Интегральный подход к выбору метода хирургического лечения пациентов с пателлофеморальным артрозом (ПФА)

Abstract

Introduction Patellofemoral arthritis (PFA) began to be studied relatively recently. At present, there are no common approaches to the terminology, etiology and pathogenesis, as well as to the tactics of treating this disease. However, orthopediс researchers started to closely investigate the PFA, since its incidence is high in various populations (up to 36 and possibly higher). The main groups of patients are young and middle-aged people. The pathology is an obligatory predictor for development of classical knee osteoarthritis. Particular attention should be paid to the development of an approach to choosing a method of treating the disease. Material and methods A prospective cohort study was conducted, the type of study design was one group study of 88 subjects (48 women and 40 men aged 18–45 years, mean age: 31.5 ± 4 years). The method of surgical treatment was chosen with the help of a computer program developed by the authors, taking into account a number of indicators: 1) relevant clinical manifestations and data of quality of life questionnaires; 2) findings of radiation diagnostic methods and MRI. Postoperative follow-up was 3–6–12 months. Results The integral evaluation of the results obtained was analyzed using clinical cases. Discussion We developed a program for assessing the condition of the knee joint for abnormalities in the patellofemoral articulation. It demonstrated good evaluation results, which were instrumentally confirmed by such precise diagnostic methods as MRI / CT and arthroscopy. The program contains integral information of important criteria, specific for normal biomechanics of the patellofemoral joint: quadriceps angle (Q-angle), patellar type, trochlear dysplasia, Insall-Salvatti index and TT-TG distance. In addition, it uses modern scale system assessment, containing not only subjective, but also objective parameters for evaluating the function of the knee joint.