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PubMed1990

[A complex injury of the knee joint associated with a popliteal artery lesion--case report].

Injuries of the popliteal artery are frequent in the dislocations of the knee joint, and an early diagnosis of a lesion of the popliteal artery is the base for the successful treatment. Generally, in all the traumas in the region or proximity of the knee joint, it should always be taken into consideration a possibility of arterial injury. In our case there was a posterior knee joint luxation with evidently contused and thrombosed popliteal artery. The surgery was done in an inappropriate time (more than 14 hours after the injury), and consisted in a Goretex graft interposition, and following a ligamentary reconstruction a transitory arthrodesis with external fixator (AO) in one level was carried out, what can be a model for similar situations. A control arteriography immediately before the patient's discharge from the hospital showed an arterial passage, while clinically an evidently lesser posterior unstability existed. In the surgical managing of such injuries it is necessary an interdisciplinary approach, appropriate period of time and corresponding sequences of repairs.

Accidents, Traffic↗
PubMed1988

Total knee arthroplasty in a patient with congenital dislocation of the patella. Case report.

A 63-year-old man with bilateral congenital dislocation of the patella developed severe osteoarthritis of his knee joints. Bilateral total knee arthroplasty was performed without an attempt to correct the dislocated patella and extensor mechanism. Four years later the patient had excellent, painless function of his knee joints with stability and excellent quadriceps strength.

Humans↗
PubMed1981

Anterior subluxation of the lateral tibial plateau. A new clinical test and the morbidity of this type of knee instability.

A new clinical test is presented for the diagnosis of anterolateral knee instability. The advantages of the test are obviation of apprehension- and muscle spasm avoiding false negative results and also the recognition by the patient of his sensation of "collapsing at the knee". This allows for differentiation between "giving away" due to a torn meniscus alone and concomitant anterolateral knee instability. It implies important consequences for prognosis and treatment of the knee problem of the athlete. Underlying pathology consists of a torn anterior cruciate ligament and primary or secondary stretching of the soft tissues at the lateral and posterolateral capsule. These lesions and a positive test for anterolateral knee instability does not inevitably result in a disability for sports activity. The dynamic muscular control protects the knee in many instances from collapsing at cross over cutting.

Diagnosis, Differential↗
PubMed1983

Severe cardiac anomalies in sibs with Larsen syndrome.

Larsen syndrome is characterised by congenital anterior dislocation of the knees, associated with other joint dislocations, and a characteristic facies. Autosomal recessive and dominant inheritance have been proposed. A brother and a sister with consanguineous parents, suggesting autosomal recessive inheritance, were found to have the typical features of Larsen syndrome. In addition, they had severe cardiac manifestations, never reported before in familial cases of the syndrome. We suggest that the recessive form is probably more severe than the dominant form because of the frequent presence of concomitant cardiac anomalies.

Abnormalities, Multiple↗
PubMed1988

The patellofemoral component of total knee arthroplasty.

Patellofemoral complications continue to form a large proportion (up to 50%) of total knee arthroplasty (TKA) complications. If adequate attention is paid intraoperatively to patellar tracking and component position, the incidence of subluxation, component loosening, and fracture should decrease. When treating patellar subluxation and dislocation, tibial tubercle transfer should be avoided because there is an unacceptably high incidence of complications. Care should be taken to treat the underlying cause of dislocation with either a soft tissue procedure or component revision. Fracture of the patella may be treated nonoperatively in 50% and 80% of patients. Cysts, if large, may be bone-grafted to avoid the potential complications of stress fracture and component loosening. Loosening of the patellar component is likely to be symptomatic and to require surgery in up to 75% of cases. A displaced patellar component may cause attritional wear of the quadriceps tendon or patellar ligament. All rheumatoid patellae should be resurfaced. The present trend in the osteoarthritic patella is toward resurfacing more often. With improved implant design and a predicted decrease in complications, resurfacing in the osteoarthritic patella may become routine. Osteoarthritic patellae that maintain good cartilage, normal anatomic shape, and congruent tracking need not be resurfaced.

Adult↗
PubMed2004

[Dislocation of the proximal tibio-fibular joint due to severe leg and knee trauma].

PURPOSE OF THE STUDY: Dislocation of the proximal tibio-fibular joint is a rare lesion generally described in athletes. In our experience, high-energy trauma in traffic accident victims was a frequent cause. Dislocation of the proximal tibio-fibular joint is generally described as anterolateral, posteromedial, superior, or subluxation. We describe an inferior form of dislocation. MATERIALS AND METHOD: The study population included eight men aged 21-55 years (mean 31 years). One patient had bilateral dislocation. There were four superior, one posterior, and four inferior dislocations. All patients also had an associated fracture of the tibia which was an open fracture in eight cases. Five patients suffered a lesion to the common fibular nerve. Three had tibial nerve involvement in a context of inferior disclocation. The lateral collateral ligament was torn in six cases. The central pivot was involved in four. Two patients had an avulsion of the patellar ligament on the tibial tuberosity. Five patients had vessel damage. Three required emergency amputation. Two patients (one superior and one inferior dislocation) underwent emergency bypass surgery but required below-knee amputation later due to persistent ischemia. All dislocations, excepting the one case of complete fibular avulsion and one emergency above knee amputation were treated by transarticular screw fixation of the proximal tibio-fibular joint. RESULTS: Mean follow-up was 5.8 years (1-9 years). At last follow-up, there were no cases of instability or pain in the proximal tibio-fibular joint. The patient with an initial neurapraxia in territory of the common fibular nerve recovered totally. The five amputated patients had prostheses and walked without crutches. DISCUSSION: Dislocation of the proximal tibio-fibuilar joint is a rare entity, but the frequency is probably underestimated. The dislocation can go unrecognized in patients with multiple injuries. Careful search should nevertheless be undertaken due to the risk of secondary involvement of the common fibular nerve. The Harrisson and Hindenach classification, inspired by the Lyle classification, does not mention inferior dislocation of the proximal tibio-fibular joint, a recently described entity. Our series included dislocations resulting from high-energy trauma associated with numerous ligament, nerve, and vessel injuries. In this context, dislocation of the proximal tibio-fibular joint constitutes an epiphenomenon.

