[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"disease-index":3,"disease-14":121,"navigation-categories":885,"navigation-categories-en":1003},{"data":4,"meta":117},[5,11,17,23,28,34,40,46,52,58,64,70,76,82,88,94,100,106,111],{"id":6,"attributes":7},4,{"title":8,"title_en":9,"slug_en":10},"Hernie discale lombaire","Lumbar Disc Herniation","lumbar-disc-herniation",{"id":12,"attributes":13},5,{"title":14,"title_en":15,"slug_en":16},"Prothèse totale de hanche ","Total Hip Replacement","total-hip-replacement",{"id":18,"attributes":19},7,{"title":20,"title_en":21,"slug_en":22},"ménisque","Meniscus","meniscus",{"id":24,"attributes":25},8,{"title":26,"title_en":26,"slug_en":27},"Hallux Valgus","hallux-valgus",{"id":29,"attributes":30},16,{"title":31,"title_en":32,"slug_en":33},"Pathologie dégénérative cheville","Degenerative Ankle Disease","degenerative-ankle-disease",{"id":35,"attributes":36},20,{"title":37,"title_en":38,"slug_en":39},"Prothèse épaule","Shoulder Replacement","shoulder-replacement",{"id":41,"attributes":42},19,{"title":43,"title_en":44,"slug_en":45},"Pathologies de la coiffe des rotateurs ","Rotator Cuff Disorders","rotator-cuff-disorders",{"id":47,"attributes":48},18,{"title":49,"title_en":50,"slug_en":51},"Rupture du tendon d'Achille","Achilles Tendon Rupture","achilles-tendon-rupture",{"id":53,"attributes":54},9,{"title":55,"title_en":56,"slug_en":57},"Le névrome de Morton ","Morton's neuroma","morton-s-neuroma",{"id":59,"attributes":60},22,{"title":61,"title_en":62,"slug_en":63},"L’instabilité d’épaule","Shoulder Instability","shoulder-instability",{"id":65,"attributes":66},23,{"title":67,"title_en":68,"slug_en":69},"Capsulite rétractile","Adhesive Capsulitis (Frozen Shoulder)","adhesive-capsulitis-frozen-shoulder",{"id":71,"attributes":72},11,{"title":73,"title_en":74,"slug_en":75},"La Pathologie Ligamentaire","Ligament Pathology","ligament-pathology",{"id":77,"attributes":78},17,{"title":79,"title_en":80,"slug_en":81},"La prothèse totale de genou ","Total Knee Replacement","total-knee-replacement",{"id":83,"attributes":84},24,{"title":85,"title_en":86,"slug_en":87},"Principes de rééducations ","Principles of rehabilitation","principles-of-rehabilitation",{"id":89,"attributes":90},14,{"title":91,"title_en":92,"slug_en":93},"Pathologie de la Rotule","Patellar Disorders","patellar-disorders",{"id":95,"attributes":96},21,{"title":97,"title_en":98,"slug_en":99},"Fracture épaule","Shoulder Fracture","shoulder-fracture",{"id":101,"attributes":102},15,{"title":103,"title_en":104,"slug_en":105},"Pathologie ligamentaire cheville","Ankle Ligament Pathology","ankle-ligament-pathology",{"id":107,"attributes":108},6,{"title":109,"title_en":110,"slug_en":110},"coxarthrose ","coxarthrosis",{"id":112,"attributes":113},10,{"title":114,"title_en":115,"slug_en":116},"Griffes d’orteils et métatarsalgies ","Toe claws and metatarsalgia","toe-claws-and-metatarsalgia",{"pagination":118},{"page":119,"pageSize":120,"pageCount":119,"total":41},1,100,{"data":122,"meta":884},{"id":89,"attributes":123},{"title":91,"content":124,"createdAt":556,"updatedAt":557,"publishedAt":558,"summary":183,"seoTitle":183,"seoDescription":183,"author":183,"reviewedBy":183,"medicalReviewer":183,"medicalReviewedAt":183,"associatedAnatomy":183,"title_en":92,"slug_en":93,"summary_en":183,"seoTitle_en":183,"seoDescription_en":183,"content_en":559,"associatedAnatomy_en":183,"ogImage":871,"pathologie_par_articulation":872,"sources":879,"relatedSurgeries":880,"possibleTreatments":882,"signsOrSymptoms":883},[125,131,136,139,143,147,151,155,159,162,166,172,197,201,205,209,213,216,219,223,227,231,251,255,259,263,266,269,273,276,313,316,335,339,343,346,349,353,356,360,364,367,371,375,393,397,401,405,409,413,416,420,423,427,445,449,452,456,459,463,466,470,474,478,497,501,505,509,513,516,520,523,527,531,534,538,541,545,549,553],{"type":126,"children":127},"paragraph",[128],{"text":129,"type":130},"","text",{"type":126,"children":132},[133],{"bold":134,"text":135,"type":130},true,"De quoi souffrez vous ?",{"type":126,"children":137},[138],{"text":129,"type":130},{"type":126,"children":140},[141],{"text":142,"type":130},"Vous avez :",{"type":126,"children":144},[145],{"text":146,"type":130},"– Mal à votre genou lors de la descente des escaliers .",{"type":126,"children":148},[149],{"text":150,"type":130},"– En position assise prolongée , vous ressentez le besoin d’allonger les