Internal derangement of the knee joint. I. Orthopedic treatment.
Explore the source record for details and available documents.
SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The change of patellar height after the displacement of tibial tuberosity and its effect on the improvement of clinical signs of knees was studied. The anterior displacement of tibial tuberosity was performed on fourteen knees and the anteromedial displacement on twenty knees with patellofemoral arthrosis of twenty-nine patients, four men and twenty-five women with the age at operation ranging from 47 to 79 years (average: 58.3). The anteromedial displacement of tibial tuberosity was performed on ten knees and medial displacement on fifteen knees with recurrent patellar dislocation (eleven knees) or patellar subluxation (fourteen knees) of twenty-four patients, two men and women with the an age range from 14 to 37, (average: 22.4). Patellar height was measured on lateral view by the Insall-Salvati method using Ligament/Patella ratio (Lt/Lp ratio). Ligament/Patella ratio of the older group with patellofemoral arthrosis was decreased significantly (p < 0.01) after surgery, from 1.10 to 0.94. The ratio of the younger group with patellar dislocation or subluxation showed no significant changes, but of seven knees with high riding patella, which ratio revealed more than 1.2 before operation, decreased significantly (p < 0.001) from 1.47 to 1.31. The postoperative patella baja had no poor effect on the improvement of clinical signs.
Traumatic dislocation of the hip or knee can occur after high-energy trauma and is often associated with concomitant injuries and secondary complications. Concomitant traumatic dislocation of both hip and knee is rare. We describe a case of combined ipsilateral posterior hip dislocation with a posterior acetabular fracture and a complete open knee dislocation with disruption of the popliteal artery that resulted in amputation.
Explore the source record for details and available documents.
Fifty-eight patients (69 knees) treated with the Kinematic Rotating Hinged knee prosthesis for complex primary and salvage revision total knee arthroplasty were followed up for an average of 75.2 months (range, 24-199 months). The indications for use of the Kinematic Rotating Hinged knee prosthesis included severe bone loss combined with ligamentous instability (30 knees), nonunion of a periprosthetic fracture (10 knees), an acute periprosthetic fracture (nine knees), severe collateral ligamentous instability (five knees), reimplantation for infection (six knees), nonunion of a supracondylar femoral fracture (four knees), congenital dislocation of the knee (three knees), and treatment of a severely comminuted distal femur (two knees). At the time of surgery, the average patient age was 72 years (range, 46-92 years). Preoperatively, knee extension averaged 4.94 degrees (range, 0 degrees-40 degrees) and flexion averaged 81 degrees (range, 15 degrees-125 degrees). At final followup, knee extension averaged 1.25 degrees (range, -5 degrees-25 degrees) and flexion averaged 94.2 degrees (range, 5 degrees-125 degrees). The preoperative Knee Society Knee score averaged 40.3 points (range, 2-93 points) and improved to 77 points (range, 33-99 points) at final followup. Complications were numerous: 23 (32%) patients experienced at least one complication and 12 (17%) patients had two or more complications. Deep periprosthetic infection was the most common complication (14.5%), followed by patellar complications (13%), and prosthetic component breakage (10%). During the period of this study, there were 15,798 primary and 2673 revision total knee arthroplasties done at the authors' institution. The patients receiving a Kinematic Rotating Hinged knee prosthesis represent a highly complex and small subset (0.37%) of the overall population having knee arthroplasty. Although the use of the Kinematic Rotating Hinged knee prosthesis for these limited indications has been useful for the authors, the incidence of complications and the poor outcome of these complications is disconcerting. Hinged total knee arthroplasty should be reserved for the final salvage option of the treatment options available when doing complex primary and salvage revision knee arthroplasties.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
AIM: Common peroneal nerve (CPN) injuries represent the most common nerve lesions of the lower limb and can be due to several causative mechanisms. Although in most cases they recover spontaneously, an irreversible damage of the nerve is also likely to occur. Nerve regeneration following CPN repair is poorer if compared to other peripheral nerves and this can explain the reluctant attitude of many physicians towards the surgical treatment of these patients. Among the several factors advocated to explain the poor outcome following surgery, it has been suggested that reinnervation might be obstacled by the force imbalance between the functioning flexors and the paralysed extensors that eventually results in the fixed equinism of the foot, due to the excessive contracture of the active muscles and the shortening of the heel cord. Therefore the early correction of these forces might favour nerve regeneration. Following such