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At least 343 records · Page 19Linked to original sources
PubMed1989

[Post-traumatic hemarthrosis of the knee joint--an indication for arthroscopy].

Diagnostic arthroscopy including the use of a probe should be performed if the cause for a haemarthrosis of the knee cannot be established by radiological means. The clinical examination of the recently injured knee must be considered to be unreliable due to pain. In approximately one-third of knee injuries an incorrect or incomplete diagnosis is made. Even if ligamentous injuries can be established, arthroscopy is mandatory, because this is the only sure way in which acute and degenerative meniscal or cartilaginous lesions can be diagnosed. Arthroscopy should be performed under general or spinal anaesthesia to allow the use of a tourniquet and the immediate repair of ligaments if deemed necessary. The experienced arthroscopist needs only a few minutes to obtain information that could influence the approach to the injury and its longterm prognosis. In a series of 1238 arthroscopies 252 (20.3%) were done for haemarthrosis of unknown origin. In 68% of these cases diagnosis could only have been established by arthroscopy. In this series of 252 cases 23% had an isolated complete anterior cruciate ligament (ACL) injury, 28% had anterior-medical instability, 8% had partial ACL lesions, 5% posterior cruciate ligament injuries, 15% medial collateral ligament injuries, 11% had only synovial tears or contusions. 5% of cases had chronic ACL instability, 4% had osteochondral fragments which could not be diagnosed radiologically. A recent traumatic patellar dislocation with a tear of the retinaculum was found in 1.6% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopes↗
PubMed1988

Results of bone grafting of tibial defects in uncemented total knee replacements.

Bony defects of the articular surface are frequently encountered in total knee replacement. As an alternative to excising more tibia and using a thicker tibial component, autogenous bone grafts have been used to fill these defects. The authors have analysed 43 cases in which bone grafts were used in conjunction with an uncemented tibial component. The follow-up was 2 to 7 years. The results in these cases were compared with those in a similar group using uncemented components in which bone grafting was not required. There were 15 central grafts and 28 edge grafts. All the edge grafts and seven large central grafts were fixed with screws. If the graft size was more than 1 cm2, patients were not permitted to bear weight for 4 to 6 weeks. In the others, weight bearing was allowed immediately. All grafts united, most within 6 months, and substantial collapse was not observed. Notable sinking of the tibial component occurred in one late case, in which a rotatory subluxation developed due to patellar dislocation. Collapse of the graft in a recent case, however, suggests that when large grafts are used, a heavy central stem should be used on the tibial component.

Aged↗
PubMed1987

[Patellectomy as a salvage operation].

One hundred seven patients were examined who had undergone patellectomies between 1965 and 1983 (113 patellectomies). The mean follow-up time was 10.5 years (3-17.5 years) and the average age of the patients 42.6 years. There were three distinct groups of operative techniques: (1) the purse-string technique in 40 patellectomies; (2) the vastus medialis technique in 24 patellectomies; (3) other techniques in 49 patellectomies. The indications for patellectomy were: chondromalacia, 56 cases; comminuted patellar fractures, 32 cases; arthritis, 17 cases; recurrent patellar dislocations, 8 cases. The patients were examined for pain, rage of motion, giving way, swelling, quadriceps strength, activity and cosmetic results (interview, physical examination, Cybex and radiographic study). In the purse-string technique group, 81% of the cases ended up with good or excellent results; in the vastus medialis group there were 79% and in the third group only 73% good or excellent results. Among the patellectomies for comminuted fractures, 75% had excellent results. The clinical outcome of patelletomy for arthritis is fair, for recurrent dislocation favorable, and for chondromalacia variable and not predictable.

Adolescent↗
PubMed1988

The role of arthroscopy in the treatment of postoperative fibroarthrosis of the knee joint.

