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At least 433 records · Page 24Linked to original sources
PubMed1989

Reconstruction of the four major ligaments in an unstable knee joint after dislocation by solvent-preserved human fascia lata transplantation. A case report.

Once the opportunity for primary repair of injured knee ligaments after traumatic dislocation has been lost, ligamentous reconstruction is difficult using only autogenic tissues because of the risk of loss of function at the donor site, so other substitutes are needed. The four major ligaments in the unstable knee of a 35-year-old man were reconstructed by solvent-preserved human fascia lata three months after traumatic open dislocation. The clinical results were satisfactory. Arthroscopic examination one year later showed that the reconstructed ligaments had good thickness and tension and were composed of autologous connective tissue without evidence of rejection. The literature on dislocation of the knee and on cruciate ligament reconstruction by allograft was reviewed, and a brief introduction to solvent-preserved human fascia lata was presented. The commercialization of this material has solved some common problems concerned with using allogenic tissues.

Adult↗
PubMed1988

Vascular complications in orthopedic surgery.

Vascular complications may be seen secondary to trauma or in the perioperative period following elective surgery. Prompt recognition and correction of these problems are of utmost importance to assure functional viability of the affected extremity. Evaluation may be complicated by the presence of preexisting atherosclerotic occlusive disease in the elderly patient. Relevant points in the history and physical examination include mechanism of injury, preexisting disease, evaluation of motor and sensory function, and presence and character of pulses. Noninvasive vascular studies should be obtained in all patients. Absolute indications for angiography include absent pulses, signs and symptoms of ischemia, a bruit, and a posterior knee dislocation; decreased pulses, a significant hematoma, and proximity of the fracture fragment are relative indications. Controversial issues in the management of combined orthopedic and vascular injuries include the use of internal versus external fixation, the use of prosthetic versus autogenous material, and the need for venous reconstruction. Popliteal artery trauma is still associated with a high limb loss rate, and careful evaluation of knee injuries is necessary. Vascular compromise may also complicate joint replacement surgery. These complications are preventable, and management is greatly simplified by a detailed preoperative evaluation.

Adult↗
PubMed2005

[Reconstruction of acute posterior cruciate ligament tears using a synthetic ligament].

PURPOSE OF THE STUDY: Treatment of recent laxity of the posterior cruciate ligament is not standardized. The purpose of this work was to analyze results of reconstruction with adjunction of a synthetic ligament for major recent isolated or combined laxity of the posterior cruciate ligament (triades, pentades or dislocations). Our hypothesis was that the synthetic ligament acts like a tutor for healing of the torn ligament. MATERIAL AND METHODS: This retrospective analysis included 14 patients (1 woman and 13 men), mean age 27 years. All were competition athletes except one who did not practice sports. Three quarters of the patients were traffic accident victims. The series included three isolated posterior ligament tears, six combined laxities, and five knee dislocations. Average posterior laxity was 24 mm preoperatively. The procedure was performed 7 to 53 days after the accident. Arthroscopic reconstruction was performed for six patients and arthrotomy for eight. All associated lesions were repaired during the same procedure except for two cases (one anterior cruciate ligament and one popliteal tendon). Posterior cruciate ligament repair was achieved with the adjunction of a polyester ligament (LARS) using a one or two strand technique. Patients were reviewed at 36 months mean follow-up (10 - 88 months). The IKDC score was determined. A posterior drawer was measured manually with Telos at 70 degrees. RESULTS: Five stiff knees required either mobilization under anesthesia or arthrolysis. One tear occurred late after the accident during a new trauma. Subjectively, two patients were very satisfied, eight satisfied and three disappointed. Mean knee motion measurements were 6/0/130 degrees . A differential posterior drawer persisted in twelve knees. The Telos measurement of posterior drawer changed from a mean 24 mm to a mean 8 mm. The overall IKDC score was A: 0, B: 7, C: 3, and D: 2. Persistent posterior laxity was the predominant cause of poor scores. Outcome was less satisfactory for all items of posterolateral laxity. There was no difference between the 2- and 4-strand techniques. There were no cases of morbidity (synovitis, spontaneous tear) directly related to the synthetic ligament. DISCUSSION: The gain in posterior laxity was substantial. Results depended on associated lesions, particularly lateral involvement (stiffness, IKDC score) rather than the repair technique. The synthetic ligament appeared to play the role of a tutor: a single strand measuring 6 mm in diameter is sufficient. This technique spares tendon stock and could be proposed for major posterior cruciate ligament laxity. A longer follow-up will be necessary to confirm the durable stability.