jambes",{"type":126,"children":152},[153],{"text":154,"type":130},"– Vous avez la sensation que votre genou se bloque de façon fugace",{"type":126,"children":156},[157],{"text":158,"type":130},"– Vous ne vous sentez pas sûr de votre appui",{"type":126,"children":160},[161],{"text":129,"type":130},{"type":126,"children":163},[164],{"text":165,"type":130},"Vous avez peut être un problème avec votre rotule. On parle alors d’une pathologie de l’articulation fémoro- patellaire ( patella = rotule ).",{"type":167,"level":168,"children":169},"heading",3,[170],{"text":171,"type":130},"Anatomie",{"type":173,"image":174,"children":195},"image",{"ext":175,"url":176,"hash":177,"mime":178,"name":179,"size":180,"width":181,"height":182,"caption":183,"formats":184,"provider":193,"createdAt":194,"updatedAt":194,"previewUrl":183,"alternativeText":179,"provider_metadata":183},".jpg","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule_1_555a48a67a.jpg","rotule_1_555a48a67a","image\u002Fjpeg","rotule 1.jpg",12.39,367,302,null,{"thumbnail":185},{"ext":175,"url":186,"hash":187,"mime":178,"name":188,"path":183,"size":189,"width":190,"height":191,"sizeInBytes":192},"\u002Fuploads\u002Fthumbnail_rotule_1_555a48a67a.jpg","thumbnail_rotule_1_555a48a67a","thumbnail_rotule 1.jpg",4.88,190,156,4883,"local","2024-09-03T13:30:26.574Z",[196],{"text":129,"type":130},{"type":126,"children":198},[199],{"text":200,"type":130},"La rotule est située en avant du genou . Elle coulisse à la partie antérieure du fémur dans un sillon cartilagineux appelée trochlée . Elle est reliée au fémur par le tendon quadricipital qui est la réunion de 4 muscles . Il s’agit du groupe musculaire le plus puissant de l’organisme .",{"type":126,"children":202},[203],{"text":204,"type":130},"La rotule est reliée au tibia par le tendon rotulien .",{"type":126,"children":206},[207],{"text":208,"type":130},"Lors de la flexion du genou , la rotule descend le long de la trochlée .",{"type":126,"children":210},[211],{"text":212,"type":130},"Le centrage de la rotule est fondamental afin que le mouvement se fassent de façon harmonieuse . On peut comparer le fonctionnement à celui d’une poulie . En cas de mauvais centrage de la corde dans la gorge de la poulie , la corde s’échauffe et s’use prématurément.",{"type":126,"children":214},[215],{"text":129,"type":130},{"type":126,"children":217},[218],{"text":129,"type":130},{"type":126,"children":220},[221],{"text":222,"type":130},"On dit souvent que l’articulation de la rotule est le « baromètre » du genou .",{"type":126,"children":224},[225],{"text":226,"type":130},"Tout problème de genou peut se traduire par une douleur rotulienne ou syndrome fémoro-patellaire.",{"type":167,"level":168,"children":228},[229],{"text":230,"type":130},"Imagerie",{"type":173,"image":232,"children":249},{"ext":175,"url":233,"hash":234,"mime":178,"name":235,"size":236,"width":237,"height":238,"caption":183,"formats":239,"provider":193,"createdAt":248,"updatedAt":248,"previewUrl":183,"alternativeText":235,"provider_metadata":183},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule2_8ef636eedb.jpg","rotule2_8ef636eedb","rotule2.jpg",8.21,337,193,{"thumbnail":240},{"ext":175,"url":241,"hash":242,"mime":178,"name":243,"path":183,"size":244,"width":245,"height":246,"sizeInBytes":247},"\u002Fuploads\u002Fthumbnail_rotule2_8ef636eedb.jpg","thumbnail_rotule2_8ef636eedb","thumbnail_rotule2.jpg",5.16,245,140,5159,"2024-09-03T13:30:26.456Z",[250],{"text":129,"type":130},{"type":126,"children":252},[253],{"text":254,"type":130},"L’examen du genou par le médecin et la réalisation de radiographies simples permettent habituellement de faire le diagnostic .",{"type":126,"children":256},[257],{"text":258,"type":130},"Il s’agit d’une radiographie de profil du genou à 30° de flexion qui permet d’apprécier la position de la rotule par rapport à la trochlée et d’apprécier la longueur du tendon rotulien .",{"type":126,"children":260},[261],{"text":262,"type":130},"En effet , plus celui-ci est long , plus la rotule à des chances de mal s’engager dans le sillon . On parle alors de rotule haute .",{"type":126,"children":264},[265],{"text":129,"type":130},{"type":126,"children":267},[268],{"text":129,"type":130},{"type":126,"children":270},[271],{"text":272,"type":130},"L’autre radiographie importante est la réalisation d’une cliché (dit fémoro patellaire) permettant de voir la rotule par le haut . Cela permet d’apprécier la forme de la rotule et son