Patellofemoral instability

Prva dislokacija patele naziva se akutnom ili primarnom patelarnom dislokacijom, a stanje u kojem postoji sklonost iščašenju patele iz njenog anatomskog mjesta i u kojem dolazi do ponavljanih dislokacija patele naziva se kroničnom ili rekurentnom patelofemoralnom nestabilnošću. Najčešće zahvaća ljude između 10 i 17 godina starosti. Stabilnost patelofemoralnom zglobu pružaju statički i dinamički stabilizatori. Akutna patelarna dislokacija najčešće je uzrokovana indirektnom traumom koljena, a kronična patelofemoralna nestabilnost uzrokovana je ozljedama MPFL-a ili anatomskim abnormalnostima poput trohlearne displazije, visoko položene patele, povećane TT-TG udaljenosti ili rotacijskih abnormalnosti kostiju donjih udova. Akutna patelarna dislokacija karakterizirana je intenzivnom boli i hemartrosom, a patelofemoralna nestabilnost karakterizirana je slabošću u koljenu, smanjenom mogućnošću obavljanja sportskih aktivnosti i osteoartritisom. Klinički pregled pacijenata se sastoji od uzimanja anamneze i fizikalnog pregleda. U anamnezi najvažnije je saznati mehanizam ozljede, simptome koje pacijent osjeća te je li pacijent ikad prije patio od sličnih simptoma. Tijekom fizikalnog pregleda bitno je procijeniti stabilnost patele, npr. traženjem J znaka ili testom straha. Radiološki pregled sastoji se od standardne radiografije, MR-a i CT-a. Patelofemoralna nestabilnost može se liječiti konzervativno i operacijski. Konzervativno liječenje uključuje davanje nesteroidnih protuupalnih lijekova, liječenje po RICE protokolu i fizikalnu terapiju. Najčešće primjenjivana operacijska metoda jest rekonstrukcija MPFL-a, a uz nju često se izvode i trohleoplastika i distalno preusmjeravanje.The first patellar dislocation is called acute or primary patellar dislocation, while a condition in which there is a tendency of patella escaping its anatomical position and in which repeated dislocations occur is referred to as chronic or recurrent patellofemoral instability. People aged between 10 and 17 are most commonly affected.. Patellofemoral joint is stabilized by static and dynamic stabilizers. Acute patellar dislocation is most commonly caused by an indirect knee trauma, while chronic patellofemoral instability is caused by an injury to the MPFL or by anatomical abnormalities like trochlear dysplasia, patella alta, increased TT-TG distance or rotation abnormalities of the lower extremities. Acute patellar dislocation is characterized by intense pain and hemarthrosis, while patellofemoral instability is characterized by the weakness in the knee, decrease in sporting activity, and osteoarthritis. Clinical assessment includes taking history and physical examination. In taking history, the most important things to find out are the mechanism of the injury, the symptoms that the patient experiences and if he had suffered from similar symptoms ever before. During the physical examination, it is important to test patellar stability, e.g. by looking for the J sign or by patellar apprehension test. Imaging includes conventional radiography, MRI and CT. Patellofemoral instability can be treated conservatively and surgically. Conservative treatment includes administration of the nonsteroidal anti-inflammatory drugs, RICE method, and physical therapy. Most commonly used surgical method is MPFL reconstruction, while trochleoplasty and distal realignment procedures are also commonly used