Accidents, Traffic↗
PubMed1989

The Minns meniscal knee prosthesis: biomechanical aspects of the surgical procedure and a review of the first 165 cases.

The Minns knee prosthesis has been designed so that the ligaments, soft tissues and musculature about the knee can return to their full functioning during the movement and loading that occur in usage. By utilising a third component made of polyethylene that slides back and forth in a straight line between the metallic femoral and tibial components, the knee is able to roll and slide at the plastic/metal junctions without creating high forces and loosening moments on the tibial component. The tibial tray has a central cut-out to allow the functioning of both cruciate ligaments, and the femoral component is of the total condylar design. Experimental and theoretical studies on the functioning and clinical performance of this design and the biomechanical implications of the technique of surgical implantation are described. The results of the first 165 cases, followed up for a maximum of 5 years, were ranked according to pain, mobility, and restoration of function; 75% were rated as excellent, both subjectively and objectively, 13% as good, and 9% as fair. The average range of motion measured at least 6 months postoperatively was 103 degrees. Eight knees dislocated laterally because of instability and were successfully revised using the sliding plateau without being necessary to remove the metallic components. Minimal wear has been seen on the removed menisci up to 4.5 years' use.

Biomechanical Phenomena↗
PubMed2002

Pathologic conditions of the ligaments and tendons of the knee.

Excellent spatial resolution and unparalleled contrast resolution have allowed MRI to emerge as the dominant imaging modality for diagnosis of ligament and tendon pathology of the knee joint This article presents several important mechanisms of injury associated with tendon and ligament disruptions. When present, the pattern of bone contusions may reveal the vector of force. When one is aware of the mechanism of injury, it is possible to analyze systematically the structures of the knee and maximize the detection of pathology. Recognition of a knee dislocation pattern is important because the diagnosis may be unsuspected, and the clinician may have to be alerted to the possibility of vascular and neural injury.

Humans↗
PubMed1998

Vascular trauma associated with fractures and dislocations.

Vascular trauma occurs relatively infrequently in association with general orthopedic trauma but may be seen more often in injuries involving joint dislocations and areas in which vascular structures are tethered at the fracture site. The mechanisms of vascular trauma are identified, and the general principles in managing these injuries, including the operative approach to the injury itself and the options in repairing both arterial and venous injuries, are discussed. The role of fasciotomy and primary amputation are also reviewed. Several specific injuries, including pelvic fracture, knee dislocation, shoulder and upper limb injuries, complex tibial fractures, and iatrogenic injuries, are examined from diagnostic and management perspectives. Despite an ongoing evolution in the diagnosis and management of these often challenging injuries, the essential requirements for a good clinical outcome remain early recognition of the dysvascular limb and rapid institution of therapy.

Angiography↗
PubMed2002

The acute management of soft tissue injuries of the knee.

The acute management of soft tissue injuries of the knee requires knowledge of the injury mechanism, physical findings, and results of adjunctive tests. Knee dislocations, fractures, and extensive soft tissue injury requires immediate and thoughtful treatment. All injuries are afforded the benefit of the basic principles of rest, ice, compression, and elevation until definitive treatment is carried out.

Athletic Injuries↗
PubMedDate not supplied

Periarticular heterotopic ossification after multiple knee ligament reconstructions. A report of three cases.

Heterotopic ossification is a frequently encountered clinical and radiographic entity. There are no previous reports in the English literature of heterotopic ossification after arthroscopically assisted ligament reconstructions for knee dislocations. Further, a link between the PCL reconstruction and posterior capsular ossification has not been heretofore recognized. Our three cases should raise the clinical awareness of such an entity.

Accidents, Traffic↗
PubMed1993

Hemarthrosis of the clinically stable knee due to sports and military training in young recruits: an arthroscopic analysis.

Findings of an early arthroscopy performed in 108 consecutive hemarthrotic and clinically stable knees were analyzed. The patients were young conscripts, the mean age being 19.9 years. Fifty-seven of the knees were injured during military training, 36 in different sports activities, 9 at falls, and 6 in motorbike accidents. The lesions were divided into "primary" (lesions needing operative treatment or the supposed most common lesions in incidence) and "secondary" (other lesions). An average of 1.6 lesions were observed per knee. Dislocation of the patella was the most common diagnosis in 38 (35%) cases. Dislocation of the patella was associated with military exercise (p < 0.001). Lesions of the anterior cruciate ligament (ACL) were observed in 37 (34%) cases. ACL ruptures were related to sport activities (p < 0.0001).

Adolescent↗