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PubMedDate not supplied

Congenital dislocation of the knees associated with a partial chromosome I deletion.

Congenital dislocation of the knee is a rare disorder that has been reported previously in association with neuromuscular disorders and ligamentous laxity syndromes and is related to mechanical factors. Concurrent chromosomal abnormalities have not been reported previously with congenitally dislocated knees. The authors present a case of congenitally dislocated knees in a patient with an extremely rare and only recently described partial deletion of chromosome I. There have been three previously reported cases of this particular chromosomal deletion, none of which included dislocated joints.

Abnormalities, Multiple↗
PubMedDate not supplied

[Traumatic vasculo-orthopedic combined lesions: 18-years retrospective evaluation of epidemiology and risks factors for amputation].

This study was undertaken to assess retrospectively the epidemiology and risk factors for amputation of combined vasculo-orthopaedic traumatic lesions, during a 18-year period, from March 1987 to May 2005, comprising the review of the clinical charts of 149 patients. The series includes a predominance of male patients (84%) with an average age of 34 years. Eighty-five per cent of the lesions resulted from traffic accidents (49% velocipedes, 39% automobiles, 12% trampling), 10% were consequence of falls and 5% resulted from agriculture activities. Orthopaedic lesions include 83 fractures of upper limbs (22 open), 123 of lower limbs (67 open), 21 scapulo-thoracic dissociations and 27 knee dislocations. Vascular lesions include 8 subclavian, 20 axillary, 25 braquial, 10 radial, 6 ulnar and 2 diverse, in the upper limbs; and in lower limbs 4 iliac, 27 femoral, 52 popliteal, 5 tibio-peroneal trunk, 5 anterior tibial, 12 posterior tibial and 12 peroneal. Overall mortality was 3.3% and the amputation rate was 17%. Knee dislocations were responsible for one third of amputations, followed by fractures of bone legs. The association of femur to bone legs fractures from one side and of the knee to bone legs fractures from the other, coursed with high levels of amputation, together with lacerations and crushing of the limbs. The prompt diagnosis of the lesions and the immediate, hierarchic and multidisciplinary approach were considered also as relevant prognostic factors in the management of these most demanding conditions.

Adult↗
PubMed1990

Role of routine arteriography in blunt lower-extremity trauma.

During an 18-month period, 53 patients with unilateral blunt lower-extremity trauma were entered into a prospective study designed to determine how often clinically occult arterial injuries are identified by routine arteriography, and how often these injuries are of sufficient magnitude to warrant therapeutic intervention. Patients underwent diagnostic arteriography if one or more of the following abnormal clinical findings were present: distal pulse deficit, nerve deficit, soft-tissue loss, decreased capillary refill, bruit, or a history of hemorrhage or hypotension. In the absence of these findings, arteriography was performed for significant orthopedic injuries, i.e., knee dislocations or complex long-bone fractures. In 31 patients (58%), arteriography was performed because 1 or more abnormal clinical findings were present and 12 arterial injuries were identified, 4 requiring arterial repair. The presence of a knee dislocation or complex long-bone fracture was the only indication for arteriography in 22 patients (42%) and 3 arterial injuries were identified, none requiring operative intervention. For all patients, two variables, pulse deficit and delayed capillary refill, strongly correlated (p less than 0.05) with arteriographic demonstration of an arterial injury. In the absence of these findings, routine diagnostic arteriography will have a low diagnostic yield and will rarely identify a vascular injury in a major artery that will require operative repair. Arteriography should be selectively performed and guided by examination and noninvasive Doppler indices.

Adolescent↗
PubMed2006

Single-bundle versus double-bundle posterior cruciate ligament reconstruction: scientific rationale and surgical technique.

Despite many recent advances in the understanding of the posterior cruciate ligament (PCL) and its function, the optimal treatment of PCL injuries remains controversial. Although it now is well known that the PCL is made up of two distinct bundles, each of which plays a vital role in achieving knee stability, questions abound regarding the need for double-bundle reconstruction rather than single-bundle techniques. Currently, the reconstruction technique is selected based on the injury pattern. In acute (< 3 weeks from the time of injury) combined PCL injuries (PCL/posterolateral corner, PCL/medial collateral ligament, and knee dislocations), a single-bundle reconstruction designed to replicate the anatomy of the anterolateral bundle is used. In acute or chronic PCL injuries in which both the posteromedial bundle of the PCL and the meniscofemoral ligaments remain intact, a single-bundle augmentation is used. A double-bundle reconstruction is performed when all three components of the PCL complex (anterolateral band, posteromedial band, and meniscofemoral ligaments) have been ruptured. These patterns are generally chronic, with severe knee laxity following a previous traumatic injury (PCL/posterolateral corner or knee dislocation). Tailoring the PCL reconstruction technique to the individual injury pattern will likely yield a reconstruction that better replicates the natural biomechanics of the native knee, thereby resulting in better functional outcomes.

Anterior Cruciate Ligament↗
PubMed1976

Congenital dislocation of the knee.

Four cases of congenital dislocation of the knee are presented. The incidence, associated congenital anomalies, presentation, and etiology are discussed with particular attention to the roentgenographic findings.

Abnormalities, Multiple↗
PubMed1993

Antenatal diagnosis of congenital dislocation of the knee: a case report.

