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Vascular and nervous complications in injuries of the knee joint.
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Cost effectiveness of magnetic resonance imaging of the knee.
When compared to diagnostic arthroscopy in patients with knee complaints consistent with internal derangement, MR imaging emerges as a cost effective diagnostic supplement to clinical examination. This article concludes that the results of MR imaging can be used as a guide for the management of knee pain.
Clinical test for anterolateral rotary instability of the knee.
A simplified test for anterolateral rotary subluxation of the knee is largely based on the concepts described by Galway and McIntosh although performed in a different manner. The examiner places the right hand gently on the lateral side of the knee with the thumb overlying the posterior aspect of the fibula and the index finger palpating the anterolateral aspect of the joint line to determine the the tibiofemoral relationship. The left hand embraces the lateral side of the distal end of the femur with the thumb over the posterior aspect of the lateral femoral condyle. With equal pressure on the lateral femoral condyle and fibular head the knee is pushed gently forward into flexion. When anterointernal tibial luxation is present, a reduction phenomenon is felt as the knee passes into the 25 to 40 degree flexion range. This may occur as a sudden palpable and occasionally audible repositioning which is responsible for such terminology as a "pivot shift" or "jerk sign." We have experienced many instances where the reduction phenomenon is more subtle and is determined by palpation alone. The pathologic mechanics are determined by observations at surgery in 45 patients with a positive test. This test has improved our diagnositc ability and is easly taught to those unfamiliar with knee joint disorders.
Essential facets of radiological diagnosis of extremity trauma.
Trauma to the extremities is sometimes dismissed as relatively unimportant in certain radiologic circles. In many instances, radiologic responsibility is denied and relegated to the orthopedist. Although the radiologic manifestations of much trauma to the extremities is clear cut and does not require sophisticated techniques or interpretation, there are many diagnoses which require innovative techniques and a knowledge of mechanisms of injury as well as the subtle oseous and soft tissue manifestations which may be confronted radiologically. The above factors will be stressed along with the need for the fundamental knowledge of radiologic anatomy which is required in order to appreciate some of the more subtle changes of extremity trauma.
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.
Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon from the knee. Surgical technique and case report.
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The philosophy and application of arthroscopy in nonmeniscal problems of the knee.
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Osteochondritis dissecans of the knee. A clinical survey.
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Acute anterolateral rotatory instability of the knee.
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Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured patients.
Twenty consecutive multiply injured patients who had a total of twenty-two fractures of the femoral shaft were managed with intramedullary nailing without reaming. A retrograde technique through the intercondylar notch of the knee was used. All patients were followed for at least one year or until union of the fracture. The operative time for the nailing averaged seventy-five minutes (range, thirty-five to 105 minutes). Union of the fracture occurred at an average of fifteen weeks. There were three non-unions and one rotational malunion. There were no infections, and no nail or screw failed. Normal motion of the knee was regained by all patients, except one who had had an ipsilateral dislocation of the knee. On the basis of these preliminary results, we concluded that retrograde nailing is a safe and effective technique for multiply injured patients. The apparently higher prevalence of non-union compared with that reported with antegrade nailing with reaming warrants additional study.
Guepar total knee prosthesis. Experience at the Vancouver General Hospital.
Eighty-three Guepar valgus-hinge prostheses and 30 prostheses with collinear femoral and the tibial components were inserted in 97 patients at Vancouver General Hospital between March 1975 and May 1978. One hundred and nine arthroplasties were reviewed between January 1979 and April 1980, after an average follow-up of 19 months. It was found that the amount of bone resected made arthrodesis difficult, that there was a very high incidence of patellar instability and that the disintegration of the Silastic bumper created a severe chemical synovitis. The results were excellent in 32, good in 23, fair in 8, and poor in 30. Patellar subluxation occurred in 28 per cent of the valgus prostheses, and in 10 per cent with the straight prostheses; it did not occur with the straight prostheses in rheumatoid joints. The chemical synovitis led to failure with devastating complications necessitating further operations in some knees.