hypothesis, the authors treat irreversible CPN injuries performing a one-stage procedure of nerve repair and tibialis tendon transfer. We report our experience, describing the indications to surgical treatment, the operative technique and the postoperative clinical outcome correlated with the causative mechanisms of the injuries. METHODS: A 62-patient series controlled over a period of 15 years with a post-traumatic palsy of the CPN is reported. All the patients underwent surgery. In open wounds, when a nerve transection was suspected, surgery was performed at emergency (2 cases). In closed injuries, operative treatment was advised when no spontaneous regeneration occurred 3-4 months after the injury. From 1988 till 1991, 9 patients were elected for surgery : in 6 cases treatment consisted of neuroma resection and nerve repair by means of a graft. In 3 patients it was performed only a CPN decompression at the fibular neck. Since 1991, surgical treatment has always consisted of nerve repair associated with a tendon transfer during the same procedure. Fifty-three patients were elected for surgery. Nerve repair was achieved by direct suture in 1 case and by means of a graft in 46 patients. Decompression of the CPN at the fibular neck was performed in 6 patients where nerve continuity was demonstrated. RESULTS: In the first group of patients, nerve repair outcome was highly disapponting: no recovery in 5 cases, reinnervation occurred in 1 patient only (M1-2). CPN decompression was followed by complete recovery in 2 cases, no improvement was observed in 1 case. Nerve repair associated with tibialis tendon transfer dramatically improved the postoperative outcome: at 2 year follow-up, neural regeneration was demonstrated in 90% of the patients. Surgical outcome depends on the causative mechanisms of the lesion: sharp injuries and severe dislocations of the knee had an excellent recovery, while in crush injuries and gunshot wounds good recovery was less common. CONCLUSION: Surgical treatment of CPN injuries can nowadays be highly rewarding. CPN palsies in open wounds should undergo surgical exploration at emergency. In close injuries with no spontaneous recovery within 4 months after the injury, patients should be advised to seek surgical treatment regardless the causative mechanism of the lesion. According to our experience, the association of a transfer procedure to nerve repair enhances neural regeneration, dramatically improving the surgical outcome of these injuries.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The depth of the trochlear groove was frequently noted to be insufficient in knees with patellar instability, particularly in the proximal portion of the trochlea. To confirm this observation, the depth of the trochlear groove of the femur was measured on lateral radiographs of 218 knees: 40 knees in 20 asymptomatic subjects, 116 knees in 69 patients undergoing radiography for various symptoms (96 without and 20 with patellar subluxation, determined on axial radiographs), and 62 knees in 34 patients who underwent surgery for recurrent dislocation or subluxation of one or both patellae (40 treated and 22 contralateral knees). In the 40 knees that had been operated on, the proximal trochlear depth (measured 1 cm below the upper limit of the trochlear groove) was 2.74 mm +/- 1.35, in contrast to 5.94 mm +/- 1.74 in the asymptomatic subjects and 5.84 mm +/- 1.53 in the patients with symptoms but no patellar instability. Recognition of depth insufficiency in the proximal portion of the trochlea should prompt a search for patellar instability. Axial views made with 30 degrees of knee flexion and lateral rotation of the leg are particularly helpful.
The Oxford knee is a unicompartmental knee prosthesis with a polyethylene meniscal bearing. Anterior dislocation or medial subluxation has been described in lateral compartment arthroplasties. The authors present the case of a medial dislocation of the lateral meniscal bearing and a review of the literature concerning meniscal bearing instability in the Oxford Knee.
Explore the source record for details and available documents.
The ambulatory difficulties of a patient with long standing rheumatoid arthritis with an above knee amputation and bilateral wrist dislocations has not been previously reported. Although wrist fusion did in fact increase his hand strength, control and stability, he still lacked sufficient hand strength and grip to don and doff the prosthesis, nor could he use assistive devices in order to become an independent ambulator. The results of wrist fusion and attempts at ambulation are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The fabella, a sesamoid bone in the lateral head of the gastrocnemius muscle occurring in 10% to 30% of individuals, is rarely considered a possible cause of knee dysfunction. When noted, the fabella is occasionally mistaken radiographically for an intraarticular ossified fragment; however, symptomatic conditions of the fabella have been well documented in the literature. This is a report of symptomatic dislocation of an enlarged fabella in a 37-year-old man. In a review of the literature of various lesions of the fabella, disability related to dislocation seems not to have been previously reported.