SURGICAL TREATMENT OF PATELLOFEMORAL ARTHROSIS IN WORKING AGE PATIENTS (PRELIMINARY REPORT)

Abstract

Introduction. Choice of treatment tactics for the patellofemoral arthrosis (PFA) is a complex and controversial issue especially in patients under 40 years.Purpose of study: to evaluate the early results of combined surgical interventions in patients with PFA. Patients and methods. Prospective cohort study included 24 patients (14 women and 10 men) aged 18– 45 years (mean age 31.5±4 years). Preoperative roentgenography, MRI, assessment by VAS, OKS and KSS were performed to all patients. The degree of patellofemoral joint disorders was assessed using the elaborated clinical scale that enabled to divide patients into two groups. Group 1 (n=8) with marked changes and group 2 (n=16) with the moderate changes. Corrective plasty of shin extensor mechanism with ventralization of the tibial tubercle by Fulkerson in combination with arthroscopic debridement was performed to all patients. Results. In 6 months after surgery the improvement of anatomic and functional status was observed in all patients. The pain intensity score evaluated according to the VAS scale decreased on the average from 6.6 before surgery to 2.0 at the time of the last follow-up. In the 1st group of patients preoperative and postoperative estimation by VAS made up 6±2 cm and 3±1 cm (p=0.003), by KSS — 55±2 and 61±3 points (p=0.001), by OKS — 22±4 and 32±3 points (p=0.001), respectively.Conclusion. Application of the complex of multidirectional surgical techniques (reconstruction, modelling) enables to achieve good anatomic and functional results.