Abstrakt
Osgood-Schlatter disease is a traction-induced inflammation of the patellar tendon and adjacent cartilage of the tibial tubercle growth plate. X-ray usually shows fragmentary ossification of the tibial tubercle.
The treatment is conservative in most cases. Variations of surgical treatment include drilling or excision of the tibial tubercle, longitudinal incision in the patellar tendon, insertion of bone pegs, and/or a combination of any of these procedures.
Sinding-Larsen-Johansson syndrome/disease is an overuse traction apophysitis of the distal pole of the patella. The most common clinical symptoms include pain over the inferior pole of patella precipitated by overstraining.
Initial treatment consists of cryotherapy, stretching and strengthening exercises, and modification of activities. Surgical treatment is considered rarely in skeletally immature patients.
Congenital dislocation of the patella is an uncommon condition that can have various clinical presentations. It is often associated with genetic syndromes of increased joint and connective tissue laxity.
The most common clinical features are genu valgum, flexion contracture, and external rotation of the tibia with a hypoplastic patella. Treatment usually involves early surgical reconstruction, reducing the dislocation and realigning the quadriceps mechanism.
Developmental dislocation of the patella usually manifests when the child begins to walk, because of knee instability. In this form the patella is located stably in the femoral groove when the knee is flexed but tends to drift laterally as the knee extends.
Surgical treatment usually involves lateral retinacular release in combination with medial advancements and/or distal realignments, where indicated. Acute dislocation of the patella is usually related to anatomic features such as shallow femoral groove, valgus and rotational knee mal-alignment, or ligamentous laxity.
Most acute patellar dislocations involve trauma and are reduced spontaneously. Indications for acute surgery in skeletally immature patients involve associated osteochondral fracture from the lateral femoral condyle or patellar surface.
Recurrent dislocation of the patella usually occurs in patients with a history of acute dislocation and is usually based on underlying dysplasia. The first-line treatment in skeletally immature patients is conservative focusing on relieving symptoms by reduction of activities, use of NSAIDs, and a structured physiotherapy program.
Surgical treatment is usually considered only after an unsuccessful prolonged rehabilitation program. Patella sleeve fracture is an uncommon injury unique to skeletally immature patients.
X-ray or CT/MRI diagnosis and recognition of this pathology is very important, as part of the articular surface of the patella is usually displaced with the fragment. Open reduction and internal fixation of the fragment is required in most cases.
Transverse fracture of the patella is relatively uncommon in children with open physis. The clinical presentation, diagnosis, and treatment do not differ from those in adults.