Twenty-one patients with significantly limited range of motion of the knee secondary to open surgical procedures were treated by arthroscopic resection of the adhesions and gentle manipulation. The surgical procedures consisted of realignment procedures for patellar dislocation, arthrotomy for meniscectomy and synovectomy, ligamentous reconstruction, open reduction of intraarticular fractures, and prosthetic replacement. The interval between the arthroscopic treatment and the open procedures was from four months to two years. All patients had the arthroscopic releases performed with general or spinal anesthesia, were kept in the hospital for a minimum of three days, and were placed on a continuous passive motion machine. After discharge, an intensive rehabilitation program was instituted under the supervision of a physical therapist. With a follow-up period ranging from six months to two years, marked improvement of range of motion was obtained in most patients. Preoperative flexion was between 40 degrees and 50 degrees in 13 patients, 30 degrees in two patients, 60 degrees in four patients, 80 degrees in one patient, and 10 degrees in only one patient. The final flexion was between 120 degrees and 140 degrees in 12 patients. The remaining patients had postoperative flexion between 85 degrees and 100 degrees. One patient with 10 degrees of range of motion did not improve. Six of the eight patients with an extension lag preoperatively regained full or almost full extension after arthroscopic debridement. Morbidity was low and no serious complications were encountered. This study suggests that arthroscopic intraarticular release of adhesions is efficacious in the management of arthrofibrosis of the knee subsequent to previous open operative procedures.

Adolescent↗
PubMed1986

[Complications following total knee replacement].

Complications of total knee replacement were studied by following up 218 cases operated in our clinic. The average follow-up time ranged from 24 months to 101 months (mean 44.3 months). The three most serious types of complication were: significant loosening in 8 knees; deep infection in 5 knees; and fracture in 7 knees. Patellar dislocation and extension mechanism rupture were found in 13 knees, restriction of ROM and instability in 20 knees, and other complications in 7 knees. The incidence of complications in the rheumatic group tended to be greater than that in the osteoarthritic group. The incidence of complications was significantly higher in the severely deteriorated group than in the not severely deteriorated group; and the incidence of complications in the group treated in combination with Anametric, Total Condylar and GUEPAR prosthesis was also significantly higher than in the group treated with the Kinematic Knee Prosthesis. Though 32 reoperations were performed in 23 knees, functional prognosis was not good in most cases.

Adult↗
PubMed1979

[A technique for reproducible roentgenograms of the intercondylar sulcus for the study of the femoropatellar (author's transl)].

Roentgenographic documentation of certain features of FP-joint geometry and orientation may serve as guideline in deciding on the form of treatment for chondromalacia or recurrent patellar dislocation. Reproducible conditions for taking roentgen films are equally important for this purpose as well as for quantitative measurements and possible statistical work. A new positioning device for the patient's legs has been designed utilizing a parallellogram frame. The roentgenographic technique for skyline views at 30 degree, 60 degree and 90 degree inclination of the central beam relative to the femoral axis is described. The advantages over previous techniques are the ease of handling the positioning frame, the need for only vertical and horizontal adjustment of the roentgen tube, independence of the type of tube or table, reproducibility of cassette and patient positioning.

Adult↗
PubMed1979

Tibial tubercle transfer: a long-range follow-up study.

The prime indications for tibial tubercle transfer are 2 or more complete patellar dislocations with trivial trauma or recurrent subluxation with or without pain causing "giving way." A high "Q" angle, flat lateral condyle, aplastic patella or positive apprehension test may be associated but are not always prime indications in surgery. Methods of fixation are of individual preference in this series and a single screw sufficed. An arthrotomy is not always necessary but is suggested if indicated. If the proximal tibial epiphysis is open, corrective measures are suggested that do not involve the extension of the proximal tibial epiphysis into the tibial tubercle. The tubercle should be advanced to compensate for patella alta and lined up with the femoral shaft. Transplantation of the tubercle medially 3/4'' and distally 1/2'' was generally satisfactory in a series of 377 operations with an average follow up of 3 1/2 years.

Adolescent↗
PubMedDate not supplied

Arthroscopic repair and augmentation of the anterior cruciate ligament in cadaver knees.

An experimental method for arthroscopic repair and augmentation of the anterior cruciate ligament (ACL) was designed by experiments on fresh cadaver specimens. The procedure was performed arthroscopically. No arthrotomy or patellar dislocation was necessary. Established principles of ACL surgery were strictly applied, e.g., placement of holes; internal splinting; preservation of blood supply; utilization of ACL remnants at the tibial attachment. As much of the normal anatomy of the knee as possible was preserved, and some of the undesirable features of major knee surgery were avoided. With further research and development of materials (e.g., an implantable hook and either freeze-dried fascia or biodegradable suture for the internal splint), the described technical ideas have potential application as an effective arthroscopic procedure for the treatment of ACL deficiency.

Arthroscopy↗
PubMed1982

UCI total knee replacement. A follow-up study.

