Postoperative Bestimmung des patellofemoralen Alignements nach Patellaluxation - eine computertomographische Analyse

Zusammenfassung

Ziel: Evaluation der Aussagekraft verschiedener CT-Vermessungsmethoden des Patellofemoralgelenkes nach arthroskopischer Stabilisierung bei Patellaluxation. Material und Methode: Axiale CT-Vermessung des Patellofemoralgelenkes bei 18 Patienten nach arthroskopischer medialer patellofemoraler Naht ohne oder mit postoperativer Rezidivluxation unter Verwendung sämtlicher in der Literatur bei entspanntem M. quadriceps empfohlenen Messmethoden in 4 Knieflexionsstufen (15 °, 30 °, 45 °, 60 °). Ergebnisse: Postoperativ zeigten nur der laterale Patellofemoralwinkel bei 15 ° und 30 ° und der Kongruenzwinkel bei 15 ° Flexion signifikante Unterschiede hinsichtlich der außerhalb des Normbereichs liegenden Fallzahl zwischen den nie luxierten und den postoperativ nicht reluxierten Patellae. Beide Gruppen unterschieden sich auch hinsichtlich ihrer Mittelwerte nicht signifikant. Außer bei der Patellalateralverschiebung nivellierten sich mit zunehmender Flexion die Unterschiede zwischen Normal- und Luxationsgruppen fast vollständig, Unterschiede zwischen Normal- und Reluxationsgruppe bei jedem Flexionsgrad zeigten nur der laterale Patellofemoralwinkel, der Patellaneigungswinkel und die Patellalateralverschiebung. Eine zunehmende Flexion (> 30 ° und besonders bei 60 °) führt die meisten Messwerte zurück in den Normbereich. Schlussfolgerungen: Bei der CT-Vermessung des Patellofemoralgelenkes nach Stabilisierungsoperation erscheinen der laterale Patellofemoralwinkel und der Kongruenzwinkel am nützlichsten. Die Messungen sollten in mehreren Flexionsgraden durchgeführt werden.

Abstract

Purpose: To evaluate the diagnostic impact of different CT-based measurements to analyze the patellofemoral alignment after arthroscopic reconstruction in patients with patella dislocation. Materials and Methods: In 18 patients with dislocation of the patella, CT of the patellofemoral joint was performed after arthroscopic reconstruction. Various methods recommended in the literature were used to analyze the structure and the alignment of the patellofemoral joint with a relaxed quadriceps muscle. Axial CT scans were taken in four different knee flexion angles (15 °, 30 °, 45 °, 60 °). Results: After arthroscopic stabilization in patients with patella dislocation, only the lateral patellofemoral angle (15 ° and 30 ° knee flexion) and the congruence angle (15 ° knee flexion) showed significant differences between the CT-measurements in the normal and the operated group. The differences of the remaining mean values were not significant due to a high standard deviation. With increasing flexion of the knee, the differences between the normal and the dislocation group almost disappeared. Only the lateral patellofemoral angle, the patella tilt and the lateral patella shift revealed differences between the normal and the group with recurrent dislocation in every degree of knee flexion. With increasing knee flexion above 30 ° and especially at 60 °, the majority of the measured values returned to the normal range. Conclusions: For CT-measurements of the patellofemoral joint after arthroscopic stabilization, the patellofemoral angle and the congruence angle seemed to be most useful. The measurements of the patellofemoral joint should be taken in various degrees of knee flexion.

Key words

Patellofemoral joint - patella dislocation - arthroscopic stabilization - computed tomography

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