JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2018 Month : May Volume : 5 Issue : 20 Page : 1562-1565

EVALUATION OF SYMPTOMATIC PATELLAR MALTRACKING AND RESULT FOLLOWING KEYHOLE SURGERY IN A LIMITED RESOURCE SETUP

Santhosh Kumar M. N1

Corresponding Author:
Dr. Santhosh Kumar M. N,
‘Sandeepani, Mudiyurkara,
Gandhinagar P. O., Kottayam, Kerala.
E-mail: drmnskumar@yahoo.co.in
DOI: 10.18410/jebmh/2018/329

ABSTRACT
BACKGROUND
Patellofemoral pain and catching are reported by a good number of patients with anterior knee discomfort attending orthopaedic OPD with varying age group distribution.1 The strata of patients attending Govt. Medical College OPD are from low income and middle income socio-economic groups. The symptoms often prevent them from their regular jobs as well as domestic works in older age groups and from academic activities in student age group. Identification of causes and correction of the cause to the best possible extent within the limited resources of government institutional set up, economic constraints of the patients, could give functionally good results facilitating less symptomatic more comfortable return to work and activities in a limited span of time.
Patellar maltracking was identified clinically and confirmed radiologically in a group of such patients and limited incision key hole surgery, releasing the lateral tight soft tissue gave gratifying results in this section of patients.2,3,4,5 The findings were objectively assessed and compared in the pre-operative and post-operative groups using Oxford Knee Score (OKS). The data showed significant results in the post-operative group, whereby this modality of approach and treatment could be recommended in patients with similar presentation. This achieves significance because of the zero cost, avoids the need of hospital stay, general anaesthetic procedure, costly prosthesis, sophisticated instruments, major operation theatre set up, prolonged morbidity related to surgery, long waiting list, patients’ compliance, need of domestic and workplace modification.

MATERIALS AND METHODS
This study was conducted at Government Medical College, Kottayam, Kerala. Study group included patients attending Orthopaedic OPD with complaints of knee discomfort, catching knee pain, clicks, episodes of subluxation and dislocations with or without minor trauma or strain.6 The age group varied from 16 years to 59 years. Detailed history was taken with emphasis on symptoms, duration, and appearance of symptoms, recurrence and persistence of symptoms, worsening or improvement if any. Reasons for delay in seeking medical advice were also enquired into.

RESULTS
The patellar maltracking is one of the several causes of knee discomfort and pain across various age groups. The maltracking of patella due to lateral soft tissue tightness was identified as the cause of morbidity in this group of patients clinically and radiologically.3,7 The group of patients in the study were all females. Their functional disability was assessed using OKS before surgery. These group of patients underwent the lateral soft tissue release using a mini incision key hole surgical procedure on an OPD basis under local anaesthesia.

CONCLUSION
Patellar maltracking is one of the causes of knee morbidity. Some cases go unnoticed in early life so that they present later with increased symptoms with the development of patellofemoral arthritis. Clinically suspected maltracking which is radiologically confirmed gave good results with mini incision key hole surgery with lateral soft tissue release in all the age groups under the study. The improved function confirmed using OKS, persisted at the end of 6 months, 1 year and 1 ½ years with longest follow up to 5 ½ years.

KEYWORDS
Patellar maltracking, skyline view, oks, mini incision keyhole.