management of episodic patella dislocationrhumatologie-bichat.com/poly grenoble 2011 genou/26...

Philippe NeyretElvire Servien

Management of Episodic patella dislocation

University of Lyon

Grenoble 2011

Interrogatoire

• Craquement• H +

EXAMEN

•H+ Ponction ?

EXAMEN

TROCHLEAR DYSPLASIATROCHLEAR DYSPLASIA

• Crossing sign

• Trochlear bumpH. Dejour, G Walch, Ph NeyretTrochlea dysplasia, Rev Chir Orthop 1990, 76 : 45-54

crossing

• Trochlear dysplasia

>145°

Crossing sign

EPD Control group

96% 3%

Trochlear bump

>3mm

EPD Control group

3.2mm -0.8mm+-2.4 +-2.9

Principal Factors

3

�Patellar height

�TT-TG

�Patellar tilt Threshold

Secondary Factors

4

•F. Antetorsion•G. Recurvatum•G. Valgum•Female No Threshold

P

A

T

Caton & Deschamps Index

AT/AP

1. Patella alta >1.2

T

1.0

H. Dejour

2. TT-TG >20mm

10mm

H. Dejour

19.621.7

31mm

3. Patellar Tilt >20°

15°Quadriceps DysplasiaTrochlear Dysplasia

?

Treatm

ent Surgical

� True dislocation� Young patient� Preop.planning� 1factor 1 procedure

RESULTS � N= 130 (174 knees) 1988-1999

� FU: 2y-13y N=110Subjective IKDC: 77.2 (45.9-95.4)

Very Satisf. or Satif.: 94%Post-op dislocation: 4.5%

E. Servien, T Ait Si Selmi, Ph Neyret : Subjective evaluation of surgical treatment for patellar instabilityRev Chir Orthop, 2004, 90, 137-142

TROCHLEA DYSPLASIATROCHLEA DYSPLASIA?

Discussion

MPFLMPFL ?

Distal transferDistal transfer?

The trochleaDiscussion

X-Ray

CT-Scan3D CT-Scan

• Normal Trochlea

crossing

• Trochlear dysplasia

>145°°°°

X-Rays

No previous dislocation

Several previous dislocations

Don FithianMPFL

Reconstruction

• TTd is the same in the control and EPD groups

• Mean patellar tendon length is longer in the EPD group than in the control group

Ph. Neyret, A.H.N. Robinson, …, P. ChambatPatellar tendon length – the factor in patellar instability ? The Knee 2002

Patella alta

TTd

Ph. Neyret, A.H.N. Robinson, …, P. ChambatPatellar tendon length – the factor in patellar instability ? The Knee 2002

Patella alta

Philippe NeyretElvire Servien

T

Merci

University of Lyon