Diagnosis of post-traumatic arthritis of the patellofemoral joint in patients after patellar osteosynthesis

Introdction: Pathological changes of the patellofemoral joint (PFJ) of traumatic nature occur mainly in non-disabled people of young and middle age groups, leading an active lifestyle, as well as in athletes and military personnel, which has an undeniable social significance.

Posttraumatic arthritis of the patellofemoral joint arising as a result of patellar fracture are quite common. According to some researchers, the incidence of posttraumatic arthritis of the patellofemoral joint varies from 7.1 to 35.9%. The greatest number of fractures of this region falls on its inner part. Recent studies show that stable fixation of bone fragments is achieved through metal osteosynthesis of the patella. Such operations may provoke earlier functional wear of the joint.

Various diagnostic methods such as X-ray radiography and standard CT scanning provide insufficient insight into patellofemoral osteoarthritis. The introduction of dynamic CT will allow a more accurate assessment of anatomical features and biomechanics in the patellofemoral joint, which will improve the results of treatment of patients with this pathology.

Purpose of the study: To improve the diagnosis of posttraumatic arthritis of the patellofemoral joint in patients who underwent osteosynthesis of the patella after its closed fracture by using dynamic CT examination.

Materials and Methods: This study describes the results of 74 (100%) patients, including 41 (55.4%) males and 33 (44.6%) females aged 20 to 70 years(M±s50.7±13.3 years) with a history of patellar fracture with subsequent osteosynthesis, who underwent physical examination, dynamic CT examination of the knee joint between 2000 and 2018. All patients were questioned by VAS scale (10 scores), KOOS scale, assessment of lateral hyperextension and horizontal instability of the of the patella was assessed.

Results: An analysis of the obtained data. VAS scale result (M±s)in all patients was 5.3±2.0. The total score on the KOOS scale (M±s) in all patients amounted to 36,94±3,8. According to the results of dynamic CT examination revealed that 39 (52.7%) patients had signs of lateral facet hypercompression. hypercompression of the lateral facet of the patella (narrowing of the articular gap < 3 mm), at 20 (27%) of patients - instability of the patella (TT-TG index value greater than 15 mm).

Conclusion: According to the data of the study in the period (12.5±5.5) after patellar trauma and osteosynthesis in 48.6% of patients have pathology of the patellofemoral joint is revealed in the form of lateral hypercompression of the patella (52.7%) and patellar instability (27%), which are accompanied by pain (on VAS scale more than 6 points) and knee joint dysfunction (on KOOS scale less than 25 points).

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