Scholarlink

Background <p>Patellofemoral instability has multifactorial causes in which the static, dynamic and anatomical configurations of the tibia and femur play a decisive role. In addition to the previously known pathologies, trochlear dysplasia, a lateralized tubercle of the tibia (TT), a valgus deformity, pathological torsion of the femur or tibia, increased patellar tilt and patella alta are also important. In the current literature a pathological tibiofemoral rotation (TFR) is increasingly being linked to patellar instability and recurrent patellar dislocation.</p> Case report <p>This article presents the case of a 16-year-old female patient with recurring bilateral patellar dislocation since the age of 11 years. Clinical and radiological examinations showed a pathological TFR of 20°, an increased tubercle of the tibia-trochlear groove (TT-TG) distance (23mm), a trochlear dysplasia (type B) and elevated femoral and tibial torsion. The surgical treatment included a femoral rotation osteotomy, medialization of the TT and trochleoplasty. The patient showed excellent postoperative results with stable patella management, complete range of motion (extension/flexion 5/0/150) and radiological consolidation of the osteotomy.</p> Conclusion <p>The TFR is a parameter that has so far barely been considered in the clinical routine although it decisively contributes to the development and severity of patellofemoral instability and in this context can influence both the diagnostics and treatment. The TT-TG distance is a composite measure that reflects the actual lateralization of the TT as well as the TFR and should be correspondingly interpreted to establish an optimal treatment. In complex cases imaging procedures, such as torsion magnetic resonance imaging (MRI) and/or computed tomography (CT) are essential for a precise diagnosis. There is currently no causal treatment approach for a pathological TFR with patellofemoral instability, therefore the treatment must often be carried out around the actual pathology. Procedures such as trochleoplasty and rotation osteotomy play a key role. Further research is necessary to develop specific treatment approaches to better address an elevated TFR, which could potentially improve the long-term results for patients with patellofemoral instability.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Pathologisch erhöhte tibiofemorale Rotation als Hauptursache einer chronisch lateral fixierten Patellaluxation

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年1月21日

查看全文
  • Salim Youssef,
  • Leonie Kijewskie,
  • Yasmin Youssef,
  • Thomas Engel

摘要

Background

Patellofemoral instability has multifactorial causes in which the static, dynamic and anatomical configurations of the tibia and femur play a decisive role. In addition to the previously known pathologies, trochlear dysplasia, a lateralized tubercle of the tibia (TT), a valgus deformity, pathological torsion of the femur or tibia, increased patellar tilt and patella alta are also important. In the current literature a pathological tibiofemoral rotation (TFR) is increasingly being linked to patellar instability and recurrent patellar dislocation.

Case report

This article presents the case of a 16-year-old female patient with recurring bilateral patellar dislocation since the age of 11 years. Clinical and radiological examinations showed a pathological TFR of 20°, an increased tubercle of the tibia-trochlear groove (TT-TG) distance (23mm), a trochlear dysplasia (type B) and elevated femoral and tibial torsion. The surgical treatment included a femoral rotation osteotomy, medialization of the TT and trochleoplasty. The patient showed excellent postoperative results with stable patella management, complete range of motion (extension/flexion 5/0/150) and radiological consolidation of the osteotomy.

Conclusion

The TFR is a parameter that has so far barely been considered in the clinical routine although it decisively contributes to the development and severity of patellofemoral instability and in this context can influence both the diagnostics and treatment. The TT-TG distance is a composite measure that reflects the actual lateralization of the TT as well as the TFR and should be correspondingly interpreted to establish an optimal treatment. In complex cases imaging procedures, such as torsion magnetic resonance imaging (MRI) and/or computed tomography (CT) are essential for a precise diagnosis. There is currently no causal treatment approach for a pathological TFR with patellofemoral instability, therefore the treatment must often be carried out around the actual pathology. Procedures such as trochleoplasty and rotation osteotomy play a key role. Further research is necessary to develop specific treatment approaches to better address an elevated TFR, which could potentially improve the long-term results for patients with patellofemoral instability.