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Biomedical subjects

J C Hughston

Publications and source records attributed to J C Hughston.

At least 19 recordsLinked to original sources
PubMed1995

Complications of extensor mechanism surgery for patellar malalignment.

This review focuses on the complications of extensor mechanism surgery for symptomatic patellar malalignment and ways to avoid those complications. We combined a review of new and referred patients who had complications resulting from extensor mechanism surgery with a review of selected literature specifically addressing similar complications. By studying the pathologic anatomy at the time of arthrotomy, it was possible in many cases to determine the causes of adverse outcomes with this type of surgery. The complications of extensor mechanism surgery can be avoided by performing a thorough preoperative evaluation, determining each component of the malalignment, tailoring the procedure to correct each patient's unique pathomechanics, and respecting the functional anatomy of the extensor mechanism.

Diagnostic Errors↗
PubMed1991

Popliteal cyst: a surgical approach.

Twenty-nine adult patients (30 knees) who failed conservative treatment had surgical excision of a non-rheumatoid cyst. To determine the effectiveness of this surgical procedure, we reviewed the cases of 24 patients (25 knees) who were available for subjective and objective follow up. Twenty of the 25 knees (80%) were rated excellent or good. Three knees had fair results. Two knees continued to have problems and ultimately underwent total knee replacement for degenerative arthritis.

Adolescent↗
PubMed1989

Patellar subluxation. A recent history.

For 15 years (1955 to 1970), I was plowing "new ground" pretty much by myself. When you plow behind an old mule and hit a stump hole full of cottonmouth moccasins, you have to get on the move in a hurry and figure out some solution to the predicament or you won't get your corn planted. So, I was not treating the overweight, knock-kneed, loose-jointed, teenaged girl, but the young boy or girl who thought that he or she was an athlete and had dreams of being a star. If rehabilitation did not work, then I thought a lateral release, an Elmslie, and nothing short of a full reconstruction would solve the problem. One had to develop as much vastus medialis obliquus power as this dysplastic muscle could generate, had to transfer the strong vastus lateralis to a more central pull, and, with the distal reconstruction, correct any patella alta and Q-angle abnormality. One had to give the knee every possible advantage in order to serve an athlete. As Hippocrates so wisely noted, one needed to study the athlete to know, with appropriate modifications, what is best for every patient, young or old. In the late 1960s and early 1970s, many fine young orthopedists were stimulated by the information of the AAOS postgraduate courses in sports medicine. They, after having gained further through their own experiences, have become the major contributors to our increasing knowledge of the patellofemoral joint, especially in athletes, and many of these fine "young" (now a little older) orthopedists are now the contributors to this issue. They are giving you their experiences, knowledge, and lessons. A close and repeated study of their information must be combined with compassion for your patient. Then, only experience will develop the desired fine tuning.

Humans↗
PubMed1989

Roentgenographic findings in pigmented villonodular synovitis of the knee.

Twenty-nine cases of pigmented villonodular synovitis (PVS) of the knee in 27 patients were reviewed to determine characteristic roentgenographic findings. All cases met strict histologic criteria for diagnosis. Four cases were localized PVS (LPVS), and 25 cases were diffuse PVS (DPVS). Roentgenographic findings were largely in the soft tissues. Cystic invasion of bone or degenerative changes were rare, although present in some cases. When present in DPVS, these changes were most pronounced in the patellofemoral articular surface. In the cases of DPVS, large posterior tumefactions did not correlate with extraarticular extension. Clinical behavior of PVS was governed more by anatomic site and form of disease than by the severity of histologic or roentgenographic findings.

Adolescent↗
PubMed1988

Miyakawa patellectomy.

