Thesis (M.S.)-- Springfield College, 2005. / Includes bibliographical references.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Thesis (PhD (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: A methodology to facilitate analysis of dynamic subject-specific patellofemoral function is presented. An enhanced understanding of patellofemoral biomechanics will enable orthopaedic surgeons to identify the mechanisms responsible for imbalances in the joint stabilisers, while also providing objective information on which to base treatment methods. Dynamic patellofemoral function of three volunteers was simulated with a musculoskeletal computational model. The individuals underwent scans from which three-dimensional models of their patellofemoral joints were constructed. Skeletal muscles and soft tissue stabilisers were added to the skeletal models, after which subject-specific motion was simulated. After trochlear engagement, the patellae of the volunteers followed a lateral path, whereas patella tilt was subject-specific. Comparison of the predicted tilt and mediolateral position values at 30 degrees knee flexion to in-vivo MRI values showed a mean accuracy of 62.1 % and 96.9 % respectively. The patellofemoral contact load . quadriceps tendon load ratio varied between 0.7 and 1.3, whereas the mediolateral load component . resultant load ratio ranged between 0 and 0.4. Both parameters. values were similar to previous findings. The medial patellofemoral ligament tension decreased with knee flexion, while the patellar tendon-quadriceps tendon ratio followed a similar trend to that of previous findings (varied between 0.4 and 1.2). After induction of a tubercle osteotomy in the coronal plane, Volunteer One.s patella engaged the trochlear groove at an earlier knee flexion angle, while the patella of Volunteer Two only underwent a small medial displacement. Finite element analyses were employed to investigate the influence of the osteotomy on the patellofemoral pressure distribution. The mean pressure in Volunteer One.s patellofemoral joint was alleviated (17 % smaller) at all angles of flexion with the exception of 60 degrees (12 % greater). Pressure in Volunteer Two.s joint was alleviated at 30 and 45 degrees knee flexion (6 % smaller), while it was elevated (9.1 % greater) at other angles of flexion. Two commercial patellofemoral prostheses were tested on the three Volunteers. joints in the virtual environment. Prosthesis Two delivered patella shift and tilt patterns similar to the baseline values. Patellar tendon tension was slightly greater after resurfacing, with the tensions elevated most with Prosthesis Two. Medial patellofemoral ligament tension was reduced most with Prosthesis Two, while lateral retinaculum tension was increased slightly. Prosthesis Two was the best candidate to reproduce patella kinematics, while the patellofemoral kinetics was largely independent from the type of prosthesis used. The prostheses performed worse for Volunteer Three, supporting the need for the development of patient-specific prostheses. Three validated subject-specific musculoskeletal models facilitated the analysis of the individuals. patellofemoral biomechanics. The technique can potentially be employed by orthopaedic surgeons to visualise the change that an osteotomy or patellofemoral arthroplasty might induce on an individual.s patellofemoral joint. This technique might aid in the development of a tool to assist biomedical engineers in the development of new patellofemoral prostheses. Most importantly, the outcome of surgical intervention may be predicted beforehand, and a treatment procedure may be tailored to optimally fit the patellofemoral biomechanics of that individual. / AFRIKAANSE OPSOMMING: 'n Ondersoekmetode van die dinamiese gedrag van pasiënt-spesifieke patellofemorale gewrigte word beskryf. Indien die patellofemorale biomeganika beter verstaan word, kan ortopediese chirurge die meganismes wat verantwoordelik is vir oneffektiewe stabiliseerders identifiseer en behandeling op objektiewe bevindinge baseer. Die dinamiese patellofemorale funksie van drie vrywilligers is gesimuleer m.b.v. `n spier-skelet rekenaarmodel. Drie-dimensionele modelle van die individue se patellofemorale gewrig is gekonstrueer m.b.v. skanderings. Die skeletspiere en sagte ondersteuningsweefsel is tot die model toegevoeg, voordat vrywilliger-spesifieke beweging gesimuleer is. Die knieskywe van die vrywilligers het `n laterale pad gevolg nadat dit die groef binnegetree het, met die tiltwaardes uniek vir elke vrywilliger. Vergelyking van die beraamde knieskyf mediolaterale tilt en posisies by 30 grade fleksie met in-vivo magnetiese resonansieskandering waardes het `n akkuraatheid van 62.1 % en 96.9 % respektiewelik getoon. Die patellofemorale kontaklas-kwadriseps seningspanning verhouding het gewissel tussen 0.7 en 1.3; asook die mediale komponent – resultante komponent patellofemorale kontaklas wat gewissel het tussen 0 en 0.4. Beide parameters se waardes was soortgelyk aan voorheen-gepubliseerde data. Die mediale patellofemorale ligamentspanning het afgeneem met fleksie. Die patella sening-kwadriseps seningspanning verhouding was soortgelyk aan vorige gepubliseerde waardes en het gewissel tussen 0.4 en 1.2. Nadat 'n tuberkel-osteotomie in die koronale vlak aangebring is, het Vrywilliger Een se patella die femorale groef vroeër binnegetree. Vrywilliger Twee se patella het slegs `n mediale verskuiwing ondergaan. Eindige element analises is ingespan om die effek van die osteotomie op die spanningsverspreiding in die patellofemorale gewrig te ondersoek. Die gemiddelde spanning in Vrywilliger Een se gewrig was minder by alle hoeke van fleksie (17 % minder), met uitsondering van die spanning by 60 grade (12 % meer). Die spanning in Vrywilliger Twee se gewrig was minder by 30 en 45 grade (6 % minder), maar hoër by ander hoeke (9.1 % meer). Twee kommersiële patellofemorale prosteses is getoets op die drie Vrywilligers d.m.v. die model. Prostese Twee het die knieskyf-kinematika die beste nageboots. Die patella-seningspanning was effens groter na die vervanging. Prostese Twee het gesorg vir die grootste toename. Die mediale patellofemorale ligamentspanning was die kleinste toe Prostese Twee gebruik is, maar dit het gesorg vir effense hoër laterale retinakulumlaste. Die analises het getoon dat Prostese Twee die beste kandidaat is om die korrekte kinematika te herbewerkstellig. Die kinetika daarteenoor was onafhanklik van die tipe prostese wat gebruik is. Geeneen van die twee prosteses was geskik vir Vrywilliger Drie nie, wat as motivering vir die ontwikkeling van pasiënt-spesifieke prosteses dien. Drie bekragtigde vrywilliger-spesifieke spier-skelet modelle het die analise van patellofemorale biomeganika bewerkstellig. Die tegniek het die potensiaal om ortopediste in staat te stel om die effek van `n osteotomie of patellofemorale vervanging te visualiseer. Die tegniek kan verder gebruik word deur biomediese ingenieurs in die vervaardiging van nuwe patellofemorale prosteses. Meer belangrik is die feit dat die resultaat van chirurgiese ingryping voorspel kan word en optimale behandelingsprosedures beplan kan word vir die patellofemorale biomeganika van `n individu.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diploma thesis "Patellofemoral pain syndrome and its affection by patellar taping" consists of two parts. The first general part summarises all present knowledge in the field of classification, diagnostics and therapy of this syndrome. The experimental part investigates a partial area of conservative therapy and a patellar taping technique according to McConnell. With the use of EMG records of a group of patients with patellofemoral pain syndrome it assesses the immediate effect of patellar taping on the pain intesity and timing of m. vastus medialis obliquus to m. vastus lateralis throughout three different movements. Powered by TCPDF (www.tcpdf.org)

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 xvi, 121 leaves / The purpose of the investigation was to evaluate the presence and extent of Quadriceps Femoris weakness in subjects with patellofemoral pain syndrome by the use of an isokinetic dynamometer.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2003. xix, 199 leaves / The purpose of this study was to investigate the role of Myofascial Trigger Points of the quadriceps femoris muscle in the clinical presentation of Patellofemoral Pain syndrome. Patellofemoral Pain Syndrome according to current literature suggests an extensor mechanism dysfunction as the most probable etiology, however this syndrome has posed many unsolved mysteries and challenges to the medical community and remains a difficult condition to treat. Myofascial pain syndrome in contrast to this is a regional muscular disorder that results from myofascial trigger points within the muscle. The presence of these trigger points could result in anterior knee pain, imbalance of the extensor mechanism and instability of the patellofemoral joint, which could present as a Patellofemoral Pain Syndrome.

Das mediale patello-femorale Ligament (MPFL) wurde in den letzten Jahren und Jahrzehnten als maßgeblicher passiver Stabilisator der Kniescheibe identifiziert und in biomechanischen Studien beschrieben. Auch wurden die verschiedenen Möglichkeiten der operativen Rekonstruktion des MPFL und deren klinisches Outcome bei patellofemoraler Instabilität in zahlreichen Studien beschrieben sowie relevante Ergebnisse für den klinischen Alltag formuliert. Ziel dieser Arbeit war es, die MPFL-Ersatzplastik als Revisionseingriff mit dem Outcome bei Primäreingriffen zu vergleichen und Faktoren zu bestimmen, die das klinische Outcome beeinflussen. Hierzu wurden 61 Patienten, die von Januar 2009 bis Dezember 2012 in der Klinik für Unfall- und Wiederherstellungschirurgie des Diakoniekrankenhauses Friederikenstift gGmbH Hannover operativ mittels MPFL-Ersatzplastik stabilisiert worden sind, untersucht. Retrospektiv nach Aktenlage und im Rahmen einer klinischen Nachuntersuchung wurden anhand eines standardisierten Studienprotokolls verschiedene Ausgangs- und Outcome-Parameter erhoben und mittels IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Released 2011 ausgewertet. Es zeigte sich, dass die Patienten der Primärgruppe eine signifikante Verbesserung durch die Operation erzielen konnten, bei den Patienten der Revisionsgruppe traf dies nicht auf alle Parameter zu. Im Vergleich der Ausgangs- und Outcome-Parameter der Primär- und Revisionsgruppe zeigten sich keine signifikanten Unterschiede. Des Weiteren zeigte sich, dass die Ausgangsparameter Alter bei OP, operativ-versorgte Seite, BMI, Beruf, generelle sportliche Betätigung, verwendete Fadenanker zur Transplantatfixierung an der Patella und Lage der Bohrkanäle in der Patella das Outcome der Operation signifikant beeinflussten.