Algunas consideraciones sobre la trocleoplastia del fémur / Some considerations on the trochleoplasty of distal femur

La mala alineación patelofemoral tiene múltiples causas anatómicas y una de ellas es la displasia de la tróclea del fémur distal, por lo cual su tratamiento depende de varios factores. Para profundizar en los elementos esenciales de la técnica de trocleoplastia, se realizó una revisión bibliográfica exhaustiva donde se analizaron algunos aspectos de interés, a saber: clasificación más empleada para las displasias de la tróclea, elementos imagenológicos más importantes, indicaciones de la técnica quirúrgica, contraindicaciones, principales modalidades de trocleoplastia y vías de acceso quirúrgico. Se concluyó que este es un proceder con indicaciones muy específicas y puede realizarse mediante cirugía abierta o por vía artroscópica.

The poor patellofemoral alignment has multiple anatomical causes and one of them is the dysplasia of the distal femur trochlea, reason why its treatment depends on several factors. To deepen in the essential elements of the trochleoplasty technique, an exhaustive literature review was carried out where some aspects of interest were analyzed, that is: most used classification for the trochlear dysplasias, most important imagenologic elements, indications of the surgical technique, contraindications, main modalities of trochleoplasty and surgical approaches. It was concluded that this is a procedure with very specific indications and can be carried out by means of open surgery or arthroscopic way.

Magnetic resonance imaging-based morphological and alignment assessment of the patellofemoral joint and its relationship to proximal patellar tendinopathy.

OBJECTIVE: To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. METHODS: We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. RESULTS: The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. CONCLUSIONS: Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT.