The Clinical Research Of Patellofemoral Malaignment Treatment By Patellar Retinaculum Balance Operation

With the development of socioeconomics, people tend to pay more attention to health and quality of life. Patellofemoral disorder (PFD) is a frequent disease and clinical manifestation is hydrops articuli, arthrodial cartilage cataplasis, patellofemoral joint derangement and patellofemoral arthrodial cartilage injury. Now there was no unified denomination about PFD, which includes chondromalacia patella (CP), patellofemoral joint arthralgia, patellofemoral malaignment (PM) and patellofemoral joint unsteadiness. Brattstroom considers that Q-angle is the included angle of musculus quadriceps rally line with the direction of the long axis of patellar ligament. That is the included angle of the line of quadriceps and patellar ligament angle of the line. Clinically on the anterior superior iliac crest with the midpoint of the patella and patellar connection with the midpoint of the angle between the tibial tubercle known as the Q angle. The average Q angle of the normal knee is 150, more than 200 is usually suggested that abnormal patellofemoral joint presence and the Q-angle often increases in the patellofemoral pain patients (an average of 200). The lateral retinaculum contracture and medial retinaculum relaxation are the important reasons of the lateral pressure of whirbone increasing, patellar cartilage degeneration, patellar dumping, the patellofemoral joint dislocation. The lateral retinaculum release treatment, only with the recent good results, but long-term satisfaction is poor, which is a problem for the treatment of the patellofemoral joint abnormal. Arthroscopic radiofrequency ablation using vaporization joint meniscus knives endoscopic surgical instruments on different internal and external support with patellar week by changing the balance of the patella trajectory of the patellofemoral joint, and the elimination of abnormal clinical symptoms, improve the quality of life is of important significance.Objective:To evaluate the clinical value of patellofemoral joint support with internal and external balance with arthroscopic in the treatment of the patellofemoral joint abnormal through the anatomy of lateral and medial retinaculum around the patella.Methods:Retrospective analysis of 24 patients (37 knee) from 2002 to 2005, applicated sodium hyaluronate for osteoarthritis of the knee merger of the patellofemoral joint after a bad case more. Q angle was measured and movement trajectory was evaluated.Retrospective analysis of 34 patients (53 knee) from 2002 to 2005, which were arthroscopic lateral support with simple release of the patellofemoral joint of bad cases. Q angle was measured and movement trajectory was evaluated. And effects of the last two years with support of the patellofemoral weeks balance in the treatment of the patellofemoral joint were assessed. Paired t test was used to statistical analyse. .From March 2005 to February 2007, 45 elder patients (67 knee) with the patellofemoral joint dysannealed, conventional arthroscopied and the lens were displayed at the bottom near the patellofemoral joint articular Wochu, dynamic observation of the patellofemoral trajectory. Arthroscopy equipment produced by Germany stryker company were applicated to hook knife lateral support with cutting, release. In support of the medial patellar with relaxation, radiofrequency ablation knife gasification of the tissue tightening, adjusting patella trajectory until patellofemoral trajectory back to normal. Other intra-articular lesions were treated accordingly. .Patellofemoral joint of a bad post-trip from knee flexion and extension exercises, joint plot without blood, preoperative pain symptoms disappeared, joint normal activities. And after eight weeks, 16 weeks, 32weeks filming patella axial X-ray observation of patients with Congruence Angle, Insall Salvati index, the lateral patellofemoral angle (LPFA ), patellofemoral Index (PEI) and Q angle was measured. cartilage injury graded by Outerbrige[5], patella trajectory evaluated by Casscell[6] .Conclusion:Patellar retinaculum balance treatment with arthroscope fully strengthens inner tension after simple lateral retinaculum release. After nearly patellofemoral joint abnormalities on a recent good results, the long-term decline in satisfaction of the deficiencies. Release completely, small incision, less trauma, the shorter surgery time and reduce postoperative adhesions, rapid postoperative recovery and the pain is alleviated Obviously, the exact effect of postoperative functional training and long-term impact on our everyday life. Arthroscopic operation is the significant progress for the treatment of abnormal patellofemoral joint, opened a new treatment programs, a higher degree of application.