Clinical Research To Cure Patellofe Moral Malaigment Under The Knee Arthroscopy

ObjectiveTo evaluate the clinical efficacy of divided classes which to cure patellofemoral malalignment under the arthroscopy, it could gives guides to this treatment methed.MethodsA total of 78 primary Patellofemoral malalignment. patients (90knees) which was admitted to Tai Shan Medical College affiliated hospital Bone surgery division from January 2005 to July 2008 underwent the diagnosis and therapy of arthroscopy. We classified patients into different classes on the basis of axial view lamella(Merchant lamella) preopration and detection of the patella locus in the operation (Under the monitor of arthroscope, patients of Patellofemoral malalignment in different extention received treatment, and the criteria of success was patellofemoral joint adaptation well in genuflex from 0°to 110°).The first class is simple patellar tilt(the standed is for Lteral Patellofemoral Angle<0°); the second class is simple patellar subluxation and patellar dislocation (the standed is for Patellar Congruence Angle>16°); the third class is patellar tilt combined with patellar subluxation (the standed is Lteral Patellofemoral Angle<0°and Patellar Congruence Angle>16°). All the patients were given follow-up visiting and they were grouped into 2 groups. The first group hadn't been received operations devided from January 1th of 2005 to January 1th of 2007, and the patients were received operation l,the second group had been received operation devided from January 1th of 2007 to July 1th of 2007,which were devided into A,B,C group. The patients of the group A were received operation 1,the patients of the group B were received operation 2,the patients of the group 3 were received operation 3.(the operation 1 is underwent lateral patella retinaculun;the operation 2 is underwent tibial tubercle anteromedial transfer underwent lateral patella retinaculun ally tibial tubercle anteromedial transfer). The group 1:27 patients (28 knees) of the total patients received operation 1;A of the group 2:24 patients (25 knees) received operation 2;B of the group 2:18 patients (21 knees) received operation 2;C of the group 2: 9 patients(13 knees) received operation 3. All the patients were given follow-up visiting after the operation 3,6,12 months and each year. Lysholm questionnaires were used and the clinical datas were given retrospective analysis in order to get the message of prognosis and recur of patients. All the patients were given knee operations for the first time. The effect of the first and second group healing is basised on HSS standed.Each team was grouped into A:above 85, B:between 84 and 70, C:between 69 and 60, D:under the 59. We had a X2 test for the first and second group. We used Q Angle, CA, LPFA and HSS score standardization were used for scoring in the second group with matched-pairs t-test.ResultsUntil the last time for follow-up, HSS score standardization of the two groups have improved, and the improvement of the group 2 is more apparently, the differences have statistical significance; the paitients of the group 2,Q Angle and CA,PLFA, had statistical significance (P<0.05). All the patients'cutting edges were primary healing,could stood and walked, and go and-up stair activity with much less pain.1 patients got hydrops articuli 7 days after operation, and recovery after cover with stungth.Conclusion1,It has practical value for diagnosing and classifying which axial view lamella (Merchant lamella) and under the dynamic monitor for arthroscope Patellofemoral malalignment, and could provide definitely classify ingstanded.2,Patients of Patellofemoral malalignment in different extention received treatment Lateral patella retinaculun, tibial tubercle anteromedial transfer and lateral patella retinaculun ally tibial tubercle anteromedial transfer graded surgery can increase cure rate of Patellofemoral malalignment through operration divided classes,which has a better total follow-up effect. Patellar tilt and patellar subluxation have apperentely differences in pathogesis. The reason of the patellar tilt is patella lateral branch tension,the reason of the patellar subluxation is the lower limbs line of force (Q A) increase+later branch laxation,so simple subluxation of the patella is not the indicate of lateral solution.3,The divided classes is the effective methods for curing the patellofemora Imalalignment, but its prospective efficacy needs deeply study.