الفهرس 
abstractOnly 14 pages are availabe for public view
 |  | from | 118 |  |  |
| | | from | 118 | | |
Abstract
The patello-femoral joint refers to a specific part of the knee joint. It is the joint space between the patella and the distal femur which consists of the medial and lateral condyles with the trochlear grove in between. The patella is attached to the quadriceps tendon at its upper pole and to the patellar tendon at its lower pole which is inserted into the tibial tuberosity.
The centering of the patella in the trochlear groove is related to the strength of the vastus medialis obliqus and the medial patello-femoral ligaments which pull the patella medially while the vastus lateralis and the lateral patello-femoral ligaments pull the knee cap towards the lateral aspect of the knee joint.
When all of these factors are in proper alignment , the patella is centered in the trochlear groove of the femur.
An understanding of the normal function of the patello-femoral joint is essential for any evaluation involving patello-femoral dysfunction , such understanding results from an integration of the anatomy and biomechanics.
Patellar maltracking is a mechanical problem and occurs usually laterally. One must consider , as an aetiological factor , either abnormal tightness of the lateral capsule or abnormal weakness of the medial capsule.
Diagnosis of patellar maltracking starts with taking history of the problem during which specific complaints are identified and the physician attempts to identify any contributing factors to the knee problem. The next step is to start physical examination which includes tracking of the patella , strength of the muscles around the knee cap , tightness of the tissues and ligaments around the knee cap , areas of tenderness in the soft tissues , areas of tenderness on the underside of the patella ,the location of the patella , the prescence of abnormal grinding of the patella as it moves and the liability of the patella to be sublaxed or dislocated.
Standard radiographic evaluation including anteroposterior, lateral and axial views should be obtained in each patient with patello-femoral disorders. CT scan has been widely used to study the patello-femoral joint in the first 20 degrees of flexion where it cannot be investigated using traditional radiographic techniques.
The role of arthroscopy in the evaluation of the patello-femoral joint has been recognized for a long time. It allows direct visualization of both patellar tracking and cartilage abnormalities.
Conservative treatment has been the main stay of therapy for patello-femoral instability. The surgical correction of patello-femoral instability can be proposed when conservative treatment fails.
Generally three categories of operations prevail : proximal realignment , distal realignment and procedures where no alteration in the alignment of the extensor mechanism is contemplated.
Operative morbidity with open procedures may be avoided with an arthroscopic approach that limits violation of the extensor mechanism and reduce postoperative pain and stiffness.
.