centrage dans le sillon fémoral dont on apprécie la profondeur . Si les berges de la trochlée ne sont pas assez relevés , la rotule peut s’échapper de son rail et se luxer . On parle alors d’une Dysplasie fémoro patellaire .",{"type":126,"children":274},[275],{"text":129,"type":130},{"type":173,"image":277,"children":311},{"ext":278,"url":279,"hash":280,"mime":281,"name":282,"size":283,"width":284,"height":285,"caption":183,"formats":286,"provider":193,"createdAt":310,"updatedAt":310,"previewUrl":183,"alternativeText":282,"provider_metadata":183},".png","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule_10_31f2204c34.png","rotule_10_31f2204c34","image\u002Fpng","rotule 10.png",10.28,886,170,{"small":287,"medium":295,"thumbnail":303},{"ext":278,"url":288,"hash":289,"mime":281,"name":290,"path":183,"size":291,"width":292,"height":293,"sizeInBytes":294},"\u002Fuploads\u002Fsmall_rotule_10_31f2204c34.png","small_rotule_10_31f2204c34","small_rotule 10.png",19.44,500,96,19436,{"ext":278,"url":296,"hash":297,"mime":281,"name":298,"path":183,"size":299,"width":300,"height":301,"sizeInBytes":302},"\u002Fuploads\u002Fmedium_rotule_10_31f2204c34.png","medium_rotule_10_31f2204c34","medium_rotule 10.png",37.05,750,144,37047,{"ext":278,"url":304,"hash":305,"mime":281,"name":306,"path":183,"size":307,"width":245,"height":308,"sizeInBytes":309},"\u002Fuploads\u002Fthumbnail_rotule_10_31f2204c34.png","thumbnail_rotule_10_31f2204c34","thumbnail_rotule 10.png",6.68,47,6675,"2024-09-03T13:57:41.991Z",[312],{"text":129,"type":130},{"type":167,"level":6,"children":314},[315],{"text":230,"type":130},{"type":173,"image":317,"children":333},{"ext":175,"url":318,"hash":319,"mime":178,"name":320,"size":321,"width":322,"height":323,"caption":183,"formats":324,"provider":193,"createdAt":332,"updatedAt":332,"previewUrl":183,"alternativeText":320,"provider_metadata":183},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule5_137b20c0f7.jpg","rotule5_137b20c0f7","rotule5.jpg",6.06,174,176,{"thumbnail":325},{"ext":175,"url":326,"hash":327,"mime":178,"name":328,"path":183,"size":329,"width":330,"height":191,"sizeInBytes":331},"\u002Fuploads\u002Fthumbnail_rotule5_137b20c0f7.jpg","thumbnail_rotule5_137b20c0f7","thumbnail_rotule5.jpg",5.04,154,5039,"2024-09-03T13:30:26.459Z",[334],{"text":129,"type":130},{"type":126,"children":336},[337],{"text":338,"type":130},"Dans le cadre d’un bilan pré opératoire , il est parfois demandé un scanner. Cette examen permet de mesurer l’excentration de l’appareil extenseur du genou .",{"type":126,"children":340},[341],{"text":342,"type":130},"Cette mesure appelée TAGT est nécessaire avant de réaliser un « recentrage » chirurgical de la rotule . On étudie également la bascule de la rotule qui traduit la primauté d’un groupe musculaire sur un autre et qui gêne l’engagement .",{"type":126,"children":344},[345],{"text":129,"type":130},{"type":126,"children":347},[348],{"text":129,"type":130},{"type":126,"children":350},[351],{"text":352,"type":130},"Il est parfois réalisé un arthroscanner avec injection d’un produit de contraste dans l’articulation qui permet de repérer les zones d’usure du cartilage .",{"type":126,"children":354},[355],{"text":129,"type":130},{"type":126,"children":357},[358],{"text":359,"type":130},"Au terme de la consultation on peut distinguer 2 tableaux distincts :",{"type":126,"children":361},[362],{"text":363,"type":130},"– La rotule instable avec épisodes de luxation ou potentiellement instable . Il s’agit d’une rotule douloureuse avec des critères radiologiques d’instabilité , mais ne s’étant jamais « déboitée » .",{"type":126,"children":365},[366],{"text":129,"type":130},{"type":126,"children":368},[369],{"text":370,"type":130},"– Le syndrome douloureux rotulien ou SDR . Il s’agit d’une douleur d’origine rotulienne sans qu’il soit mis en évidence la moindre anomalie au sein de l’articulation. Il s’agit d’un problème de fonctionnement du genou , sans que celui-ci ait la moindre anomalie architecturale . La grande majorité des syndrome rotulien sont des SDR .Il s’agit d’une pathologie extrêmement fréquente chez les adolescents et les jeunes adultes ou elle représente environs 20% des