Proximal Realignment

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Aug 25, 2015 - www.AANA.org for. Master's Course catalog. ▻ Special Thanks to Smith ... Merchant, CORR 2005. Lotke, J Arthroplasty 2005. Ackroyd, CORR ...

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Treatment Methods for Patellar Malalignment Issues presented by August 25th, 2015

Proximal Realignment Murat Bozkurt Murat Bozkurt, Halil Ibrahim Acar, Safa Gursoy, Mustafa Akkaya Yildirim Beyazit University, School of Medicine Ankara, TURKEY

Proximal Realignment Murat Bozkurt

Disclosure • Educational activities Zimmer Biomet DePuy Synthes Stryker

Proximal Realignment Murat Bozkurt

Anatomy

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Proximal Realignment Murat Bozkurt

Treatment Methods for Patellar Malalignment  No single operation is universally accepted  Several techniques have been described

• Decision     

needs of the individual patient extent of the malalignment patient’s age the level of activity the condition of the joint

Proximal Realignment Murat Bozkurt

Treatment Methods for Patellar Malalignment  Proximal realignment  lateral retinacular release  medial plication  VMO advancement  MPFL repair and recons.  Distal realignment  Combined proximal and distal realignment

Proximal Realignment Murat Bozkurt

Lateral Release Indications • • • •

episodic patellar dislocation (EPD), Patellofemoral osteoarthritis (PF OA), excessive lateral hyperpression syndrome (ELHS) total knee replacement (TKR).

Technique • •

5 mm lateral to the patellar border, Hemarthrosis; electrocautery

The role of lateral retinacular release in the treatment of patellar instability. Lattermann C, Toth J, Bach BR Jr. Sports Med Arthrosc. 2007;15:57-60.

Don’t extend or detache vastus lateralis obliquus.

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Proximal Realignment Murat Bozkurt

Lateral Release Long-term results of lateral retinacular release. Panni AS, Tartarone M, Patricola A, Paxton EW, Fithian DC.

Arthroscopy. 2005 May;21(5):526-31.

• 50 patients • 5-year follow-up • In patellar instability the results are less favorable in long-term follow-up

Proximal Realignment Murat Bozkurt

Medial Procedures • Since the recognition of the importance of the medial patellofemoral ligament (MPFL), there has been increasing interest in different techniques for managing the medial stabilizer.     

Repair Radio-frequency thermal reefing Imbrication (reefing) Plication VMO advancement

Proximal Realignment Murat Bozkurt

Medial Plication • Surgical Techniques for Medial Plication Arthroscopic All-Inside Medial Plication Arthroscopically Assisted Medial Reefing Mini-Open Medial Reefing

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Proximal Realignment Murat Bozkurt

VMO advancement Insall technique Patellar pain and incongruence. II: Clinical application. Insall JN, Aglietti P, Tria AJ Jr. Clin Orthop Relat Res 1983;176:225-32.

• 53 knees • 81% excellent or good • 19% fair or poor.

Proximal Realignment Murat Bozkurt

MPFL Reconstruction

 First described by Kaplan 1957,but not named.  Superior medial border of the patella  Between the epicondyle and the adductor tubercle

Proximal Realignment Murat Bozkurt

MPFL Reconstruction



The MPFL is a thin fascial band approximately 53 (range 45–64) mm long , that links from the region of the medial epicondyle of the femur to the proximal part of the medial border of the patella.





It has been shown that this structure is present in all knees and that it is the major medial stabilizer of the patellofemoral joint.

MPFL had a mean tensile strength of 208 N and it is surprisingly strong for such an insubstantial appearance.

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Proximal Realignment Murat Bozkurt

MPFL Reconstruction



MPFL is the primary restraint and provides 60% of the restraining force to lateral translation. • •



Patellar dislocation is a disabling condition that often results in disruption of the MPFL. Tearing of the MPFL at or near its femoral insertion is present in 80% to 100% of cases.

The MPFL reconstruction is an accepted surgical technique for treatment of chronic patellofemoral instability.

