RU2551204C1 - Method of treating patellofemoral arthrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: long flap is cut out in the middle of an extensor expansion of quadriceps muscle of thigh with dissecting away in the proximal direction and preserving an attachment to an upper pole of a patella. The flap is moved behind the patella, brought between articular surfaces of femoral and patellar condyles so that the anterior surface of the flap adjoins the condyles, whereas the posterior one - to the patella. The flap is fixed in a split of patellar ligament.

EFFECT: invention enables providing more effective surgical treatment, reducing the number of postoperative complications.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to orthopedics traumatology, and can be used in patients with patellofemoral arthrosis, where all the possibilities of conservative therapy have been exhausted.

Arthrosis in general, and patellofemoral arthrosis in particular, is a severe suffering caused by a pathological process or injuries of the articular cartilage of the condyles of the thigh and patella. Clinically, the leading symptom in this disease is pain and restriction of freedom of movement. Unfortunately, in advanced cases, all modern conservative medical methods do not give the desired effect and you have to resort to operational tactics. A method for the treatment of patellofemoral arthrosis is described, which consists in dissecting the supporting ligaments of the patella in combination with plasty and ventralization of the tuberosity of the tibia according to Badri (A. p. 1641302, authors: Miroshnichenko V.F. and Izmalkov S.N.). The antalgic effect of this method is supposed by reducing the pressure of the patella on the articular surface of the femoral condyles by ventralizing it. In our opinion, the placement between the rubbing articular surfaces of an elastic, healthy autotendinous tissue should be more pathogenetic and, accordingly, radically than “pushing” the patella anteriorly by ventralizing the tuberosity of the tibia, and is technically simpler.

The authors propose a method for treating patellofemoral arthrosis, which differs from the well-known methods in that a “gasket” is created between the friction surfaces of the femoral condyles and the patella by an autotendinous plastic material cut from the central parts of the tendonous quadriceps femoris.

The method is as follows. In the patient’s position on the back, with a longitudinal section above the projection of the tendon extension of the quadriceps femoris, the latter is layered in layers and a tendon flap is cut out in the central sections, cutting off proximally and maintaining attachment to the upper pole of the patella (Fig. 1-a), b)). Then this flap is moved behind the patella, held between the articular surfaces of the condyles of the thigh and patella so that the front surface of the flap is adjacent to the condyles, and the back to the patella (Fig. 1-b), c)). In order to keep this flap in the interposition position, its distal end is brought out into the cleavage of the patellar ligament and is fixed with sutures. The defect in the tendon stretch of the quadriceps muscle is sutured (Fig. 1-c)). Plaster immobilization is applied to the limb for a period of 3 weeks. Then - warm baths, exercise therapy, massage of the thigh muscles.

An example of the execution of the method: B.I. S.V., born in 1957, was admitted to the orthopedic and traumatology department of the Republican Clinical Hospital on October 27, 2010 with complaints of pain in the right knee, especially when bending, climbing up the stairs. Clinical, radiological and patellofemoral arthrosis. November 2, 2010, the operation was performed according to the above description. The pain decreased immediately after surgery and disappeared after a course of rehabilitation treatment. Examined 6 months after surgery. Pleased with the operation. Recommendations fulfills. The range of flexion in the knee is limited to 90 °.

The invention is illustrated in figure 1.

FIG. 1. A method of treating patellofemoral arthrosis includes:

a) cutting a flap from the tendon of the 4-head muscle of the thigh,

b) holding a tendon flap on the posterior surface of the patella,

c) fixation of the tendon flap lig, patelle and suturing of the tendon defect with the 4-head muscle.

Literature

1) The magazine. Orthopedics, traumatology, prosthetics. 1980, 10, p. 59.

2) A. p. 1641302, authors: Miroshnichenko V.F., Izmailov S.N., Kultyshev.

3) A. p. 2212203, authors: Bogosyan A.B., Chernyak E.E., Kayumov A.Yu. Nizhny Novgorod, 2002

Claims (1)

A method of treating patellofemoral arthrosis, including cutting a longitudinal flap in the center of a tendon extension of the quadriceps femoris muscle, cutting off proximal and retaining attachment to the upper pole of the patella, then moving the flap behind the patella, conducting it between the articular surfaces of the condyles of the femur and patella of the elbow so that the anterior surface of the patella is adjoined to the condyles, and the back to the patella, fix it in the splinter of its own ligament of the patella.

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