consultations.",{"type":167,"level":168,"children":372},[373],{"text":374,"type":130},"Rééducation",{"type":173,"image":376,"children":391},{"ext":175,"url":377,"hash":378,"mime":178,"name":379,"size":380,"width":323,"height":381,"caption":183,"formats":382,"provider":193,"createdAt":390,"updatedAt":390,"previewUrl":183,"alternativeText":379,"provider_metadata":183},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule6_0409ef813a.jpg","rotule6_0409ef813a","rotule6.jpg",4.12,228,{"thumbnail":383},{"ext":175,"url":384,"hash":385,"mime":178,"name":386,"path":183,"size":387,"width":388,"height":191,"sizeInBytes":389},"\u002Fuploads\u002Fthumbnail_rotule6_0409ef813a.jpg","thumbnail_rotule6_0409ef813a","thumbnail_rotule6.jpg",2.45,120,2450,"2024-09-03T13:30:26.450Z",[392],{"text":129,"type":130},{"type":126,"children":394},[395],{"text":396,"type":130},"La rééducation est le traitement phare de toute douleur rotulienne .",{"type":126,"children":398},[399],{"text":400,"type":130},"Elle se réalise en parallèle avec la réduction des activités physiques et la prise éventuelle d’antalgique et d’anti inflammatoire .",{"type":126,"children":402},[403],{"text":404,"type":130},"Elle doit répondre à 2 objectifs :",{"type":126,"children":406},[407],{"text":408,"type":130},"– Le premier objectif est de lutter contre la rétraction musculaire qui majore l’hyperpression sur la rotule .",{"type":126,"children":410},[411],{"text":412,"type":130},"– Le deuxième est d’optimiser la position de la rotule par rapport à la trochlée pour assurer une course rotulienne la plus ergonomique possible . Elle nécessite d’étirer les structures qui attire la rotule vers l’extérieur de la jambe . On y associe le renforcement du faisceau interne du quadriceps . Cette rééducation doit s’effectuer genou discrètement fléchi et doit absolument être effectué sans poids au bout du pied . En effet , ceci plaque la rotule contre le fémur et risque de majorer les lésions cartilagineuses .",{"type":126,"children":414},[415],{"text":129,"type":130},{"type":126,"children":417},[418],{"text":419,"type":130},"En pratique, on débute après échauffement à des auto étirements Genou en extension , on effectue un étirement des structures postérieures.",{"type":126,"children":421},[422],{"text":129,"type":130},{"type":126,"children":424},[425],{"text":426,"type":130},"Allongé sur le ventre , on s’efforce de poser le talon sur la fesse ; étirement structures postérieures .",{"type":173,"image":428,"children":443},{"ext":175,"url":429,"hash":430,"mime":178,"name":431,"size":432,"width":433,"height":322,"caption":183,"formats":434,"provider":193,"createdAt":442,"updatedAt":442,"previewUrl":183,"alternativeText":431,"provider_metadata":183},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule7_e580ec4371.jpg","rotule7_e580ec4371","rotule7.jpg",8.24,488,{"thumbnail":435},{"ext":175,"url":436,"hash":437,"mime":178,"name":438,"path":183,"size":439,"width":245,"height":440,"sizeInBytes":441},"\u002Fuploads\u002Fthumbnail_rotule7_e580ec4371.jpg","thumbnail_rotule7_e580ec4371","thumbnail_rotule7.jpg",2.93,87,2933,"2024-09-03T13:30:26.481Z",[444],{"text":129,"type":130},{"type":126,"children":446},[447],{"text":448,"type":130},"Chirurgie de recentrage rotulienne",{"type":126,"children":450},[451],{"text":129,"type":130},{"type":126,"children":453},[454],{"text":455,"type":130},"l s’adresse en premier lieu aux rotules instables avec antécédents de luxations . Il sera proposé après échec de la rééducation.",{"type":126,"children":457},[458],{"text":129,"type":130},{"type":126,"children":460},[461],{"text":462,"type":130},"L’intervention associe généralement la réalisation de 3 gestes :",{"type":126,"children":464},[465],{"text":129,"type":130},{"type":126,"children":467},[468],{"text":469,"type":130},"– Premièrement : la section de l’aileron externe structure fibreuse attirant la rotule vers l’extérieur du genou",{"type":126,"children":471},[472],{"text":473,"type":130},"– Deuxièmement : le transfert de la tubérosité tibiale antérieure (TTA ) . Il s’agit du relief osseux sur lequel est inséré le tendon rotulien . Le déplacement de la TTA vers le versant interne de 10 mm permet de recentrer la. On y associe parfois un abaissement lorsque la rotule est trop haute .",{"type":126,"children":475},[476],{"text":477,"type":130},"– Troisièmement : la plastie du vaste interne . On modifie l’angle d’insertion du quadriceps sur la partie haute de la rotule . Ce geste permet de majorer l’attraction de la rotule en interne et de lutter contre sa