Proximal Realignment Murat Bozkurt

MPFL Reconstruction Pre-Op Planning • X-ray • Measuring Q angle

Proximal Realignment Murat Bozkurt

MPFL Reconstruction Pre-Op Planning • TT-TG lenght measurement on CT scan

Normal : < 15-20 mm

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Proximal Realignment Murat Bozkurt

MPFL Reconstruction Pre-Op Planning • MRI

Proximal Realignment Murat Bozkurt

MPFL Reconstruction Single Patellar Tunnel Fixation with

Bioabsorbable Screws

Proximal Realignment Murat Bozkurt

MPFL Reconstruction Double Patellar Tunnel Fixation with Bioabsorbable Screws

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Proximal Realignment Murat Bozkurt

MPFL Reconstruction Patellar Tunnel Fixation with Endobutton

Proximal Realignment Murat Bozkurt

MPFL Reconstruction Patellar Tunnel Fixation with Anchor

Proximal Realignment Murat Bozkurt

MPFL Reconstruction Use of contact pressure-sensitive surfaces as an indicator of graft tension in medial patellofemoral ligament reconstruction Kadir Ilker Yildiz · Cetin Isik · Osman Tecimel · Nurdan Cay · Ahmet Firat · Ramazan Akmese · Murat Bozkurt Arch Orthop Trauma Surg (2013) 133:1657–1663

Figure. Pressure analysis with Fuji FPD-8010 E Ver. 2.0 program after MPFL reconstruction

Conclusion: Contact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.

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Treatment Methods for Patellar Malalignment Issues presented by

[email protected]

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Diagnosis of patellar malalignment Sébastien LUSTIG MD, PhD, Prof J Caton, E Servien, Ph Neyret Albert Trillat Center, Lyon, france

Clinical situation

PatelloFemoral Instability

PatelloFemoral Instability

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Patellar malalignment

Trauma

PatelloFemoral Instability

Episodic Patellar Dislocation

Potential Patellar Dislocation

No Dislocation Al

No morphological

Morphological abnormalities

abnormalities

Morphological abnormalities In Patellofemoral Instability One or more P. dislocations

Morphological Abnormalities

vs

No Symptom

Control Group

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Morphological abnormalities In Patellofemoral Instability Trochlear

Patellar malalignment

Dysplasia

Principal factors

Secondary factors

• Crossing sign • Trochlear bump • Patellar height • TT-TG • Patellar tilt • • • •

F. Antetorsion G. Recurvatum G. Valgum Female

Trochlear Dysplasia « Fundamental factor »

Crossing sign Trochlear bump H. Dejour, G Walch, Ph Neyret: RCO 1990, 76 : 45-54

Trochlear Dysplasia

>145°

crossing

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Trochlear Dysplasia

Crossing sign EPD 96%

Control group 3%

Trochlear Dysplasia

Trochlear bump EPD group

Control

3.2mm±2.4

-0.8mm±2.9

66%

6%

>3mm

Trochlear Dysplasia

H Dejour and G Walch 1987

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Trochlear Dysplasia D Dejour RCO 1998 KSSTA 2006

X-rays CT-scan

Trochlear Dysplasia GRADE A X-rays Crossing sign

Trochlear Dysplasia GRADE A CT-scan Subnormal Trochlea

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Trochlear Dysplasia GRADE B

X-rays Crossing sign Supra-trochlear spur

Trochlear Dysplasia GRADE B CT-scan Trochlea flat or convex

Trochlear Dysplasia GRADE C X-rays Crossing sign Double contour

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Trochlear Dysplasia GRADE C

CT-scan Asymmetry of facets : - Lateral = convex - Medial = hypoplastic

Trochlear Dysplasia GRADE D X-rays Crossing sign Supracondylar spur Double contour

Trochlear Dysplasia GRADE D CT-scan Asymmetry of facets Cliff pattern

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Instability Trochlear Dysplasia

Patellar malalignment

• Crossing sign • Trochlear bump

Principal factors

H Dejour, Ph Neyret, G Walch. Factors in patellar instability. In P. Aichroth Knee Surgery Current Practice, NY, 1992

H. Dejour, G Walch, Ph Neyret Trochlea dysplasia Rev Chir Orthop 1990, 76 : 45-54

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Principal Factors Patellar height TT-TG Patellar tilt Threshold

H. Dejour

1. Patella alta >1.2 P A T T

Caton & Deschamps Index

AT/AP

1.0

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Basic Sciences  To our knowledge no biomechanical studies has proven the negative effect of patella alta in case of trochlea dysplasia  Nevertheless it is logical to aim that the distal transfer allows the patella to better engage in the trochlea.  Contact surfaces increases from 15 to 18% at 15° flexion after a 10% shortening of the Patellar tendon without augmentation of patellar forces N Upadhyay,… AJSM. 2005: 1565-1573

What’ new ? • Patella alta is due to a too long patellar tendon and not to an abnormal proximal tibial insertion of the patellar tendon

