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Abstract: A middle-aged patient had degenerative changes in the patellofemoral joint resulting in patellofemoral cartilage damage, which resulted in patellar maltracking and affected motor function to some extent. The arthroscopic surgery was performed to release the lateral patellar support band, and postoperative rehabilitation exercises were used to restore the stability of the patellofemoral joint.
Basic information】Male, 50 years old
Disease Type】Arthrosis
Hospital】Harbin First Hospital
Date of consultation】August 2021
Treatment plan】Surgery (arthroscopic minimally invasive surgery) + brace fixation + rehabilitation exercises (quadriceps strength training)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] Pain relief, basic recovery of knee movement
I. Initial consultation
The patient was 50 years old and came to the clinic with knee pain and limited movement. He reported that his symptoms were severe when walking up and down stairs, but slightly reduced when walking on a flat road. On axial patellar radiographs, a lateral tilt of the patella was found, resulting in poor patellofemoral joint alignment, which was diagnosed as arthrosis. Since conservative treatment could not correct the malposition of the patella and the recurrent discomfort caused by arthrosis, the patient was recommended to undergo surgery.
II. Treatment history
The patient’s knee joint was painful, affecting normal life and sports, and conservative treatments such as local heat application were not effective, so the patient was advised to choose arthroscopic surgery. During the surgery, it was found that the patellofemoral joint had lost its normal alignment, the patella was obviously tilted outward, the patellar cartilage had degenerative changes, and the lateral patellar support band was tense. Through arthroscopic clearance and release of the lateral support band, the patellar valgus was corrected. Postoperative brace fixation and rehabilitation exercises were given to enhance patellofemoral stability and restore patellofemoral joint alignment, while strengthening quadriceps strength training to correct leg muscle atrophy and gradually restore motor ability. The patient was discharged at 7 days of hospitalization and was followed up in the outpatient clinic for 1 month.
III. Treatment effect
Through the minimally invasive arthroscopic surgery, the patellofemoral cartilage was protected from excessive patellar cartilage wear, thus improving the patient’s knee joint pain and restricted movement, and increasing joint flexibility. The post-operative review confirmed that the patient’s symptoms were significantly reduced when squatting or walking up and down stairs, and he could basically resume normal life, and could participate in light exercise, such as jogging and swimming, etc. The joint stability and muscle strength of the lower limbs gradually improved.
IV. Notes
We are glad that the patient is in remission after the minimally invasive arthroscopic surgery and the undamaged articular cartilage is preserved, but the joint function will still be affected to some extent and the patient cannot complete competitive sports such as basketball and soccer, etc. Light to moderate sports can be completed. Therefore, patients need to pay attention to control the intensity of sports in daily life and warm up sufficiently before exercising to avoid sports injuries due to arthrosis. Swelling and pain symptoms after arthroplasty usually last for 2-3 months, and if they continue to worsen, they need to promptly follow up to confirm the cause. Patients should always adhere to the strength training of the medial head muscles of the quadriceps, such as using static squatting exercises, while controlling body weight to reduce pressure on the patellofemoral joint, which is essential to protect the patellofemoral cartilage.
V. Personal insight
The occurrence of patellofemoral arthropathy in patients is related to ageing, degenerative changes in articular cartilage such as insufficient blood flow and cartilage nutrient metabolism. The patient’s patella is tilted to the lateral side, resulting in excessive wear of the patellofemoral cartilage and patellofemoral joint symptoms, and after active treatment, although the symptoms are relieved, attention still needs to be paid to protecting the patellofemoral joint. Muscle strength exercises are more commonly used to increase athletic ability as well as improve joint stability. In addition, the knee patellofemoral joint pressure is significantly increased when going up and down stairs, so reducing the frequency of going up and down stairs is also important to protect the patellofemoral joint.