A Miyakawa patellectomy was done in seventeen patients (twenty knees) for either osteoarthritis or chondromalacia of the patella, or both, secondary to malfunction of the extensor mechanism. Patients who had had a patellar fracture were not included in the series. The Miyakawa patellectomy realigns the extensor mechanism, with the proper tension, and centers the functional pull of the quadriceps tendon and patellar ligament. A superficial strip of the quadriceps tendon is pulled distally to fill the void that was left by removal of the patella and to maintain proper length. The musculotendinous portions of the vastus lateralis and vastus medialis are advanced over this defect in the midline and are sutured to the quadriceps tendon. The average length of follow-up was 13.8 years (range, 3.6 to 31.7 years). Nineteen of the twenty knees had a good or excellent subjective result and eighteen had a good or excellent objective result. No subsequent surgical treatment was needed for problems that were caused by malfunction of the extensor mechanism of the knee.

Adult↗
PubMed1985

Associated joint pathology in the anterior cruciate ligament-deficient knee with emphasis on a classification system and injuries to the meniscocapsular ligament-musculotendinous unit complex.

This article defines the anterior cruciate ligament-deficient knee in terms of capsular instabilities. This definition lends itself to a better assessment of the associated pathology consisting of torn capsular ligaments, torn medial and lateral menisci, chondral fractures, subluxation of the patella, and acute contusion of the peroneal nerve. The specific incidence of torn medial meniscus was 70 per cent, with a torn lateral meniscus identified 77 per cent of the time.

Humans↗
PubMed1985

Chronic posterolateral rotatory instability of the knee.

Posterolateral rotatory instability of the knee, usually accompanied by other instabilities, is easily missed, misdiagnosed, and mistreated. The correct diagnosis requires a complete examination of the knee, including both the external rotation-recurvatum and posterolateral drawer tests. The most effective operative approach when the lesion is interstitial or at the site of the femoral attachment consists of advancing the arcuate ligament complex and its osseous attachment anteriorly and distally on the femur to support the arcuate ligament repair. When the lesion is distal and the arcuate ligament attachment to the tibia and fibula is loose, this area must be stabilized. In a consecutive series of 140 patients, 141 knees were reconstructed with this procedure. Ninety-five patients (ninety-six knees), with a follow-up of two to thirteen years, form the basis for this report. Seventy-one of the patients had undergone a combined total of 112 prior operations on the knee without functional recovery. After surgery directed at the arcuate ligament complex, eighty-two knees (85 per cent) were objectively rated as good; thirteen (14 per cent), as fair; and one, as poor. Subjectively, seventy-five (78 per cent) of the patients considered the result to be good; twenty-one (22 per cent), fair; and none, poor. Functionally, seventy-seven (80 per cent) of the knees were rated by the patient as good; sixteen (16 per cent), as fair; and three (4 per cent), as poor. This is the first report on the long-term results of reconstruction of the arcuate ligament complex for the correction of chronic posterolateral rotatory instability. The results demonstrate the effectiveness of the procedure.

Adolescent↗
PubMed1985

Complications of anterior cruciate ligament surgery.

In summation, the solution to many complications of anterior cruciate ligament surgery seems to be increasing the surgeon's knowledge of its complex anatomy and surgical techniques. Once the surgeon has learned firsthand the details of a relatively successful procedure, he can perform it on anatomic specimens for finesse. All he needs then is appropriate instrumentation and a postoperative protocol for rehabilitation under his direct supervision. Although not necessarily experienced, at that point he should be prepared to perform anterior cruciate ligament reconstructions without too many complications. With careful attention to detail and cumulative experience, he may modify his procedures for his own advantage, for that of the patient, and for the larger orthopedic community.

Ankylosis↗
PubMed1984

Osteochondritis dissecans of the femoral condyles.