Adult↗
PubMed1994

Refixation of large chondral fragments on the weight-bearing area of the knee joint: a report of two cases.

In most cases of cartilage avulsion, the chondral fragments are severely damaged, and refixation is therefore impossible. We present two cases with large intact cartilage fragments from the weight-bearing area of the femoral condyle after patellar dislocation. We tried refixation using fibrin sealant (Tisseel-Kit, Immuno AG, Vienna, Austria) and polydioxanone-pins (Bio-fix-Pins, Miracon AB, Helsingborg, Sweden). At second look arthroscopy, we found only one third to one half of the defects healed. Due to these results, the refixation of chondral fragments without attached bone seems to be questionable.

Adolescent↗
PubMedDate not supplied

Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment.

We performed a prospective analysis of 29 Fulkerson anteromedial tibial tubercle transfers in patients with chronic anterior knee pain. The average followup was 32 months (range, 25 to 44). Fourteen patients (Group 1) had subluxation-type malalignment (congruence angle > 20 degrees, tilt angle > 8 degrees) and were treated with an isolated anteromedial tibial tubercle transfer. Fifteen patients (Group 2) had combined subluxation and tilt malalignment (congruence angle > 20 degrees, tilt angle < 8 degrees) and underwent anteromedial tibial tubercle transfer combined with a lateral release. Pre- and postoperative evaluations included clinical and radiographic examinations, Lysholm and Kujala patellofemoral scores, and standing-alignment computed tomography scans in 15 degrees of flexion taken transversely at the midpatellar. In all but one patient a dramatic improvement in Lysholm and Kujala scores was noted. The congruence angle improved in all patients except one, with an average improvement of 16 degrees in Group 1 and of 14 degrees in Group 2. The tilt angle remained relatively unchanged (change, -0.5 degree) in Group 1, but it improved by 11 degrees in Group 2. We conclude that an isolated anteromedial tibial tubercle transfer can consistently improve patellar subluxation and, when combined with a lateral release, can improve patellar subluxation and tilt, resulting in improved functional scores for patients with chronic anterior knee pain.

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↗
PubMed1994

Patterns of knee arthrosis and patellar subluxation.

This study was based on the unexpected observation of lateral patellofemoral subluxation in the varus osteoarthritic knee. Standardized radiographs of 109 knees (65 patients with osteoarthritis) were selected randomly from the authors' database and retrospectively reviewed. Hip-knee-ankle alignment data were correlated with patellofemoral subluxation and tilt, as well as with radiographic patellofemoral grades for arthrosis. The amount and site of patellofemoral arthrosis were correlated with patellar position and limb alignment. Patellae that were located centrally in the trochlear groove had the lowest radiographic score for arthrosis. Subluxation of the patella, either medially or laterally, was correlated with increased radiographic scores. Limb alignment was not correlated with the radiographic score. A significant percentage of varus knees (28%) had unexpected lateral subluxation of the patella. This observation has not been reported previously. It may have an impact on surgical decision-making for total knee arthroplasty and osteotomy.

Biomechanical Phenomena↗
PubMed1994

Computer simulation of glenohumeral and patellofemoral subluxation. Estimating pathological articular contact.

Analytic stereophotogrammetry and an interactive computer graphics program were used to obtain first order assessments of joint contact patterns in patellofemoral and glenohumeral joints, simulating normal and abnormal articulations. Precise (90 microns accuracy) computer graphic representations of the humeral head, glenoid, patella, and femoral articular surfaces were obtained from cadaver knees and shoulders. These surface representations were then manipulated into an articulated position, and joint contact areas computed by a proximity criterion. Pathologic states were then simulated, and contact recomputed. Simulated glenohumeral subluxations dramatically reduced contact area, and focused it eccentrically on the glenoid rim. Simulated size mismatch of humeral heads to glenoids reduced contact area, producing a pattern of peripheral contact on the glenoid if the humeral head had a larger radius of curvature, and central contact on the glenoid if the humeral head had a smaller radius of curvature. At 30 degrees knee flexion, the patellofemoral joint demonstrated a broad distribution of contact along the distal aspect of the patella and proximal aspect of the trochlea. Simulated lateral tilt (5 degrees) and translation (5 mm) of the patella resulted in shift of the predominant contact area laterally, along with a drastic decrease in the contact area. These results have implications for prosthetic sizing and biomechanical modeling of the glenohumeral and patellofemoral joints, and in selecting models for more rigorous empiric studies of joint contact. Furthermore, this technique allows a first order assessment of the effects of specific surgical reconstructions on articular mechanics.

Computer Graphics↗