2019 ISAKOS Biennial Congress ePoster #1446
Patellofemoral Realignment: The “Dynamic Quadriceps” as a New Technique
Cesar Guillermo Zvietcovich-Cornejo, MD, Arequipa PERU
Orestes Rolando Suarez, MD, Lima, Lima PERU
Clinica Vallesur - AUNA, Arequipa, PERU
FDA Status Cleared
The technique of patello-femoral Realignment by “Dynamic Cuadriceps” clinically improves the outcome of patients respecting the anatomic parameters and subcondral circulation.
The trochlear patella instability is dependent on the ligamentous balance of its medial and lateral retinacular components. This imbalance generates osteochondral lesions that act as triggers of early Osteoarthrosis. The Patella Femoral Ligament reconstruction is a surgical technique used to correct in some cases this imbalance. Conventionally this procedure requires the fixation of the graft but multiple studies describe a high rate of failure, leading to an unwanted overload of patellofemoral.
Facing this difficulty, "dynamic techniques" have been described. This study proposes the use of the tendon graft of the quadriceps instead of a graft of the conventional hamstring tendons respecting the concepts of insertional dependency of the cuadricipital tendon and the subchondral circulation offering neurocirculatory . The technique in the medial fixation was completed by the use of a dynamic tenodesis to the adductor magnum. Patients enrolled had patellofemoral overload symptoms, after at least 3 months of rehabilitation had no clinical improvement, had an altered congruence angle (>10°) and a TG-TT distance between 16mm and 20mm. Kujala test was used to evaluate improvement.
Sixteen patients were included in this study, with a mean age of 22.4 years (S.D. ±7.6). The basal Kujala score had a mean value of 51.5 (S.D. ±4.1). The evaluation at 1st, 2nd, and 3rd months following surgery were 67.3 (±4.3), 81.1 (±5.1) and 92.3(±2.4), respectively. The mean score recovery difference (between basal and 3rd month) was 40.8 (±3.9). When the hypothesis that this procedure improved the Kujala score throughout time, two aspects were assessed: first, if the score increased significantly in time (Friedman test) and second, if the score increased significantly between evaluations (basal vs. 1st vs. 2nd vs. 3rd month; Kendall´s W test). Both assessments were statistically significant (P-value<0.0001)
Therefore, we can conclude that the technique of patello-femoral Realignment by “Dynamic Cuadriceps” clinically improves the outcome of patients respecting the anatomic parameters and subcondral circulation.