Zusammenfassung
Das Verständnis der Biomechanik des Patellofemoralgelenks (PFG) ist die Grundvoraussetzung für das Erkennen von Pathologien und für deren erfolgreiche Therapie. Zahlreiche biomechanische Studien beschreiben das Gleiten der Patella in der Trochlea unter verschiedensten Bedingungen, wodurch heute ein breites Wissen über die veränderte Mechanik bei vorhandener Pathologie besteht. Die arthroskopische Untersuchung des PFG beschränkt sich auf die passiven stabilisierenden Strukturen der Patella. Dabei können eine pathologische Form der Gleitflächen mit Gelenksinkongruenz, eine gestörte Balance der medial und lateral stabilisierenden Strukturen sowie degenerative Veränderungen dokumentiert werden. Inwiefern sich diese arthroskopischen Befunde auf spezifische Pathologien übertragen lassen ist unklar, denn es fehlen Arbeiten, in denen normale und pathologische Befunde des PFG in der Arthroskopie gegenübergestellt werden.
Abstract
A profound knowledge of patellofemoral biomechanics is mandatory for the understanding of patellofemoral disorders and for successful therapy. Many biomechanical studies have described the gliding behaviour of the patella in the trochlear groove yielding valuable information about altered biomechanics in patellofemoral diseases. The form and function of passive stabilizing structures of the patella can only be visualized using arthroscopy, therefore, trochlear dysplasia with joint incongruity, ligamentous disequilibrium of the medial and lateral stabilizing structures and degenerative changes can be observed and documented. However, the arthroscopic findings remain unspecific and do not permit a diagnosis of the underlying pathology and no scientific study has yet been performed to compare arthroscopic findings in normal and pathological patellofemoral joints.
Literatur
Amis AA, Firer P, Mountney J et al (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220
Amis AA, Senavongse W, Bull AM (2006) Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res 24:2201–2211
Amis A (2004) Patellofemoral joint biomechanics. In: Biedert RM (ed) Patellofemoral disorders, diagnosis and tretment. Wiley, New York, pp 37–53
Arendt E (2005) Anatomy and malalignment of the patellofemoral joint: its relation to patellofemoral arthrosis. Clin Orthop Relat Res 436:71–75
Besier TF, Draper CE, Gold GE et al (2005) Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res 23:345–350
Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712
Bizzini M, Biedert R, Maffiuletti N et al (2008) Biomechanical issues in patellofemoral joint rehabilitation. Orthopäde 37:864, 866–871
Bull AM, Katchburian MV, Shih YF et al (2002) Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Traumatol Arthrosc 10:184–193
Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg [Am] 75:682–693
Farahmand F, Senavongse W, Amis AA (1998) Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 16:136–143
Feller JA, Amis AA, Andrish JT et al (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23:542–553
Grelsamer RP (2000) Patellar malalignment. J Bone Joint Surg [Am] 82-A:1639–1650
Haim A, Yaniv M, Dekel S et al (2006) Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res 451:223–228
Hungerford DS, Barry M (1979) Biomechanics of the patellofemoral joint. Clin Orthop Relat Res 144:9–15
Iranpour F, Merican AM, Baena FR et al (2010) Patellofemoral joint kinematics: the circular path of the patella around the trochlear axis. J Orthop Res 28:589–594
Katchburian MV, Bull AM, Shih YF et al (2003) Measurement of patellar tracking: assessment and analysis of the literature. Clin Orthop Relat Res 412:241–259
Lin F, Wilson NA, Makhsous M et al (2010) In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain. J Biomech 43:235–241
Lingg G, Hering L (1984) Computed tomography and the pathogenic potential of the medial parapatellar fold. Rofo 140:561–566
Lustig S, Servien E, Biedert R et al (2008) Isolated arthrosis of the patellofemoral joint in younger patients (<50 years). Orthopäde 37:848, 850–842, 854–847
MacIntyre NJ, Hill NA, Fellows RA et al (2006) Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg [Am] 88:2596–2605
Merican AM, Amis AA (2008) Anatomy of the lateral retinaculum of the knee. J Bone Joint Surg [Br] 90:527–534
Merican AM, Amis AA (2009) Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech 42:1539–1546
Minkowitz R, Inzerillo C, Sherman OH (2007) Patella instability. Bull NYU Hosp Jt Dis 65:280–293
Nha KW, Papannagari R, Gill TJ et al (2008) In vivo patellar tracking: clinical motions and patellofemoral indices. J Orthop Res 26:1067–1074
Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg [Br] 87:577–582
Spang JT (2009) Patellofemoral disorders. In: McKeon BP, Bono JV, Richmond JC (eds) Knee arthroscopy. Springer, Berlin Heidelberg New York
Kampen A van, Huiskes R (1990) The three-dimensional tracking pattern of the human patella. J Orthop Res 8:372–382
Vuorinen OP, Paakkala T, Tunturi T et al (1985) Chondromalacia patellae. Results of operative treatment. Arch Orthop Trauma Surg 104:175–181
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Bachmann, M., Pagenstert, G. Arthroskopische Biomechanik bei patellofemoralen Beschwerden. Arthroskopie 23, 170–175 (2010). https://doi.org/10.1007/s00142-010-0566-3
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DOI: https://doi.org/10.1007/s00142-010-0566-3