Instabilitatile femuro patelare
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Instabilitatile femuro - patelare PowerPoint PPT Presentation


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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

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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


Examen radiologic

EXAMEN RADIOLOGIC


Rmn ct

RMN CT


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


Mecanisme

MECANISME


Evolutia artrozica

Evolutiaartrozica


Tratament

TRATAMENT

ORTOPEDICVERSUS CHIRURGICAL


Conservator

Conservator

- ortezare

- kinetoterapie

- antiinflamatoare

- condroprotectoare


Chirurgical

Chirurgical

Realiniereaaparatului extensor prinosteotomii de TAT


Instabilitatile femuro patelare

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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