F.M. SAID¹, I.F. AKHTIAMOV^1,2, A.I. KUDRYAVTSEV^2,3, M.J. HELO¹, M.A. AL—LAMI¹

¹Kazan State Medical University, 49 Butlerov Str., Kazan, Russian Federation, 420012

²Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064

³Kazan State Medical Academy ― Branch Campus of the FSBEI FPE RMACPE MOH Russia, 36 Butlerov Str., Kazan, Russian Federation, 420012

 Said F.M. ― postgraduate student of the Department of Traumatology, Orthopedics and Surgery of Extreme States, tel. (843) 236-06-52, e-mail: Firassss86@gmail.com, ORCID ID: 0000-0002-7712-3266

Akhtiamov I.F. ― D. Sc. (medicine), Professor, Head of the Department of Traumatology, Orthopedics and Surgery of Extreme States, Chief Researcher of the Scientific Department, tel. (843) 236-06-52, e-mail: Yalta60@mail.ru

Kudryavtsev A.I. ― PhD (medicine), Head of the Orthopedics Department №2, Assistant of the Traumatology and Orthopedics Department, tel. (843) 231-20-17, e-mail: kdalex@bk.ru

Helo M.J. ― postgraduate student of the Department of Traumatology, Orthopedics and Surgery of Extreme States, tel. (843) 236-06-52, e-mail: dr_helo_ortho@hotmail.com

Al-Lami M.A. ― postgraduate student of the Department of Traumatology, Orthopedics and Surgery of Extreme States, tel. (843) 236-06-52, e-mail: Ms19882002@yahoo.com

 Patellofemoral arthritis is considered as one of the subtypes of the classical knee osteoarthritis, which manifests itself at a fairly young age, but is often ignored by patients, leading ultimately to the development of classical knee osteoarthritis involving all the structures and parts of the knee joint.

Arthroscopic debridement gives favorabl results in 85-90% of cases. However, with time, the percentage of positive outcomes gradually decreases.

The article presents a clinical observation of a patient suffering from patello-femoral arthritis of the right knee joint and chondromalacia of the femoral trochlea in the 3-4 stage. In this patient’s history, there had been a knee joint discomfort for 4 years. Multiple conservative treatments gave a short-term effect, enabling the patient to have a sedentary lifestyle. On admission, according to the clinical examination and radiological studies, the patient was diagnosed as patella-femoral arthritis with chondromalacia of the femoral trochlea in the 3-4 stage.

It was decided to perform two-stage surgical treatment. The first stage was arthroscopic debridement with resection chondroplasty and lateral retinaculum release. The second stage was corrective plastic of the extensor mechanism of the knee joint with ventralization of tibia tuberosity by Fulkerson. After each stage of the surgical treatment the patient received a course of conservative treatment.

Close monitoring was conducted for 12 months with an assessment of the intensity of pain in the knee joint (VAS), the activity of the disease and functional disorders ― Oxford Knee Score (OKS), assessment of the range of motion in the knee joint ― Knee Society Score (KSS).

X-rays were taken during the follow-up period to determine changes in the Q-angle and an evaluation of the fusion after osteotomy was made.

Positive effects were shown by the above treatment in several aspects of the patient’s quality of life including her capabilities in physical, domestic and social domains.

Key words: arthroscopy, patella, patellofemoral arthritis, ventralization.

(For citation: Said F.M., Akhtiamov I.F., Kudryavtsev A.I., Helo M.J., Al-Lami M.A. Treatment experience of patellofemoral arthritis (clinical case). Practical Medicine. 2018)

REFERENCES

1. Øye C.R., Foss O.A., Holen K.J. Breech presentation is a risk factor for dysplasia of the femoral trochlea. Acta Orthop, 2015, 87, p. 1721.
2. Kaymaz B., Atay O.A., Ergen F.B., et al. Development of the femoral trochlear groove in rabbits with patellar malposition. Knee Surg. Sports Traumatol. Arthrosc, 2013, 21, p. 1841-1848.
3. Sillanpää P.J., Salonen E., Pihlajamäki H., Mäenpää H.M. Medial patellofemoral ligament avulsion injury at the patella: classification and clinical outcome. Knee Surg. Sports Traumatol. Arthrosc., 2014, 22, pp. 2414-2418. DOI: 10.1007/s0016701431743
4. Tanaka M.J., Elias J.J., Williams A.A., et al. Correlation between changes in tibial tuberosity-trochlear groove distance and patellar position during active knee extension on dynamic kinematic computed tomographic imaging. Arthroscopy, 2015, 31, pp. 1748-1755. DOI: 10.1016/j.arthro.2015.03.015
5. Guilbert S., Chassaing V., Radier C., et al. French Arthroscopy Society (SFA). Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop. Traumatol. Surg. Res, 2013, 99, pp. 399-405. DOI: 10.1016/j.otsr.2013.10.006
6. Stephen J.M., Dodds A.L., Lumpaopong P., et al. The ability of medial patellofemoral ligament reconstruction to correct patellar kinematics and contact mechanics in the presence of a lateralized tibial tubercle. Am. J. Sports Med, 2015, 43, pp. 2198-2207. DOI: 10.1177/0363546515597906
7. Zhizhenkova T.V., Danilyak V.V., Klyuchevskiy V.V., Klyuchevskiy Vas.V. Evaluation of the instability of the patella after total knee arthroplasty. Travmatologiya i ortopediya Rossii, 2015, 2, p. 2431 (in Russ.). DOI: 10.21823/231129052015022431
8. Van Haver A., De Roo K., De Beule M. et al. The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am. J. Sports Med., 2015, 43, pp. 1354-1361. DOI: 10.1177/036354651557214