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Trochleaplastik bei patellofemoraler Instabilität

Trochleoplasty for patellofemoral instability

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Einleitung

Die Trochleadysplasie ist die am häufigsten gefundene Pathologie bei Patienten mit patellofemoraler Instabilität (PFI). Seit fast 30 Jahren findet die Trochleaplastik als mögliche operative Variante zur patellofemoralen Stabilisation Anwendung.

Methode

Die genaue Diagnostik der PFI muss multifaktoriell betrachtet und klinisch sowie radiologisch durchgeführt werden. Bei rezidivierender Instabilität und bei Status nach erfolglosen Voroperationen kann die Indikation zur Trochleaplastik gestellt werden. Ziel ist eine möglichst anatomische Rekonstruktion der dysplastischen Verhältnisse. Hierzu wird eine elastisch belassene osteochondrale Trochleaschuppe abgehoben und die knöcherne Kontur des anterioren Femur konkav modelliert. Anschließend kann die Schuppe zentral in die neu geformte Vertiefung mit einer Osteosutur fixiert werden.

Ergebnisse

Unsere klinischen Erfahrungswerte von über 250 durchgeführten Trochleaplastiken zeigen, dass eine deutliche Verbesserung der patellofemoralen Stabilität und der subjektiven Outcomes erreicht werden kann. Dies wird von mehreren externen Studien, welche die gleiche Operationsmethode angewendet haben, bestätigt.

Schlussfolgerung

Die Trochleaplastik beeinflusst neben der Verbesserung des lateralen Trochleainklinationswinkels das Containment und indirekt auch den patellofemoralen Druck sowie der Tibial-tuberosity-trochlear-groove(TT-TG)-Abstand positiv. Diese Methode der Trochleaplastik ist eine nachweislich sehr gute Lösung bei PFI, muss aber sowohl bei der Indikationsstellung als auch bei der chirurgischen Durchführung als aufwändig und anspruchsvoll betrachtet werden.

Abstract

Introduction

Trochlear dysplasia is the most important pathology in patients with patellofemoral instability (PFI). Trochleoplasty has been carried out for nearly 30 years as a surgical option for patellofemoral stabilization.

Method

The diagnostics of PFI have to be considered as multifactorial and should include clinical and radiological examinations, such as X-ray and magnetic resonance imaging (MRI). Recurrent instability and unsatisfactory previous operations represent medical indications for trochleoplasty. The goal of the method of trochleoplasty presented here is to reconstruct the anatomical conditions of a concave trochlea. An osteocartilaginous flake of the trochlea has to be lifted to restore the concave shape of the anterior distal femur. Fixation is performed with an osteosuture in the center of the newly formed sulcus.

Results

Clinical experiences with performing more than 250 trochleoplasties show that patellofemoral stability and the subjective outcome in particular can be improved. Other external studies have confirmed the results of this surgical method.

Conclusion

Trochleoplasty restores the lateral trochlear inclination angle (LTI) and also the containment and indirectly has a positive influence on the patellofemoral pressure and the tibial tuberosity-trochlear groove distance (TTTG). This method of trochleoplasty has been confirmed as a very good solution for patients with PFI but the process from the diagnostics to finding the right indications and performing the surgical technique correctly must be considered as time-consuming and demanding.

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Authors and Affiliations

  1. Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Schweiz

    H. Grehn, G. Bühler &  H. Bereiter

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  1. H. Grehn
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  2. G. Bühler
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  3. H. Bereiter
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Correspondence to H. Bereiter.

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H. Grehn, G. Bühler und H. Bereiter geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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F. Dirisamer, Linz-Puchenau

A. Schmeling, Berlin

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Grehn, H., Bühler, G. & Bereiter, H. Trochleaplastik bei patellofemoraler Instabilität. Arthroskopie 28, 186–193 (2015). https://doi.org/10.1007/s00142-015-0022-5

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