OSTEOCHONDRAL FRACTURE OF THE PATELLA AFTER ACUTE DISLOCATION
Autori:
Damir Matoković, Miroslav Hašpl, Joško Smilović, Nikola Gotovac
Sažetak
Akutna luksacija ivera ozljeda je mladih sportaša i posljedica je nepovoljnih biomehaničkih odnosa, kao i anatomskih odstupanja u području koljenskog zgloba. U tim nepovoljnim okolnostima naglim i snažnim napinjanjem četveroglavog mišića natkoljenice može doći do lateralne luksacije ivera. Prikazali smo slučaj mladog muškarca s akutnom luksacijom ivera te posljedičnim koštano-hrskavičnim prijelomom. Iako je rendgenska slika pokazala uredan nalaz koljena, tipična anamneza, klinički pregled i MR koljena pretrage su kojima se postavlja dijagnoza, a onda je dijagnoza ozljede indikacija za operacijsko ili konzervativno liječenje. Artroskopski je potvrđena dijagnoza, pronađen je koštano-hrskavični ulomak i učvršćen vijcima te tako učinjena rekonstrukcija zglobne površine ivera. Pojačani su medijalni, a opušteni lateralni stabilizatori ivera i uspostavljen je njegov anatomski klizni put. Drugim kirurškim zahvatom učinjen je »second look« te su izvađeni vijci. Pravodobnim operativnim liječenjem, rekonstrukcijom zglobne plohe i provedenom rehabilitacijom postigli smo dobar anatomski i funkcionalni rezultat.
Summary
Acute patellar dislocation is a common injury in young athletes, which occurs due to inappropriate biomechanical relations and anatomic deviations in the area of knee joint. In these unfavorable conditions, abrupt and vigorous strain of the quadriceps muscle of the thigh may result in lateral patellar dislocation. A case is presented of a young male athlete with acute patellar dislocation and consequential osteochondral fracture. Although x-ray showed normal knee finding, typical history, clinical examination and magnetic resonance image of the knee indicated arthroscopy, which confirmed the diagnosis of patellar dislocation. The osteochondral fragment was found and fastened by screws, thus reconstructing the articular surface of the patella. Medial patellar stabilizers were strengthened and lateral stabilizers loosened, thus re-establishing its anatomic slide way. On second-look operation, the screws were removed. In this case, good anatomic and functional outcome was achieved by timely operative treatment, joint surface reconstruction and rehabilitation.
