Schoettle, and the percentage of the anatomic tunnel covered by the tunnel created according to the method described by Stephen. These percentages were compared using paired Student's t test. RESULTS: The percentage of anatomic tunnel area covered by the femoral tunnel created using Schoettle's method was 36.7 ± 25.2 %. When using Stephen's method, the percentage of overlap with the anatomic femoral tunnel was 25.5 ± 21.5 %. There were no significant differences between the two radiographic methods (n.s.). CONCLUSION: None of the standard radiographic methods allowed a precise anatomic femoral placement. Conventional radiographic identification of the femoral graft placement site is only an approximation and should not be the sole basis for femoral attachment location. LEVEL OF EVIDENCE: IV.
Subject(s)
Anatomic Landmarks/diagnostic imaging , Femur/diagnostic imaging , Joint Instability/surgery , Ligaments, Articular/diagnostic imaging , Multidetector Computed Tomography , Orthopedic Procedures/methods , Patellofemoral Joint/diagnostic imaging , Adolescent , Adult , Anatomic Landmarks/surgery , Chronic Disease , Female , Femur/anatomy & histology , Femur/surgery , Humans , Imaging, Three-Dimensional , Joint Instability/complications , Joint Instability/diagnostic imaging , Ligaments, Articular/anatomy & histology , Ligaments, Articular/surgery , Male , Middle Aged , Patellar Dislocation/diagnostic imaging , Patellar Dislocation/etiology , Patellar Dislocation/surgery , Patellofemoral Joint/anatomy & histology , Patellofemoral Joint/surgery , Young AdultABSTRACT
En este artículo se realiza una revisión general de los diferentes procedimientos intervencionistas percutáneos, guiados mediante técnicas de imagen, y utilizados para el diagnóstico y tratamiento de las diversas causas responsables del dolor de raquis. Estos procedimientos pueden ser meramente diagnósticos, como la discografía y la biopsia, diagnósticos y terapéuticos, como las infiltraciones, o puramente terapéuticos, como la vertebroplastia, las técnicas descompresivas del disco intervertebral o la ablación tumoral. Se revisan las indicaciones, ventajas y complicaciones de las diferentes técnicas (AU)
The aim of this article is to perform a general review of the different radiological percutaneous procedures used to diagnose and treat the many causes of back pain. These procedures can be merely diagnostic, such as discography and biopsy, diagnostic and therapeutic, such as epidural and facets injections, or only therapeutic, such as vertebroplasty, decompressive techniques of the intervertebral disk and tumour ablation. We review the indications, advantages and complications of these techniques (AU)
Subject(s)
Humans , Radiography, Interventional/methods , Low Back Pain , Spinal Diseases , Spine/physiopathology , Vertebroplasty , Kyphoplasty , BiopsyABSTRACT
The aim of this article is to perform a general review of the different radiological percutaneous procedures used to diagnose and treat the many causes of back pain. These procedures can be merely diagnostic, such as discography and biopsy, diagnostic and therapeutic, such as epidural and facets injections, or only therapeutic, such as vertebroplasty, decompressive techniques of the intervertebral disk and tumour ablation. We review the indications, advantages and complications of these techniques.
