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At least 685 records · Page 38Linked to original sources
PubMed2001

The patella in total knee replacement: does it matter? 750 LCS total knee replacements without resurfacing of the patella.

Hingelike moving total knee replacement (TKR) has shown that the "rotating" function of the quadriceps muscle becomes lost. Dynamic work of the vastus medialis is no longer needed, and the static part of the quadriceps muscle assumes the major part of the work, beginning with continuously dislocating the patella to the lateral side. We operated on 436 knees using the LCS (De Puy Orthopaedics, Warsaw, IN) meniscal bearing TKR. No primary patellar resurfacing was necessary in this series. The New Jersey Score increased constantly over the 5-year follow-up from 83 after 2 years to 90 after 5 years. This shows that there is no deterioration which can be attributed to a deterioration in the patellar behavior. Nonresurfacing of the patella is a possible solution if the kinematics of the TKR allow physiological rotation, the prosthesis is built anatomically, the alignment is correct, the anatomy of decelerator/extensor mechanism is respected by the approach, and ligamentous stability is good.

Arthroplasty, Replacement, Knee↗
PubMed2006

Results of total knee replacement using a cemented stemmed prosthesis.

OBJECTIVE: To present the results of total knee replacement at the King Abdul-Aziz University Hospital in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS: The medical records of 205 patients who received 309 prostheses was reviewed. The study took place at King Abdul-Aziz University Hospital, Jeddah, KSA between May 1989 and August 2005, where patients were either examined in the outpatient clinic or interviewed on the phone. Seventeen patients (22 prostheses) were lost for follow up. The scores were registered according to the Knee Society Clinical Rating System. RESULTS: There was a significant improvement in all-functional scores postoperatively in the first year, which continues without significant change throughout the follow up period. Symptomatic deep vein thrombosis was observed in 5 patients, 3 of them had pulmonary embolism, which was fatal in 2 cases. Early deep infection occurred in 3 cases. Superficial wound infection was seen in one patient. One patient suffered peroneal nerve palsy, while 4 patients had aseptic loosening of the femoral implant. One patient had rupture of the patellar tendon. Metal breakage was observed once and one patient is diagnosed to have polyethylene wear. In the early phase, when a prosthesis type without dislocation protection was used, 7 dislocations occurred. This type was not used anymore and no such complication was observed. CONCLUSION: Total knee replacement relieves pain and improves quality of life significantly. The observed complications compare well with the results reported in the literature.

Arthroplasty, Replacement, Knee↗
PubMed1980

Resurfacing of the patella.

The results of use of twenty-nine patellar resurfacing prostheses in twenty-eight patients were studied. The diagnosis was osteoarthritis in twenty-two knees, chondromalacia in five knees, and habitual dislocation with severe osteoarthritis in two. The follow-up time was from three to six years. A cemented chromium-cobalt prosthesis was used. Of the twenty-nine knees studied, two were rated excellent; fourteen, good; three, fair; and ten, poor. Failure was always due to unrelieved pain.

Adolescent↗
PubMed1980

[Imbalance of the patella in the adolescent. Physio-pathological approach and therapeutic orientation (author's transl)].

The incorrect position of the anterior tibial tuberosity responsible for the pushing into jagged shape of the extensor apparatus of the knee has various causes. Among these, "knock-kneed"walking may induce some children to compensate by a hyper rotation of the legs in order to reestablish a normal walking position. Other origins may also be pointed out : --an outward twist of the leg bones --hyper rotation in outward turning sometimes as a result of accident but more often hereditary. The closing of angle Q of the extensor system modifies the pressure vectors on the femur patellar connection leading eventually to disturbances in the growth of its outer side and to a distension of the inner stabilizing elements leading to partial dislocation of the patella. This physiopathological conception should lead to a selective therapeutic orientation based on a clinical examination. In this field much can be said for dynamic interventions (lowering of the vastus medialis transferring of the pes cornivus muscles, etc...) aimed at correcting the imbalance.

Adolescent↗
PubMed1995

[Functional MRI of the femoropatellar joint].