Ph. Neyret, A.H.N. Robinson, …, P. Chambat Patellar tendon length – the factor in patellar instability ? The Knee 2002

TTd

>52mm Patella alta

Ph. Neyret, A.H.N. Robinson, …, P. Chambat Patellar tendon length – the factor in patellar instability ? The Knee 2002 C Meyer, … Ph Neyret, S Lustig. Patellar Tendon Tenodesis …for the Treatment of Episodic Patellar Dislocation With Patella Alta? AJSM 2011

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2. Excessive TT-TG

Goutallier D, Bernageau J, Lecudonnec B Mesure de l'écart tubérosité tibiale antérieure – gorge de la trochlée : TA-GT Rev. Chir. Orthop. (1978) 64 : 423-428

TT-TG

>20mm

19.6 21.7 31mm

10mm

3. Patellar Tilt >20°

? Quadriceps Dysplasia Trochlear Dysplasia MPFL

15°

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. Patella tilt > 20°

EPD 31.5°

90%

Control 10°

3%

33

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Clinical assessment

Instability Trochlear

Patellar malalignment

Dysplasia

Principal factors

• Crossing sign • Trochlear bump • Patellar height • TT-TG • Patellar tilt

Secondary

factors

H Dejour, Ph Neyret, G Walch. Factors in patellar instability. In P. Aichroth Knee Surgery Current Practice, NY, 1992 H. Dejour, G Walch, Ph Neyret Trochlea dysplasia Rev Chir Orthop 1990, 76 : 45-54

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Secondary Factors •F. Antetorsion •G. Recurvatum •G. Valgum No •Female

Threshold

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Conclusion Diagnosis of Patellar malalignment Trochlear Dysplasia

Principal factors

Secondary factors

• Crossing sign • Trochlear bump • Patellar height > 1.2 • TT-TG > 20mm • Patellar tilt > 20° • F. Antetorsion • G. Recurvatum • G. Valgum

Thank you for your attention

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John P. Fulkerson, M.D. Orthopedic Associates of Hartford Clinical Professor of Orthopedic Surgery University of Connecticut Farmington, Connecticut









The author receives royalties his patent and design of the Trupull braces (DJ Ortho) The author is president of the Patellofemoral Foundation that receives undirected funding from Smith and Nephew, DJ Ortho, ConmedLinvatec, Kinamed, Sanofi, KFX and Hartman Newspapers

Tibial tubercle transfer places the patella into a better tracking relationship with respect to the trochlea- this corrects alignment which almost always improves stability Medial imbrication and MPFL reconstruction stabilize only and should not be used to change the patella tracking pattern

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Never use MPFL reconstruction to move the patella

Move tibial tubercle only to restore optimal PF loading and central tracking- never too far!!

Always optimize balance first and reduce load on damaged cartilage whenever and however possible.

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As trochlea dysplasia increases, the need for precise, balanced tracking and anatomic medial and lateral retinacular balance increases

Dejour- Trochleoplasty for “high grade trochlear dysplasia with patellar instability and/or abnormal tracking.”

Consider trochleoplasty and/or femoro-tibial derotation surgery only in more extreme cases when alignment and retinacular surgery alone are insufficient





Differentiate functional from structural PF alignment disorders Always exhaust non operative measures to optimize core stability and function (Teitge, Powers, Arendt)

See where the patella goes with the quad contracted at 0 degrees and at 30 degrees flexion If you can’t center the patella with your finger, centering by medial reconstruction alone will overload cartilage OPTIMIZE ALIGNMENT and ARTICULAR LOADING FIRST, THEN STABILIZE

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Tibial tubercle transfer is the most versatile and benign way to correct structural incongruity (high TT-TG, high Q angle) of patello-femoral tracking and also unload lateral and distal patella articular lesions Tubercle transfer can compensate for structural femoral and tibial rotation problems that cause recurrent patella instability or lateral PF overload Tibial tubercle transfer can optimize balance in a dysplastic trochlea

Tibial tubercle transfer aligns and unloads lesions.. TTT osteotomy is most appropriate when there is healthy cartilage onto which to transfer patella tracking As trochlea dysplasia increases, need for MPFL/MQTFL graft and optimal alignment increases. Less containment (trochlea), more need for external support and perfect tracking

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Usually related to improper technique, inadequate fixation or a patient accident before bony union Technical precision, secure internal fixation, supervision and proper rehabilitation are imperative-complications are rare. Precise surgery and early motion will avoid complications