Because the results of treatment of osteochondritis dissecans of the femoral condyles are still not consistently satisfactory, we reviewed the cases of eighty-three patients (ninety-five knees) with osteochondritis dissecans who were followed for two to thirty-one years to identify factors that may influence treatment and long-term prognosis. Of the eighty-three patients, sixteen had only non-surgical treatment, sixty-five had only surgical treatment, and two had non-surgical treatment of one knee and surgical treatment of the other. Of the twenty-two knees (eighteen patients) that were treated non-surgically, fifteen were treated before and seven were treated after distal femoral epiphyseal closure. Of the seventy-three knees (in sixty-seven patients) that were treated surgically because of persisting symptoms, twenty-three were treated before epiphyseal closure and fifty, after closure. At follow-up, each knee was given a rating of excellent, good, fair, poor, or failure, and a corresponding point score. Seventy-seven per cent of the knees in the surgical group and 82 per cent of those in the conservatively treated group were rated either excellent or good. The average scores in both groups were higher in knees in which the osteochondritic defect was small and was treated before epiphyseal closure, and in knees in which the fragment healed as compared with the ones from which the fragment was removed. We found that knees with osteochondritis dissecans of the femoral condyles that had no other abnormal physical findings or functional disability responded well to conservative treatment before epiphyseal closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Acute posterolateral rotatory instability of the knee.

We reviewed the clinical records and operative notes of seventeen consecutive patients who were treated by surgical repair for acute posterolateral rotatory instability in order to determine the diagnostic features of the instability and the effectiveness of our surgical repair in thirteen patients who returned for objective and subjective evaluation after a mean follow-up of 53.3 months. Sixteen of the seventeen knees had a positive external-rotation recurvatum test; fifteen, a positive adduction-stress test at 30 degrees of knee flexion; and twelve, a positive posterolateral-drawer test. Associated rotatory instabilities were found in ten of the seventeen knees, with anterolateral rotatory instability being the most frequent. Two patients had associated peroneal-nerve palsy. One or more components of the arcuate ligament complex were injured in all seventeen knees. None of the thirteen patients who were followed required subsequent reconstruction for any chronic instability. Of these thirteen, the results in 85 per cent were rated good subjectively and in 77 per cent, good objectively. Eighty-five per cent of these patients had returned to athletic activity at their preinjury level; the remaining 15 per cent did not participate in sports activities. A positive posterolateral-drawer test or external rotation recurvatum test, or both, was diagnostic of posterolateral rotatory instability. The adduction stress test at 30 degrees of knee flexion was usually positive, but was not diagnostic. Accurate diagnosis and treatment of posterolateral rotatory instability in the acute stage can result in subjectively and objectively acceptable knee function.

Adolescent↗
PubMed1982

The knee in sports.

Explore the source record for details and available documents.

Athletic Injuries↗
PubMed1980

Knee surgery: a philosophy.

Functional disability should be proven before surgery is performed. If the knee demonstrates disability and simultaneously demonstrates muscle atonia and atrophy or contracture and imbalance, this dynamic support of the knee should be corrected preoperatively as far as possible and then the disability reevaluated before proceeding with surgery. A complete, documented knee examination must precede ancillary diagnostic procedures. Too often I see patients still in trouble with knees previously operated upon, who relate they had a cursory knee examination or no knee examination and were told that now there are modern diagnostic procedures such as arthrography and arthroscopy so they can be admitted to the hospital for these procedures with a resultant accurate diagnosis. This concept is not true! No ancillary procedure supercedes a knowledgeable history and clinical examination. The surgeon should operate only on the basis of objective demonstration of the need for operation, not on the basis of the history alone. In my estimation, rehabilitation accounts for 50 percent of a successful result following injury or operation. Remember, anatomy is the key to the knee.

Cartilage, Articular↗
PubMed1980

Acute tears of the posterior cruciate ligament. Results of operative treatment.

The posterior cruciate ligament, situated near the center of the knee, functions as the basic stabilizer and is located close to the axis of motion. We diagnosed and repaired thirty-two consecutive acute tears of the posterior cruciate ligament associated with tears of medial or lateral-compartment ligaments, or of both. Of the twenty-nine knees that we could evaluate, twenty-three demonstrated a 2+ to 3+ positive abduction or adduction stress test done in maximum extension and a positive anterior drawer test done in maximum internal rotation, while only nine had a definitely positive posterior drawer test. In all knees we repaired the tears, using the medial meniscus as a graft in nine knees in which the repair of the posterior cruciate ligament did not produce immediate adequate stability at operation. Five to sixteen years after operation, twenty of these twenty-nine knees were available for evaluation. The objective results were good in thirteen, fair in four, and poor in three.

Adolescent↗