Conventional X-ray examinations of the patellofemoral joint in 30 degrees, 60 degrees and 90 degrees of knee flexion demonstrate the position of the patella. On the other hand, they have been shown to be insufficient for the diagnosis of patellofemoral maltracking in the critical range between 30 degrees of flexion and full extension. Motion-triggered and ultrafast MRI offer new possibilities for functional diagnosis of the patello-femoral joint under active knee motion. Functional MRI of the patellofemoral joint is suggested as an alternative to arthroscopy, particularly in patients with anterior knee pain or suspected patellar maltracking.

Arthroscopy↗
PubMed1977

[Patellar imbalance and external rotary instability of the knee].

The importance of external hyperrotation and external rotary instability in patellar imbalance is examined. In view of the progressive nature of patellar imbalance and of the predominant part played by the muscular and capsulo-ligamentous elements in the stability of the extensor apparatus, the authors advocate an earlier and more radical surgical approach with a view to improving the patellar medialization forces (transplantation of the intermediate great muscle and retension of the lateral patellar retinaculum) as well as the elements of active internal rotation of the tibia (modified version of Slocum's operation and transfer of the internal third of the patellar tendon).

Adolescent↗
PubMed1988

Modified technique for tibial tubercle elevation with realignment for patellofemoral pain. A preliminary report.

Malalignment of the quadriceps mechanism was corrected and the tibial tuberosity elevated in 17 knees in 16 patients without the use of a free bone graft. The indications for operation were patellofemoral pain unresponsive to conservative treatment, recurrent subluxation or dislocation of the patella, and patients who had had a previous patellectomy with subsequent lateral subluxation of the patella tendon associated with pain. A bone block including the attachment of the patellar tendon is transposed medially to correct the quadriceps angle (Q-angle), elevate the tibial tuberosity, and thereby decrease patellofemoral pressure. A prerequisite for this procedure is a Q-angle of 20 degrees or more. The average age of the patients was 29 years. The follow-up period was one to four years. Eighty-five percent of the patients had an excellent or good result. The only complication was a stress fracture, which developed in one bone block.

Adolescent↗
PubMed2002

Patellar tendon anterior cruciate ligament reconstruction with conical press-fit femoral fixation: 5-year results in athletes population.

Bone-patellar tendon autograft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral conical press-fit fixation. A prospective study was performed on 40 consecutive active athletes who underwent ACL reconstruction with this technique by the same surgeon between November 1994 and September 1995 (mean follow-up 46 months, range 36-62). Results were evaluated by an independent examiner using radiography, computed tomography, subjective and objective evaluation, and isokinetic and functional strength tests. Assessment using the IKDC knee scoring revealed 85% of the patients with a normal or nearly normal knee joint; Tegner's score was 7.5 preoperatively and 6.0 postoperatively, with 60% of the athletes returning to the preinjury sport and level. No patients had instability, with 90% having less than 3 mm side-to-side difference on computerized analysis. The isokinetic test showed mild quadriceps deficit at 3 and 6 months, with no deficit at final follow-up; four patients complained of anterior knee pain and had a positive kneeling test. We found no graft dislocation. All cases showed radiological evidence of graft integration at 3 months time. Long-term results support this technique asx a simple, cost-effective, and reliable alternative for patellar tendon fixation in ACL reconstruction.

Adult↗
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↗
PubMed1991

Radiographic changes in arthrogrypotic knees.

We evaluated the knees of 62 patients with arthrogryposis multiplex congenita radiographically. Abnormal radiographs were noted in 34. The abnormalities consisted of both congenital and chronic changes secondary to long-standing clinical deformities including patellar elongation, malposition, flattening of the femoral condyles, joint incongruity, tibial plateau irregularities, tibial and femoral fractures, fibula hypoplasia, soft-tissue thickening, valgus deformity, and dislocation. The radiographic findings were consistent with the degree of longstanding physical deformity and can be used as a guide to the severity of the condition and the need for treatment.

Arthrogryposis↗
PubMed1989

Lateral release for recurrent dislocation of the patella.

We reviewed 41 knees after arthroscopic lateral release for recurrent dislocation of the patella at a mean follow-up of four years, and graded the results according to the criteria of Crosby and Insall (1976). There were no dislocations after operation in 28 knees (68%); the less satisfactory results were in patients with subluxation of the patella on extension of the knee and those with generalised ligamentous laxity. There were no complications. A characteristic and previously unreported lesion of the patellar surface was seen in eight of the 41 knees. The results of lateral release are better than those reported for other techniques. This treatment, by either open or arthroscopic methods, is recommended.