Anterolateral rotary instability of the knee joint. Results after stabilization by extraarticular transposition of the lateral part of the patellar ligament. A preliminary report.
A method using the lateral third of the patellar ligament and the adjacent part of the patella as an extraarticular transplant to the lateral femoral condyle in the stabilization of anterolateral rotary instability of the knee is described and discussed. The operation was performed in six patients. The stabilizing effect of the procedure could be evaluated in only five of them due to the development of septic arthritis in one patient. Four of these five patients had ruptured the anterior cruciate ligament, while the fifth patient had a congenital anterolateral instability. In this patient the procedure was combined with an Ellison operation. In all five patients the operation eliminated the instability and resulted in good function. The procedure is recommended for further testing in the treatment of anterolateral rotary instability of the knee as an alterative method to procedures applying the iliotibial band.
Fluoroscopic technique for double-contrast knee arthrography.
The fluoroscopic double-contrast technique of arthrography of the knee is useful in documenting the extent of suspected injury to the knee. It is of particular value in demonstrating small and large lesions involving the menisci, cruciate ligaments, patellar cartilages, as well as the articular cartilages of the femoral condyles and tibial plateaus. This examination is instrumental in the diagnosis of the patient with an atypical history of injury and unusual physical findings. A simple restraint device allows the fluoroscopist complete control over the stress applied to the knee while positioning the patient for filming. Fluoroscopic spot radiographs of excellent contrast and sharp detail can be obtained of each of the various structures, applying the stress needed. When the radiologic technologist takes a little time to become more knowledgeable about the anatomy of the knee jount, and the rationale for the various views, the knee arthrographic examination is easily understood.
Ballet injuries: the Australian experience.
There is a distinct difference between ballet injuries and sports injuries in general, and the sports medicine physician needs to study the technique of dance and the specific injuries that it may produce in order to treat dancers effectively. In Australia, which is typical of other countries where ballet is performed, ballet injuries include strained lumbar muscles, sprained ankle, Achilles tendinitis, clicking hip, jumper's knee, chondromalacia, stress fractures, patellar subluxation, and other knee and tendon problems.
Maisonneuve fracture equivalent with proximal tibiofibular dislocation. A case report and literature review.
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Injuries of the knee associated with fractures of the tibial shaft. Detection by examination under anesthesia: a prospective study.
Ligamentous injuries of the ipsilateral knee have been documented in association with 25 to 35 percent of fractures of the femoral shaft. However, to our knowledge, a similar association between ligamentous injuries of the knee and fracture of the tibial shaft has not been studied prospectively. To determine if there was such an association, a prospective study was conducted in which the knees of fifty patients who had a fracture of the ipsilateral tibial shaft of varying severity were examined manually while the patient was under general anesthesia. Eleven patients (22 percent) were found to have sustained an injury to at least one ligament of the knee that resulted in increased laxity of 2+ or more. One knee had dislocated. On the basis of the results of this study, we believe that, after stabilization of a fracture of the tibial shaft, it is essential to examine the knee thoroughly to identify any associated ligamentous injuries.
[Determination of femoropatellar joint dysplasia (author's transl)].
On the basis of more than 1400 tangential X-rays made with Knutsson's technique, the author qims to demonstrate, employing optical and measurement criteria, the limits between normal conditions and dysplasias. Since there are no fixed boundaries, these two areas can only be delimited from each other with sufficient accuracy by means of an inter-mediate zone. The patella is differentiated according to its shape in euplasia, medial hypoplasia and dysplasia, corresponding to the trochlea in Types I-V. In relation to the knee joint in question, there is a high degree of correlation between the development of the patella and the trochlea. All in all, a dysplasia can be determined more easily and more accurately at the trochlea than at the patella, since the patella is subject to greater projectural changes and the points of measurement are more difficult to establish. Ficat and Bizou's condylar depth index and the condylar-joint surface angle of Brattström are recommended as especially suitable methods of measurement. Since the shape of the trochlea changes as a function of the extent to which the knee is bent, the latter must be cited in comparative investigations.