SURGICAL TREATMENT OF PATELLOFEMORAL ARTHROSIS IN WORKING AGE PATIENTS (PRELIMINARY REPORT)


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Abstract

Introduction. Choice of treatment tactics for the patellofemoral arthrosis (PFA) is a complex and controversial issue especially in patients under 40 years.Purpose of study: to evaluate the early results of combined surgical interventions in patients with PFA. Patients and methods. Prospective cohort study included 24 patients (14 women and 10 men) aged 18– 45 years (mean age 31.5±4 years). Preoperative roentgenography, MRI, assessment by VAS, OKS and KSS were performed to all patients. The degree of patellofemoral joint disorders was assessed using the elaborated clinical scale that enabled to divide patients into two groups. Group 1 (n=8) with marked changes and group 2 (n=16) with the moderate changes. Corrective plasty of shin extensor mechanism with ventralization of the tibial tubercle by Fulkerson in combination with arthroscopic debridement was performed to all patients. Results. In 6 months after surgery the improvement of anatomic and functional status was observed in all patients. The pain intensity score evaluated according to the VAS scale decreased on the average from 6.6 before surgery to 2.0 at the time of the last follow-up. In the 1st group of patients preoperative and postoperative estimation by VAS made up 6±2 cm and 3±1 cm (p=0.003), by KSS — 55±2 and 61±3 points (p=0.001), by OKS — 22±4 and 32±3 points (p=0.001), respectively.Conclusion. Application of the complex of multidirectional surgical techniques (reconstruction, modelling) enables to achieve good anatomic and functional results.

About the authors

F. M. Said

Kazan State Medical University

Email: Firassss86@gmail.com

I. F. Akhtyamov

Kazan State Medical University

A. I. Kudryavtsev

Republican Clinical Hospital; Kazan State Medical Academy, Branch of the Russian Medical Academy of Continuous Professional Education

M. D. Helo

Kazan State Medical University

References

  1. Rodriguez-Merchan E.C. Surgical treatment of isolated patellofemoral osteoarthritis. HSS J. 2014; 10 (1): 79-82. doi: 10.1007/s11420-013-9375-3.
  2. Crossley K.M., Stefanik J.J., Selfe J. et al. Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br. J. Sports Med. 2016; 50: 839-43. doi: 10.1136/bjsports-2016-096384.
  3. Macri E.M., Stefanik J.J., Khan K.M. et al. Is tibiofemoral or patellofemoral alignment or trochlear morphology associated with patellofemoral osteoarthritis? A systematic review. Arthritis Care Res. 2016; 68 (10): 1453-70. doi: 10.1002/acr.22842.
  4. Nakagawa T.H., Moriya E.T., Maciel C.D. et al. Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome. J. Orthop. Sports Phys. Ther. 2012; 42: 491-501. doi: 10.2519/jospt.2012.3987.
  5. Crossley K.M., Vicenzino B., Lentzos J. et al. Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial. Osteoarthrithis Cartilage. 2015; 23 (9): 1457-64. doi: 10.1016/j.joca.2015.04.024.
  6. Gracitelli G.C., Moraes V.Y., Franciozi C.E. et al. Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults. Cochrane Database Syst. Rev. 2016; 3 (9): CD010675.
  7. Mosier B.A., Arendt E.A., Dahm D.L. et al. Management of patellofemoral arthritis: from cartilage restoration to arthroplasty. Instr. Course Lect. 2017; 66: 531-42.
  8. Миронов С.П., Лисицын М.Х. Ошибки в расположении трансплантата при артроскопической реконструкции передней крестообразной связки коленного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2011; 2: 89-94.
  9. Mont M.A., Johnson A.J., Naziri Q. et al. Patellofemoral arthroplasty: 7-year mean follow-up. J. Arthroplasty. 2012; 27 (3): 358-61. doi: 10.1016/j.arth.2011.07.010.
  10. Fulkerson J. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin. Orthop. Relat. Res. 1983; (177): 176-8.
  11. Zaffagnini S., Dejour D., Arendt E.A., eds. Patellofemoral pain, instability, and arthritis: Clinical presentation, imaging and treatment. Springer; 2010: 217-45.
  12. Longo U.G., Rizzello G., Ciuffreda M. et al. Distal realignment procedures for the management of patellar dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy. 2016; 32 (5): 929-43. doi: 10.1016/j.arthro.2015.10.019.
  13. Brophy R.H., Wojahn R.D., Lamplot J.D. Cartilage restoration techniques for the patellofemoral joint. J. Am. Acad. Orthop. Surg. 2017; 25 (5): 321-9. doi: 10.5435/ JAAOS-D-15-00447.
  14. Cotic M., Forkel P., Imhoff A.B. Patellofemoral arthroplasty. Oper. Orthop. Traumatol. 2017; 29 (1): 40-50 (in German). doi: 10.1007/s00064-016-0477-1.

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