Result of non anatomic MPFL graft placement

Matt Bollier(Arthroscopy, 2011), Elvire Servien(AJSM, 2011),Christian Lattermann (AJSM), Andy Cosgarea and Miho Tanaka (AAOS Scientific exhibit 2011) have shown that MPFL grafts are too often malpositioned Risk of patella fracture after MPFL reconstruction (Parikh, JBJS 2011)

The keys to success in patellofemoral surgery are good decision making, technical excellence and doing no more than is needed

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Relationship of the tibial tubercle(TT) to the

trochlear groove(TG) center (Neyret, Dejour) 

 

TT transfer when elevated TT-TG and patella tracking laterally Superimposed CT images Recent data from Tanaka and Dahm have shown that TT-TG Simply mark center of proximal measurements are trochlea on computer screen of CT variable- use with or MRI axial cut, then scroll down to caution!!! tibial tubercle and use the ruler from toolbar to measure TT-TG distance

 The

more you need to consider how tibial tubercle transfer might optimize PF tracking and articular loading





When there is a need to realign the patella , in any plane, or to unload a painful lesion permanently To achieve stability of the extensor mechanism by establishing optimal vector alignment

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      







Inadequate health, poor bone quality, gross obesity Diffuse patella or trochlea chondral degeneration Proximal patella lesions (Crush) RSD or diffuse pain Poor attitude or motivation Inadequate trial of non operative measures Instability related to retinacular and trochlear deficiency with no need for changing patella tracking vector

Resurface an area that will receive contact after TTT Unload a surface that has been treated with ACI or OC graft Farr, Cole, Minas, Gillogly, Lattermann, Peterson







High Q angle and TTTG, no medial articular lesion(Pidoriano type 2) Lateral facet lesion

No distal lesion (Pidoriano tyle 1)which will benefit from anteriorization-(tipping up the distal patella off of the lesion)

Pidoriano AJ, Am J Sports Med. 1997 Jul-Aug;25(4):533-7..

X

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 











My views: Medial TTT effectively establishes balanced PF tracking and COMPENSATES for core deficiencies that cause chronic lateral tracking Much less risk and more direct than femoral derotation (which also compensates for other structural and alignment problems) Bringing the patella into balanced alignment with the trochlea creates improved knee function overall External rotation of the tibia caused by medial TTT is preferable to the abnormal internal rotation caused by lateral PF tracking Medial TTT, particularly AMZ, proven to result in overall less load to patella than MPFL reconstruction (Elias and Cosgarea) Separate issue from MPFL or MQTFL reconstruction (balanced tracking vs stabilization)















Medial lesion from previous overzealous TT medialization +/- medial subluxation Intact lateral facet

In cases of patella infera, proximalization of the tibial tubercle may be necessary With symptomatic patella alta, distalization will get patella into deeper trochlea earlier Patella distalization becomes more important in the patient with combined patella alta and trochlea dysplasia BOTH PROCEDURES MUST BE ACCOMPANIED BY APPROPRIATE SOFT TISSUE RELEASE AND/OR BALANCING

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Anteriorization is most helpful to diminish or eliminate load on

distal patella lesions. These are 

common after a dislocation Beware of proximal lesion(crush) as

anteriorization will place load on proximal patella earlier in the flexion arc.

“TIP UP THE DISTAL POLE”











Uncommon procedure Sagittal plane osteotomy vs Maquet Sagittal plane osteotomy requires back cut from lateral side Other option is anteromedial TTT with an offset bone graft

Unloads distal and lateral lesions(the principle lesions in patients with PF rotational alignment disorders)







Requires intact proximal medial cartilage (may be a problem after dislocation or crush) Appropriate when TT-TG elevated and improved alignment is needed along with distal unloading Highly effective for the right patients- improved stability and pain relief

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 





TTT or arthroplasty? These patients do well with anteromedial tibial tubercle transfer, AS LONG AS THERE IS INTACT MEDIAL CARTILAGE onto which to transfer

Realign medial tracking patella Unload medial lesion, overloaded from previous excessive or posteromedial TTT

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 

 



Precise osteotomy, tapered to anterior cortex distally Move slightly distal to correct alta if needed and anteriorly to unload distal/lateral articular lesion Secure fixation Immediate motion Protect weight bearing 6 weeks Transfer such that PF loading will be onto better cartilage Remove hardware late (>6 months)



 

 