bascule",{"type":173,"image":479,"children":495},{"ext":175,"url":480,"hash":481,"mime":178,"name":482,"size":483,"width":484,"height":485,"caption":183,"formats":486,"provider":193,"createdAt":494,"updatedAt":494,"previewUrl":183,"alternativeText":482,"provider_metadata":183},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Frotule8_4690674f9c.jpg","rotule8_4690674f9c","rotule8.jpg",10.85,372,282,{"thumbnail":487},{"ext":175,"url":488,"hash":489,"mime":178,"name":490,"path":183,"size":491,"width":492,"height":191,"sizeInBytes":493},"\u002Fuploads\u002Fthumbnail_rotule8_4690674f9c.jpg","thumbnail_rotule8_4690674f9c","thumbnail_rotule8.jpg",4.21,206,4209,"2024-09-03T13:30:26.491Z",[496],{"text":129,"type":130},{"type":126,"children":498},[499],{"text":500,"type":130},"L’intervention nécessite une incision verticale à la partie antérieure du genou et la mise en place généralement de 2 vis pour fixer le fragment osseux .",{"type":126,"children":502},[503],{"text":504,"type":130},"L’hospitalisation est d’environs 2 jours .",{"type":126,"children":506},[507],{"text":508,"type":130},"Le tuyau permettant de prévenir l’hématome du genou est retiré au 2ème jour .",{"type":126,"children":510},[511],{"text":512,"type":130},"L’appui complet est autorisé sous couvert d’une attelle amovible à garder durant 45 jours . La rééducation est débutée immédiatement . Un arrêt de travail de 2 mois est généralement nécessaire .",{"type":126,"children":514},[515],{"text":129,"type":130},{"type":126,"children":517},[518],{"text":519,"type":130},"Bien que les résultats soient généralement bons , il peut exister des motifs d’insatisfactions :",{"type":126,"children":521},[522],{"text":129,"type":130},{"type":126,"children":524},[525],{"text":526,"type":130},"    -Précocement : La survenue d’un hématome nécessite parfois une réintervention . La survenue d’une infection est rare ( inférieur à 0,5%).La fragilisation du tibia et de la TTA nécessite parfois de rééduquer avec précautions le patient . La raideur du genou est prévenue par une rééducation appropriée .",{"type":126,"children":528},[529],{"text":530,"type":130},"    – Secondairement : une luxation récidivante de la rotule a déjà été décrit , d’autant plus que le genou est porteur de plusieurs vices architecturaux . Rarement certains patients se plaignent de la persistance de douleurs rotuliennes . ",{"type":126,"children":532},[533],{"text":129,"type":130},{"type":167,"level":168,"children":535},[536],{"text":537,"type":130},"Traitement arthroscopique des pathologies rotuliennes",{"type":126,"children":539},[540],{"text":129,"type":130},{"type":126,"children":542},[543],{"text":544,"type":130},"L’arthroscopie permet d’effectuer des gestes plus limités que la chirurgie conventionnelle . On l’utilise pour effectuer des sections d’aileron externe isolée .",{"type":126,"children":546},[547],{"text":548,"type":130},"En cas de lésions cartilagineuses de la rotule , on l’utilise parfois pour effectuer le nettoyage de l’articulation .",{"type":126,"children":550},[551],{"text":552,"type":130},"Cette chirurgie se déroule en ambulatoire .",{"type":126,"children":554},[555],{"text":129,"type":130},"2024-09-03T13:54:06.830Z","2024-10-19T13:46:16.462Z","2024-09-03T13:58:23.105Z",[560,563,567,570,574,578,582,586,590,593,597,601,607,611,615,619,623,626,629,633,637,641,647,651,655,659,662,665,669,672,680,683,689,693,697,700,703,707,710,714,718,721,725,729,735,739,743,747,750,754,757,761,764,768,774,778,781,785,788,792,795,799,802,806,812,816,820,824,828,831,835,838,842,846,849,853,856,860,864,868],{"type":126,"children":561},[562],{"text":129,"type":130},{"type":126,"children":564},[565],{"bold":134,"text":566,"type":130},"What are you suffering from?",{"type":126,"children":568},[569],{"text":129,"type":130},{"type":126,"children":571},[572],{"text":573,"type":130},"You have :",{"type":126,"children":575},[576],{"text":577,"type":130},"– Pain in your knee when going down the stairs.",{"type":126,"children":579},[580],{"text":581,"type":130},"– In a prolonged sitting position, you feel the need to extend your legs",{"type":126,"children":583},[584],{"text":585,"type":130},"– You have the feeling that your knee is temporarily locked",{"type":126,"children":587},[588],{"text":589,"type":130},"– You do not feel confident in your support",{"type":126,"children":591},[592],{"text":129,"type":130},{"type":126,"children":594},[595],{"text":596,"type":130},"You may have a problem with your kneecap. We then speak of a pathology of the patellofemoral joint (patella = kneecap).",{"type":167,"level":168,"children":598},[599],{"text":600,"type":130},"Anatomy",{"type":173,"image":602,"children":605},{"ext":175,"url":176,"hash":177,"mime":178,"name":179,"size":180,"width":181,"height":182,"caption":183,"formats":603,"provider":193,"createdAt":194,"updatedAt":194,"previewUrl":183,"alternativeText":179,"provider_metadata":183},{"thumbnail":604},{"ext":175,"url":186,"hash":187,"mime":178,"name":188,"path":183,"size":189,"width":190,"height":191,"sizeInBytes":192},[606],{"text":129,"type":130},{"type":126,"children":608},[609],{"text":610,"type":130},"The patella is located in front of the knee. It slides at the anterior part of the femur in a cartilaginous groove called the trochlea. It is connected to the femur by the quadriceps tendon which is the union of 4 muscles. This is the most powerful muscle group in the body.",{"type":126,"children":612},[613],{"text":614,"type":130},"The patella is connected to the tibia by the patellar tendon.",{"type":126,"children":616},[617],{"text":618,"type":130},"When the knee flexes, the patella descends along the trochlea.",{"type":126,"children":620},[621],{"text":622,"type":130},"Centering the kneecap is essential so that the movement occurs harmoniously. The operation can be compared to that of a pulley. If the rope is poorly centered in the groove of the pulley, the rope will heat up and wear out prematurely.",{"type":126,"children":624},[625],{"text":129,"type":130},{"type":126,"children":627},[628],{"text":129,"type":130},{"type":126,"children":630},[631],{"text":632,"type":130},"It is often said that the patella joint is the “barometer” of the knee.",{"type":126,"children":634},[635],{"text":636,"type":130},"Any knee problem can result in patellar pain or patellofemoral syndrome.",{"type":167,"level":168,"children":638},[639],{"text":640,"type":130},"Imaging",{"type":173,"image":642,"children":645},{"ext":175,"url":233,"hash":234,"mime":178,"name":235,"size":236,"width":237,"height":238,"caption":183,"formats":643,"provider":193,"createdAt":248,"updatedAt":248,"previewUrl":183,"alternativeText":235,"provider_metadata":183},{"thumbnail":644},{"ext":175,"url":241,"hash":242,"mime":178,"name":243,"path":183,"size":244,"width":245,"height":246,"sizeInBytes":247},[646],{"text":129,"type":130},{"type":126,"children":648},[649],{"text":650,"type":130},"Examination of the knee by the doctor and taking simple x-rays usually make it possible to make the diagnosis.",{"type":126,"children":652},[653],{"text":654,"type":130},"This is a profile x-ray of the knee at 30° of flexion which allows us to assess the position of the patella in relation to the trochlea and to assess the length of the patellar tendon.",{"type":126,"children":656},[657],{"text":658,"type":130},"In fact, the longer it is, the more likely the kneecap is to engage poorly in the groove. We then speak of high patella.",{"type":126,"children":660},[661],{"text":129,"type":130},{"type":126,"children":663},[664],{"text":129,"type":130},{"type":126,"children":666},[667],{"text":668,"type":130},"The other important x-ray is taking a photo (called patellofemoral) allowing you to see the patella from above. This allows us to appreciate the shape of the patella and its centering in the femoral groove, the depth of which can be appreciated. If the banks of the trochlea are not raised enough, the patella can escape from its rail and become dislocated. We then speak of patellofemoral dysplasia.",{"type":126,"children":670},[671],{"text":129,"type":130},{"type":173,"image":673,"children":678},{"ext":278,"url":279,"hash":280,"mime":281,"name":282,"size":283,"width":284,"height":285,"caption":183,"formats":674,"provider":193,"createdAt":310,"updatedAt":310,"previewUrl":183,"alternativeText":282,"provider_metadata":183},{"small":675,"medium":676,"thumbnail":677},{"ext":278,"url":288,"hash":289,"mime":281,"name":290,"path":183,"size":291,"width":292,"height":293,"sizeInBytes":294},{"ext":278,"url":296,"hash":297,"mime":281,"name":298,"path":183,"size":299,"width":300,"height":301,"sizeInBytes":302},{"ext":278,"url":304,"hash":305,"mime":281,"name":306,"path":183,"size":307,"width":245,"height":308,"sizeInBytes":309},[679],{"text":129,"type":130},{"type":167,"level":6,"children":681},[682],{"text":640,"type":130},{"type":173,"image":684,"children":687},{"ext":175,"url":318,"hash":319,"mime":178,"name":320,"size":321,"width":322,"height":323,"caption":183,"formats":685,"provider":193,"createdAt":332,"updatedAt":332,"previewUrl":183,"alternativeText":320,"provider_metadata":183},{"thumbnail":686},{"ext":175,"url":326,"hash":327,"mime":178,"name":328,"path":183,"size":329,"width":330,"height":191,"sizeInBytes":331},[688],{"text":129,"type":130},{"type":126,"children":690},[691],{"text":692,"type":130},"As