Adult↗
PubMedDate not supplied

Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts.

We reviewed the results in 13 patients who underwent simultaneous allograft reconstruction of both the anterior and posterior cruciate ligaments after a knee dislocation (nine acute and four chronic injuries). Seven patients sustained related medial collateral ligament injuries and six patients had posterolateral complex injuries. Ligament reconstructions were performed using fresh-frozen Achilles or patellar tendon allografts. At follow-up evaluation (mean of 38 months), only one patient described the reconstructed knee as normal. Six patients had returned to unrestricted sports activities and four had returned to modified sports. The average extension loss was 3 degrees (range, 0 degree to 10 degrees) and average flexion loss was 5 degrees (range, 0 degree to 15 degrees). The KT-1000 arthrometer measurements at 133 N anterior-posterior tibial load showed a mean side-to-side difference of 4.5 mm (range, 0 to 10) at 20 degrees and 5.0 mm (range, 0 to 9) at 70 degrees. The mean Lysholm score was 88 (range, 42 to 100). International Knee Documentation Committee ratings were six nearly normal, five abnormal, and one grossly abnormal. Two patients required manipulations for knee stiffness. This study demonstrates that reconstruction of both cruciate ligaments can restore stability sufficient to allow sports activity in most patients with knee dislocations, but "normal" results are difficult to achieve.

Adolescent↗
PubMed1985

[Transplantation of the anterior tibial tubercle by the Elmslie-Trillat technic. Indications as a function of morphotype].

The authors note that medial transplantation of the tibial tubercle diminishes the control of lateral rotation of the tibia by the quadriceps and increases stresses on the knee in varus. They have reviewed a hundred knees operated on between 1973 and 1981. Before operation, the morphology of the patients compared with a normal population was characterised by a moderate medial torsion of the femur, a marked lateral torsion of the tibia and some genu varum. After the transplant the varus was identical but in about half of the cases, lateral laxity was noted. Passive rotation of the tibia was increased and this sign was even greater in cases of marked tibial torsion. The authors conclude that this procedure is not indicated in cases of genu varum, excessive lateral tibial torsion and lateral laxity. The best indications are cases of recurrent dislocation of the patella in knees with normal rotary alignment and painful patello-femoral syndromes. They emphasise the importance of an extensive release of the lateral patellar retinaculum, of distal transplantation of the tubercle in cases of patella alta but not too much and of some degree of anterior displacement of the tubercle.

Adolescent↗
PubMed1991

[Are patellar tension band reconstructions with absorbable materials possible? An animal experiment].

Different biodegradable tension band reconstructions of transverse osteotomies of sheep patella were tested in an experimental pilot study. Without postoperative immobilization, 4 metallic fixations in the control group dislocated secondarily 3 +/- 2 days after the operation. After tenotomy of the gastrocnemius muscle tendon, 6 other metallic fixations showed good bone healing after 12 weeks. Therefore all other fixations were immobilized postoperatively. In 5 of 6 tension band fixations with pure polydioxanone cords (PDS) ventral callus distraction started after 18 +/- 7 days, but total consolidation had taken place after 14 weeks. One PDS fixation failed for technical reasons. The combination of two axial polyglycolide rods (BIOFIX) with two ventral PDS cords showed different results: when rods 4.5 mm in diameter were used 1 fixation dislocated because the fragments were burst by the oversized rods. With rods 3.2 mm in diameter 3 other fixations were followed by complete consolidation with no dislocation after 12 weeks. Other tested combined fixation systems made up of polyglycolide and polylactide composites (cords, screws) failed secondarily, either because the fragments were burst by the oversized implants or because of the fragility of the polylactide cords. It was impossible to use polylactide screws as lag screws, because the screw heads gave way to torque. In an additional study we observed a decrease in tissue pH after implantation of polyglycolide rods in the medullary space of the tibia. Compared with the control medullary space without implants, the pH decreased from 7.38 to 6.92 at the point of greatest implant mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