Result depends to a large extent on effectively unloading the lesion causing pain unloads distal lesion Selective use of cartilage resurfacing broadens the indications for this procedure(Farr, Minas, Schepsis, Cole, Gillogly) Safe and effective-properly done Must taper osteotomy to anterior tibia distally-do not notch tibia shaft

Pidoriano et al, AJSM, 1997

 





Saranathan A, Kirkpatrick MS, Mani S, Smith LG, Cosgarea AJ, Tan JS, Elias JJ. Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):2054-61. Epub 2011 Dec 2. The effect of tibial tuberosity realignment procedures on the patellofemoral pressure distribution. Fulkerson JP, Becker GJ, Meaney JA, Miranda M, Folcik MA. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med. 1990 Sep-Oct;18(5):490-6; discussion 496-7.

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Buuck D, Weinstein R and Fulkerson J Anteromedialization of the Tibial



Stable painfree results maintained at 4-12 year



Tjoumakaris FP, Forsythe B, Bradley JP. Patellofemoral instability in



97% return to sports

Tubercle: a 4-12 Year Follow up. Op Tech Sports Med 8(2): 131-137, 2000.

athletes: treatment via modified Fulkerson osteotomy and lateral release. Am J Sports Med. 2010 May;38(5):992-9.





Excellent exposure laterally

Note the distal taper of osteotomy anteriorly

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while 

Medialization normalizes or optimizes PF alignment and tracking

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No AMTTT





AMTTT

After a precise osteotomy stabilized with two cortical screws into the posterior cortex, patients should begin immediate range of motion Partial weight bearing for 5-6 weeks, then rapid progression to quad strengthening and weight bearing off crutches

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 







 

Schepsis description of Anteromedial Tibial Tubercle Transfer- OKO on AAOS website AMTTT presentations on www.vumedi.com Farr, Schepsis, Cole, Fulkerson, Lewis Anteromedialization, Review and Technique. J Knee Surg. 2007;20:120-128 AAOS Blu-ray DVD Patella Instability and Arthrosis The Master’s Experience series (2013)

Once the tracking is optimized by TTT, restore retinacular support as needed As trochlea dysplasia increases, need for retinacular support increases

MPFL and medial deficiency alone-no TTT Much of medial retinacular support runs to quadriceps expansion- useful in reconstruction- option of MQTFL reconstruction to quad tendon instead of MPFL reconstruction to patella

Fulkerson, J and Edgar C. Arthrosc Tech. 2013 Apr 12;2(2):e125-8. 2013. 2013 May. Medial quadriceps tendon-femoral ligament: surgical anatomy and reconstruction technique to prevent patella instability. Available at www.arthroscopytechniques.org

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Disastrous result of patella distalization in a 21 year old woman Severe PF arthrosis as a result















Use an osteotomy when you can transfer cartilage tracking onto healthy cartilage (Ficat excessive lateral pressure syndrome) Osteotomy is particularly desireable in younger patients with distal and/or lateral patella articular degeneration PF replacement when deterioration of the PFJ is diffuse

Each case is unique, and requires careful consideration of alignment, articular cartilage lesion location, trochlea dysplasia, and peripatella retinacular support. Use tibial tubercle transfer to align, balance tracking, and unload an articular lesion Balance alignment and articular loading as needed before medial restoration surgery to optimize long term results Design surgery specifically for each patient to create retinacular, tracking and articular balance

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Dedicated Patellofemoral Surgery Hands On Course at the Orthopedic Learning Center in Rosemont, IL--September 2016 www.AANA.org for Master’s Course catalog Special Thanks to Smith and Nephew for generous support of the PF Foundation

www.patellofemoral.org

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Patellofemoral Arthroplasty Pr Sébastien Parratte MD, PhD Matthieu Ollivier, JM Aubaniac, Jean-Noël Argenson

Institute for Locomotion Sainte Marguerite Hospital Marseille VuMedi Webinar Treatment Methods for Patellar Malalignment Issues 25 /08/2015

30 % rate of complications after PFA at a median follow up of 5.3 years C. J. Dy, KSSTA 2011 Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis

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Qualité de vie Questionnaire de santé perçue Survie est utile pour les cancers « Qu’est- ce qu’un bon résultats chirurgical? »

WHAT ! PFP : Survivorship 211 PFA, 5 designs

Pourcentage

100

Revision for F-Tib OA

90

90 % at 10 years

80

Revision for P-F complication 70

72 % at 10 years

60 50 0

5

10

15

Global : 65% à 10 ans Délai (années) SOFCOT 2003 Isolated Patellofemoral Arthritis, J.Allain - D.Dejour