part of a pre-operative assessment, a CT scan is sometimes requested. This examination makes it possible to measure the eccentricity of the knee extensor system.",{"type":126,"children":694},[695],{"text":696,"type":130},"This measure, called TAGT, is necessary before performing surgical “recentering” of the patella. We also study the tilt of the patella which reflects the primacy of one muscle group over another and which hinders engagement.",{"type":126,"children":698},[699],{"text":129,"type":130},{"type":126,"children":701},[702],{"text":129,"type":130},{"type":126,"children":704},[705],{"text":706,"type":130},"An arthroscopy is sometimes carried out with the injection of a contrast product into the joint which makes it possible to identify areas of cartilage wear.",{"type":126,"children":708},[709],{"text":129,"type":130},{"type":126,"children":711},[712],{"text":713,"type":130},"At the end of the consultation we can distinguish 2 distinct tables:",{"type":126,"children":715},[716],{"text":717,"type":130},"– The unstable patella with episodes of dislocation or potentially unstable. This is a painful kneecap with radiological criteria of instability, but having never “dislocated”.",{"type":126,"children":719},[720],{"text":129,"type":130},{"type":126,"children":722},[723],{"text":724,"type":130},"– Patellar pain syndrome or RDS. This is pain of patellar origin without any evidence of the slightest abnormality within the joint. This is a problem with the functioning of the knee, without it having the slightest architectural anomaly. The vast majority of patellar syndromes are RDS. This is an extremely common pathology among adolescents and young adults where it represents around 20% of consultations.",{"type":167,"level":168,"children":726},[727],{"text":728,"type":130},"Rehabilitation",{"type":173,"image":730,"children":733},{"ext":175,"url":377,"hash":378,"mime":178,"name":379,"size":380,"width":323,"height":381,"caption":183,"formats":731,"provider":193,"createdAt":390,"updatedAt":390,"previewUrl":183,"alternativeText":379,"provider_metadata":183},{"thumbnail":732},{"ext":175,"url":384,"hash":385,"mime":178,"name":386,"path":183,"size":387,"width":388,"height":191,"sizeInBytes":389},[734],{"text":129,"type":130},{"type":126,"children":736},[737],{"text":738,"type":130},"Rehabilitation is the main treatment for all patellar pain.",{"type":126,"children":740},[741],{"text":742,"type":130},"It is carried out in parallel with the reduction of physical activities and the possible taking of painkillers and anti-inflammatory drugs.",{"type":126,"children":744},[745],{"text":746,"type":130},"It must meet 2 objectives:",{"type":126,"children":748},[749],{"text":408,"type":130},{"type":126,"children":751},[752],{"text":753,"type":130},"– The second is to optimize the position of the patella in relation to the trochlea to ensure the most ergonomic patellar stroke possible. It requires stretching the structures that pull the kneecap toward the outside of the leg. This is associated with strengthening the internal bundle of the quadriceps. This rehabilitation must be carried out with the knee discreetly flexed and must absolutely be carried out without weight on the tip of the foot. In fact, this presses the patella against the femur and risks increasing cartilage damage.",{"type":126,"children":755},[756],{"text":129,"type":130},{"type":126,"children":758},[759],{"text":760,"type":130},"In practice, after warming up, we begin with self-stretching Knee in extension, we perform a stretching of the posterior structures.",{"type":126,"children":762},[763],{"text":129,"type":130},{"type":126,"children":765},[766],{"text":767,"type":130},"Lying on your stomach, you try to place your heel on your buttock; stretching posterior structures.",{"type":173,"image":769,"children":772},{"ext":175,"url":429,"hash":430,"mime":178,"name":431,"size":432,"width":433,"height":322,"caption":183,"formats":770,"provider":193,"createdAt":442,"updatedAt":442,"previewUrl":183,"alternativeText":431,"provider_metadata":183},{"thumbnail":771},{"ext":175,"url":436,"hash":437,"mime":178,"name":438,"path":183,"size":439,"width":245,"height":440,"sizeInBytes":441},[773],{"text":129,"type":130},{"type":126,"children":775},[776],{"text":777,"type":130},"Patellar