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Instabilitatile femuro - patelare

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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  1. Instabilitatilefemuro- patelare

  2. ANATOMIE - celmai mare ossesamoid - cartilajularticulargros (5 mm)

  3. Biomecanica EXTENSIE MAXIMA

  4. CONTACT MAXIM FEMURO PATELAR LA 70-80⁰ FLEXIE Cartilajmaigros in parteamijlocie!!!

  5. FACTORI DE INSTABILITATE • Displaziatrohleei(rara) • Insuficientaligamentului medial femuro-patelar • Anteversiafemuralaexcesiva • Rotatiaexternatibialaexcesiva • M.Vast medial oblic incompetent • Patella alta • Valgusulfiziologicmai mare la femei

  6. ANAMNEZA-IMPORTANTA!!! • LOCALIZAREA DURERII • ISTORICUL SPORTIV • DURATA • CAND APAR DURERILE? • OCUPATIA

  7. EX.CLINIC :METODA INSALL-SALVATI PATELLA ALTA-CONTACT LIMITAT CU TROHLEEA PATELLA BAJA-DEGENERESCENTA PROGRESIVA A CARTILAJULUI

  8. UNGHIUL Q NORMAL < 15⁰

  9. ORTOSTATISM-STATIC UNGHIUL Q NORMAL UNGHIUL Q CRESCUT

  10. POZITIA PICIORULUI PRONATIA EXCESIVA ORTEZE

  11. EVALUARE DINAMICA Dureri,cracmente,pseudo-blocaj,subluxatiepatelara

  12. Testulaprehensiunii Semnul ‘’rindelei’’

  13. PATELLA TILT TEST TEST POZITIV < 15⁰

  14. EXAMEN RADIOLOGIC

  15. RMN CT

  16. 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

  17. COMPLICATII : LUXATIA ACUTA A ROTULEI POATE FI PRIMUL SIMPTOM FRECVENT SE REDUCE SPONTAN

  18. MECANISME

  19. Evolutiaartrozica

  20. TRATAMENT ORTOPEDICVERSUS CHIRURGICAL

  21. Conservator - ortezare - kinetoterapie - antiinflamatoare - condroprotectoare

  22. Chirurgical Realiniereaaparatului extensor prinosteotomii de TAT

  23. Reconstructialigamentuluipatelar medial +/- relaxareretinacularalaterala

  24. Artroscopic Realiniereaartroscopica

  25. REABILITAREA • Kinetoterapiepana la 3 luni • Recuperareaesteceamairapidadupatehnicileartroscopicesimaidificiladupaosteotomii

  26. CONCLUZII • Luxatiatraumatica a rotuleieste o raritate;celmaifrecvent ea reprezinta un episodacut a uneiistabilitatifemuro-patelarecronice • Tratamentuloptimestecelchirurgical,(necesita o evaluareartroscopicainitiala)

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