We prospectively studied the characteristics and early recovery of an unselected population of patients who had acute first-time lateral patellar dislocation. The recovery program used standardized rehabilitation, emphasizing range of motion, muscle strength, and return of function. Patients returned to stressful activities including sports as tolerated when they regained full passive range of motion, had no effusion, and when quadriceps muscle strength was at least 80% compared with the noninjured limb. Seventy-four patients met the enrollment criteria; 37 men and 37 women. The average age was 19.9 years, and preinjury sports participation was similar to that of ligament-injury patients. Four percent of patients (N = 3) had a history of birth complications, 3% (N = 2) had a history of lower extremity problems as an infant or child, and 9% (N = 7) had a family history of patellar dislocation. Radiographs revealed a 50% incidence (N = 37) of patella alta; all patients demonstrated lateral patellar overhang. Patients regained range of motion (mean, 0 degrees to 132 degrees) by 6 weeks. Sports participation remained significantly reduced throughout the first 6 months after injury, with the greatest limitations in kneeling and squatting. At 6 months, 58% of patients (N = 43) noted limitation in strenuous activities. The patients who had acute primary patellar dislocation were young and active. Most injuries occurred during sports, and few patients had abnormal physical features, contradicting any stereotype of an overweight, sedentary, adolescent girl whose patella dislocates with little or no trauma.

Adolescent↗

PubMedDate not supplied

Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption.

Instrumented anterior/posterior laxity measurements were performed on 138 patients evaluated within 2 weeks of injury with their first traumatic knee hemarthrosis. All patients were tested with the MEDmetric Arthrometer model KT-1000 in a knee injury clinic. Seventy-five of the patients had knee arthroscopy. Thirty-three had arthrometer laxity tests under anesthesia. Eighty-seven percent of patients arthroscoped had anterior cruciate ligament (ACL) tears and 41% had meniscus tears. One hundred twenty normal subjects were tested to establish normal anterior laxity values. Three tests were used to evaluate anterior laxity: anterior displacement between a 15 and 20 pound force (compliance index), anterior displacement with a 20 pound force, and anterior displacement with a high manually applied force. Displacement measurements in normal subjects revealed a wide range of normal laxity with a small right knee-left knee difference. For example, the 20 pound anterior displacement range was 3 to 13.5 mm with a right knee-left knee difference (mean +/- SD, 0.8 +/- 0.7 mm). Eighty-eight percent of the normals had a right-left difference of less than 2 mm. In the 53 patients arthroscoped who had complete ACL tears, the anterior laxity measurements performed in the clinic were suggestive or diagnostic of pathologic anterior laxity in 50 patients.

Acute Disease↗

PubMedDate not supplied

Exercise-related knee joint laxity.

Knee injuries are the topic of increasingly sophisticated research because of the importance in professional athletics as well as increasing participation in recreational sports. The role of conditioning and fatigue in these injuries remains controversial. Ligaments have high collagen content, and a viscoelastic response to stress would be expected. Because of the postulated relationship between laxity and knee ligament injuries, an experiment was designed using highly motivated athletes to test the hypothesis that exercise to the point of muscular fatigue may cause laxity of the knee and thereby place athletes at risk for ligamentous injury to the knee when fatigued. An exercise protocol was designed to produce muscle fatigue in the hamstring and quadriceps muscle groups. Knee ligament laxity was tested prior to and subsequent to the exercise protocol. To document muscle fatigue, isokinetic testing of right knee flexion and extension power was used several times during the exercise protocol. A knee arthrometer (KT-1000) was used to quantitatively document ligamentous laxity before and after exercise. The results indicated a significant lengthening in knee joint laxity between preexercise and postexercise in the left knee as measured at 15 and 20 pounds of passive displacement force (P less than 0.05). Maximum manual displacement also demonstrated a significant increase in joint laxity (P = 0.02). The right knee, which had undergone isokinetic testing, demonstrated a similar tendency but without a statistically significant difference before and after exercise. There was no significant preexercise side to side difference, but postexercise measurements demonstrated a left-right difference at 15 pounds, 20 pounds, and maximum manual displacement of statistical significance (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Instrumented testing of functional knee braces.

The ability of seven functional knee braces to control anterior tibial displacement in three severely lax ACL deficient knees using two instrumented testing devices was studied. Some braces were statistically shown to be much better in this regard than others, but not all data obtained was statistically significant. This material should aid one in determining which braces offer the greatest degree of control of anterior tibial displacement in patients with ACL insufficiency.

Analysis of Variance↗

PubMedDate not supplied

Patellofemoral problems after anterior cruciate ligament reconstruction.

UNLABELLED: Between 1982 and 1986, 126 patients who had undergone ACL reconstruction were followed in a prospective manner. One year follow-up statistics were reviewed for the presence of 13 different complications. The most prevalent complications were quadriceps weakness, flexion contracture, and patellofemoral pain. Quadriceps weakness (strength less than 80% of the normal side) was present in 65% of patients and correlated positively with flexion contracture, patellar irritabibilty, and ACL reconstructions using patellar tendon grafts. Flexion contracture of 5 degrees or more was present in 24% of patients and correlated positively with increased age and patellar irritability. Patellofemoral pain was present in 19% of patients and correlated positively with flexion contracture. CLINICAL RELEVANCE: The three most common complications of knee ligament surgery are shown to be strongly interrelated. It is likely that a causal relationship is present in which flexion contracture causes patellofemoral irritability, and that both of these factors, alone or in combination, result in quadriceps weakness. If this theory is correct, then it is crucial that postoperative rehabilitation programs place a major emphasis on the avoidance of flexion contracture.

