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Patient specific surgery planning for treatment of patellofemoral instability

Struijs, E.M. (2018) Patient specific surgery planning for treatment of patellofemoral instability.

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Abstract:Purpose: Patellofemoral instability is one of the most frequent types of knee complaints in adolescents and young adults. Recurrent patellar instability has many causes. The most common cause is a malposition of the tibial tubercle, which is the insertion point of the patellar tendon on the tibia. Surgery can be performed to position the tibial tubercle more distally and/or medially, a tibial tubercle transfer. The current tibial tubercle transfer is performed free-hand, which may be sub-optimal, as the result of the surgery depends on the experience of the operating surgeon. With this free-hand surgery it is difficult to accurately replicate the pre-operative planned tibial tubercle transfer position. In other types of surgeries, patient-specific cutting blocks are used to improve the cut accuracy. The main question of this thesis is: How to implement patient-specific cutting blocks into a tibial tubercle transfer surgery, for patients treated for patellofemoral instability? Materials and methods: To test with patient-specific cutting blocks, two cadaver and ten sawbone experiments will be performed. For each experiment a pre-operative CT scan will be made, which will be used to design patient-specific cutting blocks. To analyze the outcomes of the cutting blocks a post-operative CT scan will be made. Results: The first cadaver study showed that it was possible to develop patient-specific cutting blocks for a tibial tubercle transfer. The second cadaver study showed that it was also possible to develop cutting blocks for another cutting approach. Within the ten sawbone experiments different cutting approaches were used. Based on the sawbone experiments it is not yet possible to determine a perfect cutting block design. Conclusion: Within this study we made a lot of progress to implement patient-specific cutting blocks in tibial tubercle transfer surgeries. However it is not yet possible to implement those blocks in the patient treatment. More research is needed to optimize the current design and approaches.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/74633
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