PF Arthroplasty : Update

Tauro, JBJS Br 2001 Kooijman, JBJS Br 2003 Lonner, CORR 2004 Cartier, CORR 2005 Merchant, CORR 2005 Lotke, J Arthroplasty 2005 Ackroyd, CORR 2005 Argenson, CORR 2005 Cossey, J Arthroplasty 2006 Sisto, JBJS Am 2006 Ackroyd, JBJS Br 2007

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3 modes of failures 1. Femoro-tibial arthritis +++ Indication 2. Loosening

Implant

3. Problems related to tracking Instability

Implant

Pain and stiffness

2008 : New Generation

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Patello-Femoral Arthroplasty

1. Indication 2.

Implant

3.

Technique

4.

Results

Indications Preoperative analysis: Clinical symptoms

Pain:

Where? When?

Indications Radiological preoperative analysis

Stress X rays

Full-length X rays

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From our experience Bone on bone PF arthris « Young » patient Arthritis post-dysplasia Post-traumatic arthritis

Avoid bad Indications Infl. disease

Patella baja

Medial OA = > PFJ + ZUK

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Patello-Femoral Arthroplasty

1. Indication

2. Implant 3.

Technique

4.

Results

PFA First generation: resurfacing Rasp and curette Bring the patella on the femur

Not longer used !

PFA: A3 Anatomy Ancillary Anterior cut: Bring the femur below the patella

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Anterior cut

Lateral arthritis => 5 to 10 ° of External rotation

Central => 3 ° of External rotation

Phil Chapman-Sheath and Versailles Concept

Normal knee = > Patella

= > Trochlea

Lateral

Medial

Lateral arthritis Patella

Trochlea

Lateral

Medial

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Solution with PFJ And trochlear dysplasia

Patella

Trochlea

Lateral

Medial

Lateral arthritis => 5 to 10 ° of External rotation Lat

Patella

Med

Solution with Central Arthtritis

Trochlea

Lateral

Medial

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Central => 3 ° of External rotation Lat

Med

Patello-Femoral Arthroplasty

1. Indication 2.

Implant

3. Technique 4.

Results

No tourniquet

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Approach

MIS Subvastus

Witheside line

Anterior cut Rotation/thickness

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Femoral reaming

Patella : Always

Cement

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Post-op X-ray

When medial OA is associated

PFJ + ZUK

Patello-Femoral Arthroplasty

1. Indication 2.

Implant

3.

Technique

4. Results

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1. Primary Arthritis with no F-Tdeformity 2. P-F Instability with aligned extensor mechanism 3. Post-traumatic: good mobility, no patella baja

Long term Results of PFA • Blazina, CORR 1979 • Arciero, CORR 1988 • Witvoet, Ch Ens Sofcot 1994 • Argenson, CORR 1995 • Krajca-Raddiffe, CORR 1996 • Mertl, RCO 1996 • De Cloedt, Acta Orthop 1999

•Tauro, JBJS Br 2001 • Kooijman, JBJS Br 2003 • Lonner, CORR 2004 • Cartier, CORR 2005 • Merchant, CORR 2005 • Lotke, J Arthroplasty 2005 • Ackroyd, CORR 2005 • Argenson, CORR 2005 • Cossey, J Arthroplasty 2006 • Sisto, JBJS Am 2006 • Ackroyd, JBJS Br 2007

Survival 85 % at 10 years and 70% at 15 years

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Mid term Results of PFA • • • • • • •

Van Jonbergen, J Arthroplasty 2010 Dahm, Am J Orthop 2010 Odumenya, JBJS Br 2010 Dy, KSSTA 2011 Mont, J Arthroplasty 2012 Walker, JBJS Am 2012 Lonner, Orthop Clin Am 2013

Survival 95 % at 5 years

Results

7 years experience: New generation Isolated or combined with the ZUK But no OA progression No patellar maltracking No loosening

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Easy conversion to TKA

• •

Lonner JH, Jasko JG, Booth RE JBJSAm 2006 Parratte S, Lunebourg A, Ollivier M, Abdel MP, Argenson JN. Are revisions of patellofemoral arthroplasties more like primary or revision TKAs. Clin Orthop Relat Res. 2015

Conclusion and Key points message Indications: learn PFJ : A3 : anatomy/ ancillary/ anterior cut Technique : rotation+++ PFJ: reproducible solution for PFA Good mid-term results new generation

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