Patellaosteotomie kombiniert mit modifizierter Trochleaplastik und Tuberositasmedialisierung als Therapie der permanenten Patellaluxation in Beugung

Zusammenfassung

Patellaluxationen in Flexion stellen die schwerste Form der patellofemoralen Dysbalance dar. Sie treten bei jeder Beugung auf, und die meisten bisherigen operativen Therapieversuche zeigten sich frustran. In einem neuen therapeutischen Ansatz wird die konkave Rückfläche der Patella, die auf dem hypoplastischen lateralen Kondylus wie auf Schienen nach lateral gleitet, in den Fokus gerückt. Die operative Therapie besteht aus einer Kombination aus lateral erweiternder Retinakuloplastik, Trochleaplastik, Patellaosteotomie, Tuberositasversetzung und MPFL-Plastik. In dem hier als OP-Video präsentierten Fall konnte bei einer 13-jährigen Patientin mit permanenter Patellaluxation in Beugung auf beiden Seiten ein physiologischer Patellalauf ohne Luxationstendenz bei schmerzfreien Kniegelenken erreicht werden.

Patellaluxationen in Flexion sind die schwerste Form der patellofemoralen Dysbalance. Die hier gezeigte operative Therapie besteht aus lateral erweiternder Retinakuloplastik, Trochleaplastik, Patellaosteotomie, Tuberositasversetzung und MPFL-Plastik, hiermit konnte ein physiologischer Patellalauf ohne Luxationstendenz erreicht werden.

Abstract

Patellar dislocations in flexion, which occurs permanently with every movement, is the most serious manifestation of patellofemoral malalignment. Surgical approaches to correct this problem have been mostly unsuccessful. In a new therapeutic approach, the concave posterior surface of the patella, which slides on the hypoplastic lateral condyle as if guided by splints, is seen as the main pathology. The appropriate surgical strategy is trochleoplasty, combined with closed wedge patellar osteotomy, tuberosity medialisation, procedure for lengthening lateral retinaculum and MPFL plasty with the quadriceps tendon. In the case of a 13-year-old female patient presented here, this procedure leads to permanent stability in a symptom-free knee joint on both sides.

Schlüsselwörter

Patellaluxation - Patellaosteotomie - Trochleaplastik - patellofemorale Instabilität

Keywords

patellar dislocation - patella osteotomy - patellofemoral malalignment - trochleoplasty

Publication History

Received: 15 March 2023

Accepted after revision: 16 June 2023

Article published online:
21 August 2023

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