Adolescent↗

PubMedDate not supplied

Graft impingement after anterior cruciate ligament reconstruction. Presentation as an active extension "thunk".

Twelve of 215 patients with an anterior cruciate ligament reconstruction developed a "thunk," a low-pitched sound, on active extension of the operative knee at an average of 5 months after surgery. In 4 of the patients the thunk resolved without surgical treatment at an average of 4 months after onset (range, 2 to 6). In 3 of the patients an increase in anterior knee laxity was associated with resolution of the thunk. Seven of the patients were treated with arthroscopic examination. Six of the patients had graft impingement on the lateral wall or the roof of the notch with knee extension. The thunk was eliminated with an adequate notchplasty that corrected the impingement. In the other patient the thunk was secondary to fibrosis of the anterior fat pad. One patient with a persistent thunk declined surgery and was lost to followup.

Adolescent↗

PubMedDate not supplied

Fate of the ACL-injured patient. A prospective outcome study.

We followed 292 patients who had sustained an acute traumatic hemarthrosis for a mean of 64 months. The KT-1000 arthrometer measurements within 90 days of injury revealed the injured knee was stable in 56 patients and unstable in 236. Forty-five unstable patients had an ACL reconstruction within 90 days of injury. Surgical procedures performed > 90 days after injury included ligament reconstruction in 46 patients. Factors that correlated with patients who had late surgery for a meniscal tear or an ACL reconstruction (P < 0.05) were preinjury hours of sports participation, arthrometer measurements, and patient age. Follow-up data are presented for the patients divided into four groups: I, early stable, no reconstruction; II, early unstable, no reconstruction; III, early reconstruction; and IV, late reconstruction. No patient changed occupation because of the knee injury. Hours per year of sports participation and levels of sports participation decreased in all groups. Joint arthrosis was documented by radiograph and bone scan. Joint surface injury abnormalities observed at surgery and meniscal surgery showed greater abnormalities by radiograph and bone scan scores (P < 0.05). Reconstructed patients had a higher level of arthrosis by radiograph and bone scan.

Adult↗

PubMedDate not supplied

Instrumented measurement of patellar mobility.

To provide an objective analysis of medial and lateral patellofemoral laxity, we examined 94 uninjured athletic subjects and 22 patients with unilateral lateral patellar dislocation. We developed an instrument to measure the compliance of the medial and lateral patellar restraints. The instrument recorded the force-displacement relationship as the patella was pushed medially and laterally. Subtracting the medial displacement from the lateral displacement at a given force level allowed the tester to assess the peripatellar soft tissue "balance." The results for both the 2.5- and the 5-pound tests were significant. Paired comparisons differentiated the three groups, with significant differences between control and affected (P = 0.0001), control and contralateral (P = 0.0036), and affected and contralateral (P = 0.0157) knees. The mean result of the lateral minus medial displacement test for our sample population of control subjects was -2.1 mm for the 5-pound test. A negative value in this test indicates that medial displacement exceeds lateral displacement. This finding was present in 81% of control subjects. In contrast, the mean result for the patients' affected knees was +3.2 mm for the 5-pound test. Using the value of 0.0 mm as the diagnostic determinant for peripatellar imbalance, we found a test sensitivity of 91% and a specificity of 81%.

Adolescent↗

PubMedDate not supplied

Estrogen-like effects in the vaginal smears of postmenopausal women.

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Rupture of the gravid uterus. Changing patterns in etiology and treatment.

Explore the source record for details and available documents.

Female↗

PubMedDate not supplied

Primary wound closure in chronic osteomyelitis.

The sequelae of chronic osteomyelitis include not only the common clinical and radiographic signs and symptoms unique to it, but also the frequent residual deformity or amputation secondary to surgical intervention. Exacerbations and relapses are common and may occur as a result of trauma or a decrease in the resistance of the patient. Treatment of this condition over the years has been controversial. Some authors (1, 2) advocate treatment with high oral doses of antibiotics over a period of time up to 6 months. Although good results have been obtained with this regimen, other factors must be taken into account before initiation of such therapy such as severity and location of infection, drug allergy, renal and hepatic function, and attainable antibiotic blood levels. However, because of thrombosis of nutrient, marrow, and periosteal blood vessels, along with fibrosis of surrounding soft tissue, there is no guarantee that adequate serum antibiotic levels provide for the minimal inhibitory concentration of the drug in the infected bone. Antibiotic therapy without surgical intervention to improve blood supply cannot cure the disease and may result in an acquired resistance by the organism (3). The most widely accepted treatment today is surgical curetment, sequestrectomy, or resection of the infected osseous tissue with extensive debridement of all sinus tracts and devitalized tissues. Adding to the morbidity of this disease is the excessive scarring produced by inadequate and improper wound closure after surgical intervention. The following is a description of several methods utilized for contaminated wound closure.

Aged↗