Using the UCI (University of California at Irvine) total knee prosthesis, an arthroplasty was performed in ninety-seven patients (121 knees) from 1972 through 1977. I examined eighty of these patients (100 knees) at three to eight years after the operation and it was necessary to either perform or recommend further surgery in twenty-five of them (twenty-seven knees). These results were designated as failures. The knees in valgus angulation that failed typically did so within the first year because of medical instability and patellar dislocation. The knees in varus angulation that failed typically did so one to six years after operation because of loosening of the tibial component. When failure became established, each knee was found to have reverted to its preoperative angular deformity, indicating that deforming factors were still operative. I suspect that ligament imbalance may have contributed to many of these failures. The surface area and stiffness of the 5.0 and 7.5-millimeter-thick tibial components of the original UCI prosthesis were not sufficient to prevent loosening and subsidence. Constraint between the tibial and femoral components was not sufficient to prevent subluxation or dislocation if soft-tissue release was needed for correction of deformity. Prompted by this experience, total knee arthroplasty using the UCI device has been discontinued at the Ochsner Medical Institutions.

Evaluation Studies as Topic↗
PubMed1982

Elevation of the insertion of the patellar ligament for patellofemoral pain.

In an effort to evaluate the use of a transverse incision and a relatively small elevation (1.25 centimeters) of the tendinous insertion of the patellar ligament into the tibial tubercle, 184 patients were treated with a modified procedure using the Maquet principle. The indications for the procedure were patellofemoral pain and loss of active function. The patients were placed in five groups based on the cause of their symptoms: chondromalacia, patellofemoral arthritis, patellar dislocation, previous trauma, and previous patellectomy. The results were evaluated on the basis of whether or not primary wound-healing was satisfactory and whether or not the patient resumed the ability to ascend stairs and could engage in previously lost athletic function, Eighty-five per cent of the patients achieved these goals of treatment. The disadvantages of the procedure appeared to be the slow return of full function (averaging six months), prominence of the area of the tibial tubercle, and persistence of crepitus on patellofemoral motion.

Adolescent↗
PubMed1982

Failure in total knee arthroplasty: mechanisms, revisions, and results.

Of 700 prosthetic knees inserted during the period from 1969 to 1978, 94 failed; 19 of the failures occurred due to infection. Other obvious mechanisms of failure were wear debris sy novitis, ligament rupture, and patellar dislocation. The majority of prosthetic loosenings occurred on the tibial side. There were five mechanical factors of such loosening: tilt and sink; compression; torsion; toggle; and a combination of these factors. Excluding those who died or were lost to follow-up, the results of revision were 37% good or excellent; 60% fair or poor; and 3% failure. To some extent the results were prosthesis dependent; the semiconstrained prosthesis had a good result in 48%, unlinked hinges a good result in 24%, and a true hinge a good result in 21%. The results in infected cases were poor; of five prosthetic revisions, only one was good. Fusion was found difficult to achieve; of 11 attempts, only six obtained solid fusion. Four amputations were performed, all for infection in hinged knee replacements.

Aged↗
PubMed1994

MR imaging of the patellofemoral compartment.

This article reviews the applications of MR imaging of the patellofemoral compartment. Axial plane images are the most informative for abnormalities of this compartment. The role of MR imaging in the evaluation of the medial synovial plica and in the detection of chondromalacia is discussed. MR imaging can reliably detect and delineate the complex of injuries associated with patellar dislocations and valgus hyperextension.

Cartilage Diseases↗
PubMed1995

Acute knee injuries: Part II. Diagnosis and management.

The most common acute knee injuries are collateral ligament sprains, meniscal damage, cruciate ligament sprains and patellar dislocation or subluxation events. Initial treatment for these soft tissue injuries includes rest, ice application, compression and elevation for the first 24 to 72 hours, as well as anti-inflammatory medication. Accurate assessment, utilizing a thorough history and physical examination and judicious use of radiographic studies, facilitates proper management and return to activity. Athletic patients should be offered the option of surgical reconstruction.

Acute Disease↗
PubMed1993

Femoral fracture mimicking acute arthritis in Down's syndrome.

We describe a 38-year-old white woman with Down's syndrome with a history of chronic arthritis and hyperuricemia who presented with acute left knee pain, patellar tenderness and patello-femoral instability. Findings appeared due to a fracture of the lateral femoral condyle, which responded to conservative therapy with a spica cast. Patellofemoral instability in Down's syndrome can be associated with significant morbidity including femoral condyle fracture. Patients with Down's syndrome who present with acute knee arthritis responding poorly to antiinflammatory agents and other conventional therapy should be assessed for fractures related to patellar dislocation, as treatments for the 2 disorders differ.

