Osteotomía de Fulkerson modificada por Heatley para tratamiento del dolor patelofemoral: serie de casos / Heatley modified Fulkerson osteotomy for the treatment of patellar femoral pain. A case series

Introducción El síndrome de dolor patelofemoral (SDPF) es una posible causa de dolor anterior en la rodilla que afecta predominantemente a mujeres jóvenes. No existe hasta el momento un consenso en cuanto a la etiología, pero la evidencia sugiere que el malalineamiento patelofemoral probablemente desempeña un papel en la patogénesis del dolor y particularmente en la condromalacia. Las osteotomías clásicamente utilizadas y descritas en la literatura reportan resultados funcionales variables, sin embargo los buenos resultados descritos en la literatura se encuentran en un rango entre el 50%-80%, lo que indica alguna dificultad con la reproducibilidad de la técnica o su eficacia, por lo que queremos evaluar los resultados de una técnica diferente. Materiales y Métodos Estudio de serie de casos prospectivo de pacientes con síndrome de dolor patelofemoral tratados con una nueva técnica de osteotomía de la tuberosidad tibial anterior anteromedializadora en V. Resultados Se evaluaron 19 rodillas, los promedios de intensidad de dolor fueron de 9 en el preoperatorio, 4 y 3 en el seguimiento a tres y seis meses, en la escala de Kujala se obtuvo un promedio de 33 puntos en el preoperatorio, de 75 a los 3 meses y de 87 a los seis meses. Discusión En nuestro estudio consideramos un porcentaje de 94,7% de buenos o excelentes resultados y 5% de malos resultados. La técnica descrita y utilizada en nuestro estudio presenta una tasa de buenos resultados similar a las descritas en la literatura con otras técnicas quirúrgicas y con diferentes escalas funcionales.

Background Patellofemoral pain syndrome (PFPS) is a possible cause of anterior knee pain that predominantly affects young women. To date, there is no consensus regarding the aetiology, but the evidence suggests that patellofemoral misalignment probably plays a role in the pathogenesis of pain and particularly in chondromalacia. Osteotomies classically used and described in the literature report variable functional results. As the good results described in the literature are in a range between 50%-80%, this indicates some difficulty with the reproducibility of the technique, or its effectiveness, we wish to evaluate the results of a different technique. Materials and Methods Prospective case series study of patients with patellofemoral pain syndrome treated with a new osteotomy technique of the anterior tibial tuberosity, anterior-medialized, in V. Results A total of 19 knees were evaluated. The mean pain intensity was 9 in the preoperative period, and 4 and 3 in the follow-up at three and six months, respectively. A mean of 33 points on the Kujala scale was obtained in the pre-operative period, and 75 at 3 months and 87 at six months follow-up. Discussion A percentage of 94.7% was considered good or excellent results, and 5% of considered as bad. The technique described and used in our study presents a rate of good results similar to those described in the literature with other surgical techniques and with different functional scales.

Relação entre função do joelho e índice de massa corporal na síndrome patelofemoral / Relation between knee function and body mass index in patellofemoral syndrome

A Síndrome Patelofemoral (SPF) pode ser definida como uma dor anterior ou retropatelar na articulação do joelho. A obesidade e o sedentarismo podem gerar disfunções músculo-esqueléticas, e desequilíbrio entre as forças musculares exercidas na articulação do joelho, gerando desalinhamento articular e hiperpressão patelar. A amostra foi composta por 50 indivíduos com idade compreendida entre 18 e 60 anos. Como instrumento para coleta de dados fez-se uso do Questionário de Lysholm para avaliar a função do joelho. O índice de massa corporal (IMC) foi calculado pelo peso corporal dividido pelo quadrado da altura. Fez-se correlação de Pearson para o IMC e o estado funcional do joelho. A prevalência foi de 26% sobrepeso e 20% de obesidade, 62% dos participantes apresentaram função do joelho insatisfatória. Através da estatística aplicada observa-se relação significativa entre o score obtido pela escala de Lysholm e o IMC (p=0,0083), onde se encontra que para cada aumento no IMC as notas obtidas pela escala de Lysholm diminuem 1,5182 pontos. O sobrepeso corporal e obesidade constituem um problema de saúde pública, comprometem a função do joelho, o que colabora para o surgimento da SPF.

The Patellofemoral Syndrome (PFS) can be defined as an anterior retropatellar pain in the knee joint. The obesity and the sedentariness can generate musculoskeletal dysfunction, and unbalance among the muscular forces exercised at the knee joint. This cause bad alignment on the joint and patellar hyper pressure. The sample was formed by 50 people with PFS aged about 18 to 60 years old. Data was collected by Lysholm scale to evaluate the knee function. Body mass index was calculated through the body weight divided by the square height. Pearson's test was applied for correlational analysis for body mass index and the functional state was done. The prevalence was 26% overweight and 20% obesity, 62% of the participants presented unsatisfactory knee function. Thought the statiscal analysis, significant relation in observed between the obtained score by scale of Lysholm and the body mass index (p=0.0083), where it shows that for each increase in the body mass index the obtained notes by scale of Lysholm diminish 1.5182 points. The corporal overwight and obesity constitute a public health problem, compromise the function of the knee and can cause PFS.