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Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.8 ) Pub Date : 2020-03-04 , DOI: 10.1007/s00167-020-05906-9
Elias Ammann 1, 2 , Rahel L Meier 2 , Erich Rutz 2, 3 , Patrick Vavken 3, 4 , Kathrin Studer 5 , Carlo Camathias 2, 4, 5
Affiliation  

Abstract

Purpose

To investigate if a trochleoplasty increases knee flexion angles and extensor moments in the gait of patients with patellar instability and to compare postoperative gait to a healthy control group.

Methods

A bilateral dislocation group (6 patients) and a unilateral dislocation group (14 patients) were treated with bilateral and unilateral trochleoplasty, respectively. Kinematics and kinetics of the lower extremity were captured using 3D-gait analysis (VICON, 12 cameras, 200 Hz, plug-in-gait, two force plates). The mean of six trials was computed. The gait cycles were compared pre to postoperatively for each group. The gait of the two groups was compared to each other and the gait of a healthy population (54 knees).

Results

After trochleoplasty, the knee flexion angles and knee extensor moments only increased in the bilateral dislocation group, whereas the gait pattern of the unilateral dislocation group remained unchanged. Compared to the healthy population, the postoperative gait pattern of the bilateral dislocation group did not differ. In contrast, knee flexion angles and extensor moments of the unilateral dislocation group were still lower.

Conclusion

In adolescents with bilateral recurrent patellar dislocations, trochleoplasty of both knees increases knee flexion angles and knee extensor moments comparable to normal gait. Unilateral symptomatic patients undergoing a unilateral trochleoplasty did not achieve normal walking. These findings point out that patellar instability should be considered as a bilateral problem, even in patients with unilateral dislocations.

Level of evidence

III.



中文翻译:

仅在双侧进行时,滑车成形术可改善步态中膝盖的屈曲角度和股四头肌功能。

摘要

目的

调查滑行成形术是否会增加pa骨不稳定患者步态的膝关节屈曲角度和伸肌力矩,并将术后步态与健康对照组进行比较。

方法

双侧脱位组(6例)和单侧脱位组(14例)分别接受了双侧和单侧滑车成形术治疗。使用3D步态分析(VICON,12个摄像头,200 Hz,插入式步态,两个测力板)捕获下肢的运动学和动力学。计算了六次试验的平均值。比较各组手术前后的步态周期。比较两组的步态和健康人群(54膝)的步态。

结果

滑囊成形术后,双侧脱位组的膝关节屈曲角度和伸膝力矩仅增加,而单侧脱位组的步态模式保持不变。与健康人群相比,双侧脱位组的术后步态没有差异。相反,单侧脱位组的膝关节屈曲角度和伸肌力矩仍然较低。

结论

在双侧复发性pa骨脱位的青少年中,与正常步态相当,双膝的滑车成形术可增加膝关节屈曲角度和伸膝力矩。接受单侧滑车成形术的单侧症状患者未实现正常行走。这些发现指出,即使在单侧脱位的患者中,pa骨不稳也应被视为双侧问题。

证据水平

三,

更新日期:2020-03-04
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