Instabilitatile femuro patelare
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Instabilitatile femuro - patelare. ANATOMIE. - cel mai mare os sesamoid - cartilajul articular gros (5 mm). Biomecanica. EXTENSIE MAXIMA. CONTACT MAXIM FEMURO PATELAR LA 70-80⁰ FLEXIE. Cartilaj mai gros in partea mijlocie !!!. FACTORI DE INSTABILITATE. Displazia trohleei ( rara )

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Instabilitatile femuro patelare

Instabilitatilefemuro- patelare


Anatomie
ANATOMIE

- celmai mare ossesamoid

- cartilajularticulargros

(5 mm)


Biomecanica
Biomecanica

EXTENSIE MAXIMA


Contact maxim femuro patelar la 70 80 flexie
CONTACT MAXIM FEMURO PATELAR LA 70-80⁰ FLEXIE

Cartilajmaigros in parteamijlocie!!!


Factori de instabilitate
FACTORI DE INSTABILITATE

  • Displaziatrohleei(rara)

  • Insuficientaligamentului medial femuro-patelar

  • Anteversiafemuralaexcesiva

  • Rotatiaexternatibialaexcesiva

  • M.Vast medial oblic incompetent

  • Patella alta

  • Valgusulfiziologicmai mare la femei


Anamneza importanta
ANAMNEZA-IMPORTANTA!!!

  • LOCALIZAREA DURERII

  • ISTORICUL SPORTIV

  • DURATA

  • CAND APAR DURERILE?

  • OCUPATIA


Ex clinic metoda insall salvati
EX.CLINIC :METODA INSALL-SALVATI

PATELLA ALTA-CONTACT LIMITAT CU TROHLEEA

PATELLA BAJA-DEGENERESCENTA PROGRESIVA A CARTILAJULUI


Unghiul q
UNGHIUL Q

NORMAL < 15⁰


Ortostatism static
ORTOSTATISM-STATIC

UNGHIUL Q NORMAL

UNGHIUL Q CRESCUT


Pozitia piciorului
POZITIA PICIORULUI

PRONATIA EXCESIVA

ORTEZE


Evaluare dinamica
EVALUARE DINAMICA

Dureri,cracmente,pseudo-blocaj,subluxatiepatelara


Testul aprehensiunii
Testulaprehensiunii

Semnul ‘’rindelei’’


Patella tilt test
PATELLA TILT TEST

TEST POZITIV < 15⁰




Diagnostic diferential
DIAGNOSTIC DIFERENTIAL

  • FRACTURI OSTEOCONDRALE

  • SDR.DE IMPINGEMENT ANTERIOR AL MENISCULUI

  • SDR.DE COMPRESIUNE LATERALA A PATELEI

  • BURSITA PREPATELARA

  • TENDINITA PATELARA

  • SDR.OSGOOD-SCHLATTER

  • SDR.PLICII DUREROASE

  • BOALA HOFFA

  • LEZIUNEA LIA


Complicatii luxatia acuta a rotulei
COMPLICATII : LUXATIA ACUTA A ROTULEI

POATE FI PRIMUL SIMPTOM

FRECVENT SE REDUCE SPONTAN



Evolutia artrozica
Evolutiaartrozica


Tratament
TRATAMENT

ORTOPEDICVERSUS CHIRURGICAL


Conservator
Conservator

- ortezare

- kinetoterapie

- antiinflamatoare

- condroprotectoare


Chirurgical
Chirurgical

Realiniereaaparatului extensor prinosteotomii de TAT


Reconstructialigamentuluipatelar medial +/- relaxareretinacularalaterala


Artroscopic
Artroscopic

Realiniereaartroscopica


Reabilitarea
REABILITAREA

  • Kinetoterapiepana la 3 luni

  • Recuperareaesteceamairapidadupatehnicileartroscopicesimaidificiladupaosteotomii


Concluzii
CONCLUZII

  • Luxatiatraumatica a rotuleieste o raritate;celmaifrecvent ea reprezinta un episodacut a uneiistabilitatifemuro-patelarecronice

  • Tratamentuloptimestecelchirurgical,(necesita o evaluareartroscopicainitiala)


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