Więtek Bogdan, Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski w Krakowie, 2006, 130 k. : il., tab., bibliogr. 143 poz., streszcz., sum.
The main indication to arthroscopic lateral release of patella in patello-femoral syndrome, habitual subluxation of patella and recurrent dislocation of patella is a painful tight lateral retinaculum and patellar malalignment not responding conservative treatment. The main problem after lateral release of patella is the postoperative bleeding. A new device using a kind of intraarticular electrocauterization – vaporization could resolve this problem. Only several papers were published on this subject so far.
The aims of this thesis were:
- Evaluation of the results of arthroscopic lateral release in patello-femoral syndrome, habitual subluxation of patella and recurrent dislocation of patella
- Comparison of postoperative period after arthroscopic lateral release performed by vaporization technique or simple cut.
- Comparison of results of arthroscopic lateral release performed by vaporization technique or simple cut.
105 patients were operated on and 56 of them, who responded the call, were assessed for final evaluation. All operations were carried out by the author of this thesis. The material was divided into two groups at random: group A – operated on by vaporization and group B – operated by a simple cut. During arthroscopy all necessary procedures were carried on: loose bodies were removed, unstable parts of menisci and cartilage were excised, osteophytes were cut off and in case of excessive patella malalignment percutaneus riffing of medial retinaculum was carried on. None statistically important differences in aspect of gender, age, lateralization, BMI and intraarticular additional procedures between groups were proved.
The results were assessed prospectively by means of modification of Lysholm-Gillquist scale and retrospectively in original Lysholm-Gillquist, Insall scale, VAS, by physical examination of ROM, thigh circumference, and dystrophy of VMO and ultrasound examination.
In ultrasound examination the mean thickness of rectus muscle of the thigh was statistically greater, and the mean thickness of vastus lateralis and the whole quadriceps muscle were smaller in operated extremity than in nonoperated. That indicates a compensative hypertrophy of the rectus muscle. Considerable weakness of vastus lateralis after lateral release in operated extremity was also noticed.
In group A the postoperative bleeding was significantly greater. However, it has no influence on the late result of the treatment. The mean period to acquire by the patient self service after the operation was 4,0+2,3 weeks. The results of treatment didn’t show expected prevalence of vaporization over simple cut of the retinaculum.
The analysis of results according the specific diagnosis revealed high effectiveness of applied treatment in habitual subluxation of patella and in recurrent dislocation of patella and lower but still significant effectiveness in patello-femoral syndrome. The final result depended on arthritic changes in X-ray and on the stage of chondromalacia observed in arthroscopy.
On the basis of acquired results conclusions were formulated.
- Arthroscopic lateral release of patella is an effective method of treatment in patello-femoral syndrome, habitual subluxation of patella and recurrent dislocation of patella. The results are better when the degenerative changes on X-ray and the chondromalacia are smaller, and when the patient is younger.
- Arthroscopic lateral release gives the opportunity to precise debridemenet of chondromalacia in patello-femoral joint and simultaneous diagnosis and treatment in tibio-femoral joint: excision of torn meniscus, instable cartilage
- Medial retinaculum riffing complementary to lateral release gives good results in excessive recurrent dislocation of patella
- Lateral retinacular release by vaporization significantly decreases postoperative bleeding in postoperative period. However, it does not influence the time of walk ability after the operation.
- No difference in results of treatment in patello-femoral syndrome, habitual subluxation of patella and recurrent dislocation of patella was observed, if it comes to technique of retinaculum cut.