- Email: [email protected]
Arthroscopic Treatment of Patients With Chronic Patellar Tendinosis (SS-59)
e30
ABSTRACTS
Conclusions: Arthroscopic excision of the distal pole of the patella, in addition to tendon debridement, offers promise as a means of treating refractory patellar tendinitis. Arthroscopic Treatment of Patients With Chronic Patellar Tendinosis (SS-59). Olaf Lorbach, MD, Andreas Diamantopoulos, MD, Hans Paessler, MD Purpose: The aim of this prospective study was to evaluate the clinical results of arthroscopic resection of the lower patellar pole in patients with patellar tendinosis. Methods: Twenty patients underwent an arthroscopic resection of the lower patellar pole between 2002 and 2004. All of them were followed-up 6 weeks, 3,6,12 and 24 months after surgery using the Tegner activity level, the Lysholm score, the Kujala score, a modified classification according to Blazina and visual analog scales for pain, function and satisfaction. In addition MRI was performed preoperative and at 2-years follow-up. Results: Already 6 weeks postoperative and at every other follow-up significant improvements were seen in the Lysholm score (p⫽0,001), the Kujala score (p⫽0,001) and the visual analog scales. The Tegner score improves significantly 3 months after surgery (p⫽0.001).2 years after surgery Tegner Score improved from 4,4 to 7,95 (p⬍0.0001), Lysholm score from 57,1 to 97,3 (p⬍0.0001) and Kujala score from 53,7 to 95,4 (p⬍0.0001) postoperatively. The jumper⬘s knee classification according to Blazina showed excellent results in 18 of 20 patients (Stadium I or II). At follow-up all but one MRI showed hypodens areals in the proximal aspect of the patellar tendon and small osteophytes were seen in some cases at the resection area which does not seem to have any influence on the results. Conclusions: The arthroscopic resection of the lower patellar pole as a minimal invasive method to treat jumper⬘s knee showed very promising clinical results in knee function and pain reduction. Comparison of Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Realignment for Treatment of Patellar Instability (SS-60). Sean Grace, MD, Walter R. Shelton, MD, Gene Barrett, MD Purpose: A variety of proximal and distal realignment techniques have been described for patellar instability. We conducted a review of patients treated with tibial tubercle transfer/lateral release compared to MPFL
reconstruction/lateral release to formulate an operative treatment algorithm for patellar instability. Methods: A retrospective chart review of patients treated for patellar instability with either tibial tubercle transfer/lateral release or MPFL recon/lateral release was performed. Patients with patellofemoral pain without instability were excluded. 36 patients (42 knees) were included in the tibial tubercle transfer group and 24 patients (25 knees) were included in the MPFL recon group. Patients were assessed postoperatively regarding patellofemoral stability, pain, and level of activity with average followup of 2.3 years. Results: Of the 42 knees in the tibial tubercle group, 6 had mild persistent knee pain, 2 had recurrent instability. 35 of 36 patients were able to return to sport/activity within 3-6 months with 32 at pre-injury level of function. Painful hardware was the most common complaint in this group. 22 of 42 knees required screw removal in a secondary procedure. There were no reported complications. Of the 25 knees in the MPFL recon group, 5 had mild/moderate persistent knee pain, 5 had recurrent instability. 2 patients who failed MPFL reconstruction subsequently underwent tibial tubercle transfer and reported no further instability or dysfunction. 2 patients reported loss of motion with one patient requiring arthroscopic debridement and manipulation. One patient developed deep MRSA infection requiring multiple debridements. 19 patients were able to return to full activity/sport in 4-6 months. All of the patients with recurrent postoperative instability had Q angles greater than 18 degrees. Conclusions: We have formulated an operative treatment algorithm for patellar instability based upon the results of this study. Both MPFL reconstruction and tibial tubercle transfer procedures are viable procedures allowing quick recovery, low rates of instability, and minimal risk of complication. Tibial tubercle transfers are indicated for patients with Q angles greater than 18 degrees and generalized ligamentous laxity; however, they carry a greater chance for painful hardware requiring removal. Wrist Arthroscopy in Intra-Articular Distal Radius Fracture (SS-61). Ferdinando Battistella, MD, Ettore Taverna, MD Summary: This clinical study in a prospective case series, with control group was made to determine the usefulness of arthroscopically assisted reduction of displaced intra-articular fractures of the distal aspect of the radius. We treated with arthroscopic reduction 40 pa-
