Current methods of patellar instability imaging in children. Selection of the best treatment approach

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Abstract

Background. Patellar instability is a common problem in pediatric patients. Up to 2%–3% of all knee injuries are associated with acute patellar dislocation. According to the data in the literature, patients aged 10–17 years are at the highest risk of patellar dislocation and subsequent instability. These patients must be evaluated according to the proposed algorithm to select the optimal treatment method.

Aim. To diagnose patellar instability in children and subsequently select the optimal treatment method based on acquired data.

Materials and methods. The study is based on data acquired through the examination and treatment of 147 patients at the 9th Department of Pediatric Traumatology and Orthopedics. Great emphasis was put on computed tomography (CT) data, its essential parameters, which require the most thorough analysis, and assessment methods. These parameters include patellar tilt, dysplasia of the distal metaepiphysis of the femur, the tibial tubercle–trochlear groove index, and the rotational relation of the femur and tibia.

Results. A novel algorithm for patient examination using CT is proposed. Data obtained by multislice CT (MSCT) had a significant influence on the selection of the surgical method for treating patients with patellar instability.

Conclusion. The examination of patients with patellar instability using MSCT in adherence to the proposed diagnostic algorithm allows the selection of the optimal treatment method, which will increase the likelihood of rapid recovery of patients and their return to the level of activity similar to that before injury.

About the authors

Alexander A. Sautenko

N.N. Priorov Central Institute of Traumatology and Ortopedics

Author for correspondence.
Email: dr.sautenko@yandex.ru
ORCID iD: 0000-0003-1264-7162

MD, PhD Student of the 9th Department of Pediatric Traumatology and Orthopedics

Russian Federation, 10, Priorova str., Moscow, 125299

Egor V. Ogarev

N.N. Priorov Central Institute of Traumatology and Ortopedics

Email: dr.sautenko@yandex.ru

MD, PhD, Radiology Specialist

Russian Federation, 10, Priorova str., Moscow, 125299

Alexander G. Eltsin

N.N. Priorov Central Institute of Traumatology and Ortopedics

Email: dr.sautenko@yandex.ru

MD, PhD, Leading Research Fellow, Pediatric Trauma Surgeon of the 9th Department of Pediatric Traumatology and Orthopedics

Russian Federation, 10, Priorova str., Moscow, 125299

Vladimir N. Merkulov

N.N. Priorov Central Institute of Traumatology and Ortopedics

Email: dr.sautenko@yandex.ru
ORCID iD: 0000-0003-0368-3890

MD, PhD, Professor, Head of the 9th Department of Pediatric Traumatology and Orthopedics

Russian Federation, 10, Priorova str., Moscow, 125299

Dmitry S. Mininkov

N.N. Priorov Central Institute of Traumatology and Ortopedics

Email: dr.sautenko@yandex.ru

MD, PhD, Research Fellow, Pediatric Trauma Surgeon of the 9th Department of Pediatric Traumatology and Orthopedics

Russian Federation, 10, Priorova str., Moscow, 125299

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Supplementary files

Supplementary Files
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2. Fig. 1. Measurement of the TT-TG index

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3. Fig. 2. Measurement of patella tilt

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4. Fig. 3. Measurement of the true antterissia (retroversion) of the femoral neck

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Copyright (c) 2018 Sautenko A.A., Ogarev E.V., Eltsin A.G., Merkulov V.N., Mininkov D.S.

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