recentering surgery",{"type":126,"children":779},[780],{"text":129,"type":130},{"type":126,"children":782},[783],{"text":784,"type":130},"It is primarily aimed at unstable kneecaps with a history of dislocation. It will be offered after failure of rehabilitation.",{"type":126,"children":786},[787],{"text":129,"type":130},{"type":126,"children":789},[790],{"text":791,"type":130},"The intervention generally combines the performance of 3 actions:",{"type":126,"children":793},[794],{"text":129,"type":130},{"type":126,"children":796},[797],{"text":798,"type":130},"– First: the section of the external fin fibrous structure attracting the patella towards the outside of the knee",{"type":126,"children":800},[801],{"text":473,"type":130},{"type":126,"children":803},[804],{"text":805,"type":130},"– Third: plasty of the vastus medialis. We modify the angle of insertion of the quadriceps on the upper part of the patella. This gesture makes it possible to increase the attraction of the patella internally and to fight against its tilt",{"type":173,"image":807,"children":810},{"ext":175,"url":480,"hash":481,"mime":178,"name":482,"size":483,"width":484,"height":485,"caption":183,"formats":808,"provider":193,"createdAt":494,"updatedAt":494,"previewUrl":183,"alternativeText":482,"provider_metadata":183},{"thumbnail":809},{"ext":175,"url":488,"hash":489,"mime":178,"name":490,"path":183,"size":491,"width":492,"height":191,"sizeInBytes":493},[811],{"text":129,"type":130},{"type":126,"children":813},[814],{"text":815,"type":130},"The procedure requires a vertical incision in the anterior part of the knee and the installation generally of 2 screws to fix the bone fragment.",{"type":126,"children":817},[818],{"text":819,"type":130},"Hospitalization is approximately 2 days.",{"type":126,"children":821},[822],{"text":823,"type":130},"The tube to prevent knee hematoma is removed on the 2nd day.",{"type":126,"children":825},[826],{"text":827,"type":130},"Full support is authorized under the cover of a removable splint to be kept for 45 days. Rehabilitation began immediately. A 2-month work stoppage is generally necessary.",{"type":126,"children":829},[830],{"text":129,"type":130},{"type":126,"children":832},[833],{"text":834,"type":130},"Although the results are generally good, there may be reasons for dissatisfaction:",{"type":126,"children":836},[837],{"text":129,"type":130},{"type":126,"children":839},[840],{"text":841,"type":130},"-Early: The occurrence of a hematoma sometimes requires reoperation. The occurrence of an infection is rare (less than 0.5%). The weakening of the tibia and the TTA sometimes requires careful re-education of the patient. Knee stiffness is prevented by appropriate rehabilitation.",{"type":126,"children":843},[844],{"text":845,"type":130},"– Secondarily: a recurrent dislocation of the patella has already been described, especially since the knee carries several architectural defects. Rarely, some patients complain of persistent patellar pain.",{"type":126,"children":847},[848],{"text":129,"type":130},{"type":167,"level":168,"children":850},[851],{"text":852,"type":130},"Arthroscopic treatment of patellar pathologies",{"type":126,"children":854},[855],{"text":129,"type":130},{"type":126,"children":857},[858],{"text":859,"type":130},"Arthroscopy allows more limited procedures to be performed than conventional surgery. It is used to make isolated external fin sections.",{"type":126,"children":861},[862],{"text":863,"type":130},"In the event of cartilage damage to the patella, it is sometimes used to clean the joint.",{"type":126,"children":865},[866],{"text":867,"type":130},"This surgery takes place on an outpatient basis.",{"type":126,"children":869},[870],{"text":129,"type":130},{"data":183},{"data":873},{"id":95,"attributes":874},{"createdAt":875,"updatedAt":876,"publishedAt":877,"name":878},"2024-09-03T13:59:17.058Z","2024-09-03T14:00:10.311Z","2024-09-03T14:00:10.309Z","Pathologie de la rotule",[],{"data":881},[],[],[],{},[886,904,923,936,956,989],{"id":112,"name":887,"pathologie_par_articulation":888,"texte_articles_pathologie":-1},"Ankle",[889,894,898],{"id":59,"name":890,"texte_articles_pathologie":891},"Pathologie dégénérative de cheville 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