Congenital dislocation of the knee was diagnosed antenatally in an abdominal flat plate. This is probably the first time that this condition has been diagnosed prior to delivery. Examination of the newborn after delivery revealed dislocation of the right hip and knee. The obstetric and orthopedic implications and suggested treatment are discussed.

Adolescent↗
PubMed1983

The surgical treatment of blunt and penetrating injuries of the popliteal artery.

Thirty-six patients sustaining blunt and penetrating injuries to the popliteal artery underwent vascular reconstruction with an average ischemic interval of eight and one-half hours (range: four to 14 hours). There were 16 associated venous injuries, 15 nerve injuries, and 20 fractures with or without knee dislocations. Arterial repair was performed by saphenous vein interposition graft in 23 patients and by end-to-end anastomosis in 16 patients (three patients had more than one operation). Eight of the venous injuries were reconstructed and the remaining eight veins were ligated. Fasciotomy was performed in 22 patients. Skeletal stabilization by external support was necessary in 12 instances and by internal fixation in eight patients. Five patients required amputation after vascular reconstruction failed. The presence of an ischemic interval greater than ten hours, associated fractures, and/or knee dislocation carried a serious prognosis for limb survival.

Adolescent↗
PubMed1999

Primary repair of the cruciate and collateral ligaments after traumatic dislocation of the knee.

The management of traumatic dislocation of the knee in 40 patients (41 knees) with a mean age of 26.3 years is described. They were treated by primary repair and reconstruction with autologous grafting of the anterior (ACL) and posterior cruciate ligaments (PCL) and repair injuries to the collateral ligament and soft-tissue. The ACL and PCL were reconstructed using the patellar tendon and the gracilis and semitendinosus tendons, respectively. Early mobilisation using a continuous-passive-movement machine and active exercises was started on the second day after operation. At a mean follow-up of 39 months no patient reported 'giving way' and all except one had good range of movement. Of the 41 knees, 21 were rated as excellent, 15 good, four fair and one poor. Early reconstruction of the cruciate ligaments and primary repair of the collateral ligaments followed by an aggressive rehabilitation programme are recommended for these young, active patients.

Adolescent↗
PubMed2006

Surgical treatment of multiple knee ligament injuries in 44 patients: 2-8 years follow-up results.

The purpose of the study was to evaluate the mid-term results of surgical treatment in different groups of patients with multiple knee ligament injuries. Review of our patients' records revealed that 48 acute and chronic patients were surgically treated for combined knee injury. Due to severe capsular damage in these injuries, open techniques were used. In our treatment protocol, avulsed ligaments and tears of the posterolateral and posteromedial corner were repaired if possible, whereas midsubstance tears of cruciate ligaments and chronic cases were reconstructed with autografts. Postoperatively, an accelerated program of rehabilitation was introduced, aiming to progressively mobilize the joint and improve muscle endurance. For the follow-up evaluation we designed a protocol composed of two parts. In the first part, anatomical lesions were recorded and in the second part, clinical evaluation was performed using the Lysholm score, the Tegner rating system, the IKDC evaluation form, and the KT1000. Student's t tests and chi-square tests were used for data analysis. Forty-eight patients (mean age 28.6+/-11.9 years; 41 males) were classified according to the specific anatomical structures involved. Group A included 12 anterior cruciate ligament (ACL) and medial structure injuries, group B included 11 ACL or posterior cruciate ligament (PCL) ruptures combined with posterolateral injuries, and group C consisted of 25 knee dislocations (ACL and PCL ruptures which might be combined with damage of the collateral ligaments). Thirty-eight patients were surgically treated during the acute phase and ten patients were treated chronically. Forty-four patients (91.6%) were followed up at a mean of 51.3+/-29.9 months. Average Lysholm score was 87+/-12.3; average Tegner score was 5.09+/-2.19 before accident and 4.34+/-2.12 in re-examination; IKDC score was A in 10 cases, B in 22, C in 6, and D in 6. The mean range of motion was 129.9 degrees +/-12.5 degrees . The average loss of extension and flexion were 1.6 degrees +/-2.5 degrees and 7.6 degrees +/-7.9 degrees , respectively. The side-to-side difference in corrected anterior and posterior translation in quadriceps neutral angle and in anterior translation in 30 degrees angle was <3 mm for about 65% of our patients. Surgical treatment of multiple knee ligament injuries, using autografts, provided satisfactory stability, range of motion, and subjective functional results. However, despite the improvement of the quality of life, the preinjury patients' activity level was not fully obtained in re-examination. Patients underwent surgical treatment during the acute phase had better scores in several points, but finally there was no statistical significance between acute and chronic patients. Moreover, no statistically significant differences were observed among the groups with specific damaged anatomical structures.

Adult↗
PubMed1989

[Treatment of complications of complete dislocation of the knee joint].

12 cases of complete dislocation of knee joint were reported. Of them, 5 were anterior, 3 posterior, 2 rotational and the remaining 2 were uncertain. Neurovascular complications occurred in 5: 3 with injury of popliteal vessels, 2 with injury of peroneal nerves. The limbs of the cases with vascular injury were all saved after repair of the vessel in 2, and following conservative treatment in 1. Surgical repair of cruciate and collateral ligaments as well as the capsule were properly carried out in 11 cases, in early due time. One of them has also had peripheral tear of meniscus which was repaired incidentally. Follow-up study showed excellent and good result in 9 cases. Points of operative indications were discussed.

Adult↗