Patello-Femoral OA - Lucy Dennell 18/6/2002
Patellofemoral arthritis- treatment
Nonnoperative treatment
Weight loss/quads strengthening/modification of activities
Surgical Options
Surgical Options
Lateral release/Chondroplasty (
Spongialisation
)/Tibial tubercle elevation/Patellar osteotomy/Patellectomy/Patellar resurfacing/Patellofemoral joint replacement/TKR
Lateral release
Lateral release
Usually performed with some other procedure such as chondroplasty, tibial tubercle elevation, or patellofemoral joint replacement
Abstracts of papers imply that alone it is suited to younger patients with patellofemoral pain or instability or minimal patellofemoral arthrosis
Chondroplasty
such as shaving of the cartilage surface yielded poor results
(Bentley 1978)
Spongialisation
is a technique described by Ficat involving removal of all articular cartilage and subchondral bone leaving a completely exposed cancellous bony bed. The term spongialisation comes from exposure of the "spongiosa" portion of the cancellous bone. It is an extension of the technique of perforation of the subchondral plate suggested by Pridie to allow ingrowth of fibrous tissue A method of resurfacing. Also, allows removal of the painful well innervated subchondral bone
Spongialisation
is a technique described by Ficat involving removal of all articular cartilage and subchondral bone leaving a completely exposed cancellous bony bed. The term spongialisation comes from exposure of the "spongiosa" portion of the cancellous bone. It is an extension of the technique of perforation of the subchondral plate suggested by Pridie to allow ingrowth of fibrous tissue A method of resurfacing. Also, allows removal of the painful well innervated subchondral bone
Spongialisation
is a technique described by Ficat involving removal of all articular cartilage and subchondral bone leaving a completely exposed cancellous bony bed. The term spongialisation comes from exposure of the "spongiosa" portion of the cancellous bone. It is an extension of the technique of perforation of the subchondral plate suggested by Pridie to allow ingrowth of fibrous tissue A method of resurfacing. Also, allows removal of the painful well innervated subchondral bone
Ficat RP et al Clin Orth. 1070;144:74-83 claimed 79% good or excellent results at av 15 months follow up in 85 pts. Some pts had additional lateral releases or tubercle advancement
This technique did not take off because of unpredictable and incomplete regeneration.
Tibial tubercle elevation
Maquet, a Belgian, first described his osteotomy in 1963(in French).
Maquet P Advancement of the tibial tuberosity Clin Orth 1976;115:225., was proposed for both chondromalacia patellae and pf osteoarthritis.
Its aim is to reduce articular pressures across the pfj
This has been confirmed subsequently by other authors in cadaveric and biomechanical studies.
In a nutshell the lever arm of patellar tendon is lengthened
In a nutshell the lever arm of patellar tendon is lengthened
In a nutshell the lever arm of patellar tendon is lengthened
The angle subtended by the pat ligament and quads mechanism is made more obtuse.
Both resulting in a decrease force required by the quadriceps and a decreased joint reaction force in both the pfj
and
the tibio femoral joint.
For a 2cm advancement of tt a 50% decrease in joint reaction force.
For a full explanation of mechanics see;
Maquet P Mechanics and osteoarthritis of the patellofemoral joint. CORR 1979; 144:70-73
(which has 6 references all by a certain P Maquet)
Despite his claims as a final solution to the problem of pfa it has not been widely adopted.
Despite his claims as a final solution to the problem of pfa it has not been widely adopted.
Despite his claims as a final solution to the problem of pfa it has not been widely adopted.
Patellectomy
Patellectomy Results in a reduction of the quads force lever arm Decreased flexion esp when ascending and descending stairs An increase of 15-30% of force required across PFJ
Increased instability. Poor cosmesis.
A salvage procedure
Patellar resurfacing and arthroplasty
Mckeever 1955 anatomically shaped cobalt chromium alloy prosthesis attatched to bone w transfixation screw. Poor results at FU
Mckeever 1955 anatomically shaped cobalt chromium alloy prosthesis attatched to bone w transfixation screw. Poor results at FU
Mckeever 1955 anatomically shaped cobalt chromium alloy prosthesis attatched to bone w transfixation screw. Poor results at FU
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ACL