Acute Disease↗
PubMed1993

A new method using computed tomographic scan to measure the rectus femoris-patellar tendon Q-angle comparison with conventional method.

The Q-angle should be the angle generated by a line connecting the anteroinferior iliac spine (AIIS), the bottom of the groove of the femoral condyle, and the tibial tubercle. The Q-angle was measured by computed tomography (CT) in 43 lower limbs with recurrent patellar dislocation and 26 normal controls. The mean Q-angle was 20 degrees in the dislocated group and 13 degrees in controls, a significant difference. No significant difference was found in the Q-angle between the dislocated and control groups using the conventional method. Lower limb rotation had little effect on accuracy of the method.

Adolescent↗
PubMedDate not supplied

Ultrasonography of the patellofemoral joint in diastrophic dysplasia.

Plain radiographs do not provide adequate information in diastrophic dysplasia (DD) because of abnormal ossification and severe deformation of the knee joint. Radiographically, the lateral femoral condyle is hypoplastic, and the position of patella is difficult to define. In clinical examination, the patella is inferior and lateral. In this study, the anatomy of the patellofemoral joint in DD is described using ultrasound. Both knees of 13 patients with DD were examined. The alignment of patella, the angle of femoral sulcus, and the size of both femoral condyles were measured. Student's paired t test with two-tailed significance probability was applied for differences in mean values, and their 95% confidence limits were computed. The femoral sulcus angle averaged 129 degrees and was deeper than that (142 degrees) in normal knees. The lateral femoral condyle was smaller than the medial condyle. The patella was aligned lateral to the bottom of femoral sulcus. In 10 degrees knee flexion, the patella remained laterally in the sulcus with no true patellar dislocation. Vertical position of the patella averaged 2.9 mm distal to the femorotibial joint. The study showed that, in patients with DD, the anatomic complex of the femoral condyles and patella deviates laterally, and the patellofemoral joint is deformed with a hypoplastic lateral condyle, a deep femoral groove, and a distally aligned patella.

Adolescent↗
PubMed1997

Total knee arthroplasty in the young rheumatoid patient.

Thirty-four total knee arthroplasties were performed for severe rheumatoid arthritis in 25 patients younger than 45 years. All patients were available for follow-up evaluation at an average of 7.2 years. According to the Knee Society scoring system, the knee score improved from an average of 21 points preoperatively to 85 points at follow-up (p < 0.001). The average functional score improved from 23 points to 87 points (p < 0.001). Average range of motion improved from 71 degrees to 93 degrees (p < 0.001). Nonprogressive radiolucencies less than 1-mm thick were observed in 6 knees. One knee was revised for severe polyethylene wear; another case was revised for chronic patellar dislocation. Actuarial survivorship analysis estimates a 97% survivorship after 5 years and 90% after after 10 years. In young rheumatoid patients, total knee arthroplasty can therefore be considered as a reliable procedure, with satisfactory results during at least the first 5 to 10 postoperative years.

Actuarial Analysis↗
PubMed1997

10- to 20-year followup of total knee arthroplasty for valgus deformities.

One hundred eight knees in 83 patients with a valgus alignment of greater than 10 degrees underwent total joint replacement performed by a single surgeon using the same technique for ligament balancing, which involved releasing the lateral retinaculum and iliotibial band, followed when necessary by detaching the lateral collateral ligament and popliteus tendon from the femur. Sixty knees in 46 patients had followup of at least 10 years and were the focus of study. At an average followup of 14.1 years, the mean Knee Society knee score was 88.7 and the mean functional score was 69.2. Postoperative knee alignment averaged 4.5 degrees with 75% of the knees corrected to between 2 degrees and 7 degrees valgus. Postoperative flexion averaged 101 degrees. There were no cases of peroneal nerve palsy or patellar dislocation. Six knees underwent revision surgery with two for sepsis, three for aseptic loosening, and one for a traumatic patella fracture. Radiographic component loosening also was seen in one knee. The probability of retention of the prosthesis was 91% (+/- 11.7%) at 13.2 years. Although the results in this group of patients seem acceptable, the rate of postoperative instability for all patients treated using this ligament balancing technique was 24%. Because of the high rate of instability, a new soft tissue release technique has been developed and is the preferred method for ligament balancing of the valgus knee during total knee arthroplasty.

Adult↗