ABSTRACTS
Conclusions: Arthroscopic excision of the distal pole of the patella, in addition to tendon debridement, offers promise as a means of treating refractory patellar tendinitis. Arthroscopic Treatment of Patients With Chronic Patellar Tendinosis (SS-59). Olaf Lorbach, MD, Andreas Diamantopoulos, MD, Hans Paessler, MD Purpose: The aim of this prospective study was to evaluate the clinical results of arthroscopic resection of the lower patellar pole in patients with patellar tendinosis. Methods: Twenty patients underwent an arthroscopic resection of the lower patellar pole between 2002 and 2004. All of them were followed-up 6 weeks, 3,6,12 and 24 months after surgery using the Tegner activity level, the Lysholm score, the Kujala score, a modified classification according to Blazina and visual analog scales for pain, function and satisfaction. In addition MRI was performed preoperative and at 2-years follow-up. Results: Already 6 weeks postoperative and at every other follow-up significant improvements were seen in the Lysholm score (p⫽0,001), the Kujala score (p⫽0,001) and the visual analog scales. The Tegner score improves significantly 3 months after surgery (p⫽0.001).2 years after surgery Tegner Score improved from 4,4 to 7,95 (p⬍0.0001), Lysholm score from 57,1 to 97,3 (p⬍0.0001) and Kujala score from 53,7 to 95,4 (p⬍0.0001) postoperatively. The jumper⬘s knee classification according to Blazina showed excellent results in 18 of 20 patients (Stadium I or II). At follow-up all but one MRI showed hypodens areals in the proximal aspect of the patellar tendon and small osteophytes were seen in some cases at the resection area which does not seem to have any influence on the results. Conclusions: The arthroscopic resection of the lower patellar pole as a minimal invasive method to treat jumper⬘s knee showed very promising clinical results in knee function and pain reduction. Comparison of Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Realignment for Treatment of Patellar Instability (SS-60). Sean Grace, MD, Walter R. Shelton, MD, Gene Barrett, MD Purpose: A variety of proximal and distal realignment techniques have been described for patellar instability. We conducted a review of patients treated with tibial tubercle transfer/lateral release compared to MPFL
reconstruction/lateral release to formulate an operative treatment algorithm for patellar instability. Methods: A retrospective chart review of patients treated for patellar instability with either tibial tubercle transfer/lateral release or MPFL recon/lateral release was performed. Patients with patellofemoral pain without instability were excluded. 36 patients (42 knees) were included in the tibial tubercle transfer group and 24 patients (25 knees) were included in the MPFL recon group. Patients were assessed postoperatively regarding patellofemoral stability, pain, and level of activity with average followup of 2.3 years. Results: Of the 42 knees in the tibial tubercle group, 6 had mild persistent knee pain, 2 had recurrent instability. 35 of 36 patients were able to return to sport/activity within 3-6 months with 32 at pre-injury level of function. Painful hardware was the most common complaint in this group. 22 of 42 knees required screw removal in a secondary procedure. There were no reported complications. Of the 25 knees in the MPFL recon group, 5 had mild/moderate persistent knee pain, 5 had recurrent instability. 2 patients who failed MPFL reconstruction subsequently underwent tibial tubercle transfer and reported no further instability or dysfunction. 2 patients reported loss of motion with one patient requiring arthroscopic debridement and manipulation. One patient developed deep MRSA infection requiring multiple debridements. 19 patients were able to return to full activity/sport in 4-6 months. All of the patients with recurrent postoperative instability had Q angles greater than 18 degrees. Conclusions: We have formulated an operative treatment algorithm for patellar instability based upon the results of this study. Both MPFL reconstruction and tibial tubercle transfer procedures are viable procedures allowing quick recovery, low rates of instability, and minimal risk of complication. Tibial tubercle transfers are indicated for patients with Q angles greater than 18 degrees and generalized ligamentous laxity; however, they carry a greater chance for painful hardware requiring removal. Wrist Arthroscopy in Intra-Articular Distal Radius Fracture (SS-61). Ferdinando Battistella, MD, Ettore Taverna, MD Summary: This clinical study in a prospective case series, with control group was made to determine the usefulness of arthroscopically assisted reduction of displaced intra-articular fractures of the distal aspect of the radius. We treated with arthroscopic reduction 40 pa-