Trohleoplastika: Kirurške indikacije i operacijska tehnika u liječenju rekurentne patelarne dislokacije pri uznapredovaloj patelofemoralnoj displaziji

Trochleoplasty is a surgical procedure which was initially reserved for the refractory cases where previous surgery has failed, but has become more popular in the past years because of a better knowledge of the knee anatomy and biomechanics and a greater availability of surgical instruments. The technical difficulty of the sulcus-deepening trochleoplasty lies in the fact that surgeons aim to reshape a usually extremely dysplastic articular surface of the trochlea without damaging it. If patients are carefully selected and the surgical rationale is carefully followed, recent bibliography presents very encouraging results of the application of trochleoplasty with other procedures in patients with severe trochlear dysplasia and recurrent patellar dislocation, in whom benign neglect of dysplasia would lead to unfavourable results. The surgical steps and technical pearls of the procedure are described in this review.Trohleoplastika je kirurški zahvat koji se koristi u liječenju rekurentnih dislokacija patele kod displazija patelofemoralnog zgloba. U početku se trohleoplastika primjenjivala samo kod pacijenata kod kojih ostale metode nisu polučile uspjeh. Kako saznanja o anatomiji i biomehanici napreduju, kao i tehnološka dostignuća u konstruiranju kirurških instrumenata, tako raste i popularnost takve vrste kirurškog zahvata raste. Radi se o zahtjevnom kirurškom zahvatu kod kojeg je potrebno preoblikovati displastično promijenjenu trohleu femura, a da se pritom značajno ne ošteti zglobna hrskavica. Noviji rezultati u pacijenata s visokim stupnjem displazije trohlee femura i rekurentnim dislokacijama patele, govore u prilog trohleoplastike u usporedbi s ostalim kirurškim postupcima. Ovaj rad u detalje opisuje kiruršku tehniku trohleoplastike

Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality

The aim of this study was to present the different surgical procedures of tibial tubercle osteotomies for patellar instability or patellar mispositioning such as patella alta or patella infera. This study analysed the Caton–Deschamps index used for assessment of vertical patella height in order to make a precise plan for tibial tuberosity osteotomies. This study included 61 knees (50 patients) treated for patellar instability with patella alta and 24 patients treated for patella infera of mechanical origin. The results of medial transfer of the tibial tuberosity, with or without distal transfer in cases of patellar instability with patella alta, gives excellent results for stability in 76.8% of the cases. The results of the proximal transfer of the tibial tuberosity in cases of patella infera were excellent or good in 80% of the cases in our series of 24 patients. A precise preoperative plan is needed with determination of the vertical patellar height using the Caton–Deschamps index and the situation of the tibial tuberosity and the Tibial Tubercle to Trochlear Groove distance (TT-TG) of the knee on CT scan in order to obtain satisfactory results