Skip to main content
SpringerLink
Log in

Osteotomien

Osteotomies

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Skelettale Geometrie, Weichteile und neuromuskuläre Kontrolle beeinflussen den Bewegungsablauf im Patellofemoralgelenk. Skelettale Anomalien, wie z. B. ein vergrößerter Antetorsionswinkel, eine Dysplasie der Trochlea, eine Patella alta sowie eine veränderte Tibiatorsion können zu patellofemoralen Beschwerden führen. Die einwirkenden pathologischen Kraftvektoren, die veränderten Kontaktflächen und Druckverhältnisse können zu Arthrose, Instabilitäten und Insuffizienz der Weichteile führen. Nach ausführlicher Dokumentation der zugrunde liegenden primären Pathologie kann die Indikation zu einer gezielten Osteotomie mit gleichzeitiger Weichteilkorrektur gegeben sein. Die operative Intervention soll die Pathomorphologie beheben.

Abstract

Skeletal geometry, soft tissues, and neuromuscular control influence the patellofemoral gliding mechanism. Abnormal skeletal geometry – such as increased femoral anteversion, trochlear dysplasia, patella alta, increased tibial external torsion, increased tibial tubercle lateralization, and variations of combined deformities – may lead to patellofemoral complaints. Altered vectors and forces acting on the patellofemoral joint can cause cartilage failure with later arthrosis, instability, and musculotendinous insufficiency. Osteotomy with soft tissue repair might be the best treatment, depending on the primary pathology. Surgery aims to eliminate the underlying pathomorphology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 13
Abb. 14

Literatur

  1. Biedert RM (2004) Patellofemoral Disorders. Diagnosis and Treatment. John Wiley & Sons Ltd, Chichester, England

  2. Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14: 707–712

    Article  PubMed  Google Scholar 

  3. Biedert RM, Gruhl C (1997) Axial computed tomography of the patellofemoral joint with and without quadriceps contraction. Arch Orthop Trauma Surg 116: 77–82

    Article  PubMed  CAS  Google Scholar 

  4. Bereiter H (2000) Die Trochleaplastik bei Trochleadysplasie zur Therapie der rezidivierenden Patellaluxation. In: Wirth CJ, Rudert M (Hrsg) Das patellofemorale Schmerzsyndrom. Steinkopff, Darmstadt, S 162–177

  5. Bruce WD, Stevens PM (2004) Surgical correction of miserable malalignment syndrome. J Pediatr Orthop 24: 392–396

    PubMed  Google Scholar 

  6. Dejour D (2005) Predisposing factors to recurrent dislocation and the surgical options. ISAKOS, Hollywood, FL, pp 40–48

  7. Dejour H, Walch G, Nove-Josserand L, Guier Ch (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2: 19–26

    Article  PubMed  CAS  Google Scholar 

  8. Delgado ED, Schoenecker PL, Rich MM (1996) Treatment of severe torsional malalignment syndrome. J Pediatr Orthop 16: 484–488

    PubMed  CAS  Google Scholar 

  9. Ferrandez L, Usabiaga J, Yubero J et al. (1989) An experimental study of the redistribution of patellofemoral pressures by the anterior displacement of the anterior tuberosity of the tibia. Clin Orthop 238: 183–189

    PubMed  Google Scholar 

  10. Fulkerson JP (1990) Anteromedial tibial tubercle transfer without bonegraft. Am J Sports Med 18: 490–497

    Article  PubMed  CAS  Google Scholar 

  11. Fulkerson JP (2000) Anteromediale Versetzung der Tuberositas tibiae. In: Wirth CJ, Rudert M (Hrsg) Das patellofemorale Schmerzsyndrom. Steinkopff, Darmstadt, S 156–161

  12. Fulkerson JP (2005) Patellofemoral arthritis: Tubercle transfer osteotomy or patellofemoral replacement. Proceedings symposium: new concepts in the treatment of patellofemoral arthritis. ISAKOS, Hollywood, FL, pp 472–475

    Google Scholar 

  13. Fulkerson JP, Shea K (1990) Current Concepts: Disorders of patellar alignment. J Bone Joint Surg Am 72: 1424–1429

    PubMed  CAS  Google Scholar 

  14. Hefzy MS, Jackson WT, Saddemi RS (1992) Effects of tibial rotations on patellar tracking and patello-femoral contact areas. J Biomed Eng 14: 329–343

    Article  PubMed  CAS  Google Scholar 

  15. Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18: 359–365

    Article  PubMed  CAS  Google Scholar 

  16. Meister K, James SL (1995) Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity. Am J Orthop 24: 149–155

    PubMed  CAS  Google Scholar 

  17. Murphey SB, Simon SR, Kijewski PK (1987) Femoral anteversion. J Bone Joint Surg Am 69: 1169–1176

    Google Scholar 

  18. Nakamura N, Ellis M, Seedhom BB (1985) Advancement of the tibial tuberosity. A biomechanical study. J Bone Joint Surg Br 67: 255–260

    PubMed  CAS  Google Scholar 

  19. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP (1997) Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 25: 533–537

    Article  PubMed  CAS  Google Scholar 

  20. Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med 21: 521–546

    Article  PubMed  Google Scholar 

  21. Server F, Miralles RC, Garcia E (1996) Medial rotational tibial osteotomy for patellar instability secondary to lateral tibial torsion. Int Orthop 20: 153–158

    Article  PubMed  CAS  Google Scholar 

  22. Servien E, Neyret P, Aït Si Selmi T, Biedert RM (2004) Radiographs. In: Biedert R (ed) Patellofemoral disorders. John Wiley & Sons Ltd, Chichester, England

  23. Steimer O, Kohn D (2008) Anteromedialisierung der Tuberositas tibiae. Operation nach Fulkerson. Arthroskopie 21:15–21

    Article  Google Scholar 

  24. Strecker W, Keppler P, Gebhard F, Kinzl L (1997) Length and torsion of the lower limb. J Bone Joint Surg Br 79: 1019–1023

    Article  PubMed  CAS  Google Scholar 

  25. Teitge R (2004) Patellar pain and instability due to abnormal skeletal torsion. In: Biedert R (ed) Patellofemoral disorders. John Wiley & Sons Ltd, Chichester, England

  26. Teitge RA (2006) Osteotomy in the treatment of patellofemoral instability. Tech Knee Surg 5: 2–18

    Article  Google Scholar 

  27. Teitge RA, Torga-Spak R (2006) Skeletal malalignment and anterior knee pain: rationale,diagnosis and management. In: Sanchis-Alfonso V (ed) Anterior knee pain and patellar instability. Springer, London, pp 185–199

  28. Thomee R, Renström P (1995) Patellofemoral pain syndrome in young women. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports 5: 237–244

    PubMed  CAS  Google Scholar 

  29. Van Kampen A, Huskies R (1990) The three-dimensional tracking pattern of the human patella. J Orthop Res 8: 372–382

    Article  Google Scholar 

  30. Yoshioka Y, Cooke TD (1987) Femoral anteversion: assessment based on function axes. J Orthop Res 5: 86–91

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenskonflikt

Der korrespondierende Autor hält fest, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Sportclinic Villa Linde, Swiss Olympic Medical Center Magglingen-Biel, Blumenrain 87, CH-2503, Biel, Schweiz

    R.M. Biedert

Authors
  1. R.M. Biedert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R.M. Biedert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Biedert, R. Osteotomien. Orthopäde 37, 872–883 (2008). https://doi.org/10.1007/s00132-008-1294-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-008-1294-5

Schlüsselwörter

Keywords

Search

Navigation