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Chondral Disease of the Knee - part 10

Lưỡng cực patellofemoral tươi osteochondral allograft với tổ chức lại xa (Tại thời điểm này, tác giả, cũng như các bác sĩ phẫu thuật khác, những người thực hiện cấy ghép allograft osteochondral, bác sĩ phẫu thuật chỉ định tiên lượng bảo vệ đáng kể cho hoạt động tái tạo bề mặt sinh học | PATHOLOGY Isolated patellofemoral arthritis TREATMENT Bipolar patellofemoral fresh osteochondral allograft with distal realignment At this juncture the author as do other surgeons who perform osteochondral allograft transplantation assigns a significantly guarded prognosis to bipolar biologic resurfacing operations. These surgeons obtain full patient informed consent regarding the guarded prognosis and proceed with surgery only under the auspice that revision to arthroplasty is not knowingly compromised should the allograft fail. SUBMITTED BY Jack Farr MD Cartilage Restoration Center of Indiana Ortholndy Indianapolis Indiana USA CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS This patient is a 37-year-old female nurse who presented with progressive patellofemoral pain of her right knee. She had intermittent pain since a medial arthrotomy was performed 22 years previously to treat a crushed patella she sustained from direct impact. Her pain increases with any increase in activity. She experiences marked pain at the end of an 8-hour nursing shift. She is unable to perform squats or climb stairs. Repeated attempts at rehabilitation failed to reduce her symptoms. hension. Her ligament examination is normal. Meniscal findings are absent. Quadriceps bulk is near normal. RADIOGRAPHIC EVALUATION Posteroanterior 45-degree flexion weightbearing radiographs demonstrate neutral alignment with no joint space narrowing. Merchant views demonstrate patellofemoral arthritis in the right knee with no significant subluxation or tilt Figure C36.1 but there is joint space narrowing at the medial aspect of the patellofemoral articulation. PHYSICAL EXAMINATION SURGICAL INTERVENTION Height 5 ft 5 in. weight 1351b body mass index of 23. She ambulates with an antalgic gait. Limb alignment is neutral. She is unable to step up on a 6-in. step secondary to pain. Range of motion is from 5 to 130 degrees of flexion. Pain and crepitus are limited to the patellofemoral joint. She hastno patellar .