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PubMed1976

[Fresh combination injuries of the knee joint--diagnosis and treatment (author's transl)].

The diagnosis of fresh combination injuries of the knee joint is difficult. It is under all circumstances mandatory, occasionally by employing general anesthesia, to establish a diagnosis and the extend of the injury to decide on a conservative or surgical approach. Partial ruptures of the capsule and ligaments may be treated conservatively, complete ruptures are a surgical must. Between 1963 and 1974 we operated on 35 knees in 34 patients after afresh combination injury of the knee joint. 14 patients (15 knees) could be followed between 2 and 10 years postoperatively. All patients were satisfied with the result and were participating in sports. The objective results were excellent in 2, good in 12 and sufficient in 1. Knee joint stability could be reestablished in all knees. Follow-ups of a similar group of 14 patients after reconstructive treatment of an old "unhappy triad" showed considerably poorer results both subjectively and objectively. We conclude that fresh complete ruptures of the ligamentous and capsular structures of the knee joint have to be surgically repaired immediately to prevent permanent damage.

Adult↗
PubMed1993

Use of a modified Quengel hinge to prevent posterior displacement of the tibia during treatment of PCL injury.

During treatment of posterior cruciate ligament (PCL) injuries, posterior displacement of the tibia may occur inside the cast due to the effect of gravity on the lower leg. To prevent this problem the authors attempted to apply the original Quengel cast, first described by Mommsen in 1922 and perfected by Jordan, to correct the flexion contracture of the knee in hemophiliacs. However, the authors found that the cast was not effective in preventing the posterior displacement of the tibia during management of PCL injuries. They modified the design of the original Quengel hinge to obtain a more effective anterior traction on the tibia parallel to the knee joint line. Of the 32 patients who used the modified Quengel brace, 15 who could be followed had less than a 3 mm difference between the injured and uninjured knee 3 months postoperatively.

Adolescent↗
PubMed1975

The diagnosis and initial management of the acutely injured knee with particular reference to sport injuries.

A series of 115 consecutive cases of acutely injured knee, occurring mainly as a result of rugby-football, is analysed. It is suggested that the successful management of an acute knee injury often depends on the doctor of first contact. A scheme of diagnosis and early management is outlined. Acute subluxation of the patella is shown to be a definite entity in the differential diagnosis of an acute knee injury, and a classification for the purposes of the doctor of first contact is proposed.

Acute Disease↗
PubMed1982

Patellar complications after total condylar arthroplasty.

The incidence of complications in the initial three years' experience with total knee arthroplasty and patellar replacement was 9%. Of the total knee arthroplasties perforated in the last three years, neither fracture nor subluxation of the patella has occurred. A prosthesis with right and left femoral components and slight lateral (physiologic) slanting of the patellar groove is recommended. Lateral release is done only if absolutely necessary and is performed at a considerable distance from the patella to preserve blood supply. Excess bone removal from the patella is avoided. The fat pad is preserved in all cases. Patients who have undergone a patellectomy had a definitely weak knee. Treatment by simple immobilization failed to produce an excellent functional result.

Aged↗
PubMed1986

A male infant with the Catel-Manzke syndrome and dislocatable knees.

A male infant is described with severe micrognathia and bilateral duplication of the proximal phalanges of the index fingers, an association which is characteristic of the Catel-Manzke syndrome. In addition, he had dislocatable knees, which have not been described in this disorder before.

Fingers↗
PubMed1991

Arthroscopic resection of the shelf (mediopatellar plica) in the knee under local anesthesia in outpatient clinic.

Forty-two knees with symptomatic mediopatellar plicae (shelves) were managed using the operative method under local anesthesia. Of these, thirty-one knees had isolated mediopatellar plicae, and eleven had other associated intra-articular pathologic condition, such as meniscal tear, lateral patellar tracking, osteochondritis dissecans, and minor osteoarthritic changes. The clinical results were excellent or good in thirty-seven (88%) patients, fair in five patients after an average follow-up of twenty-five months. No case showed deterioration after surgery. Because there are no definitive criteria for the indication of shelf resection, arthroscopic resection of the shelf under local anesthesia is recommended if there is any possibility of it being the cause of knee pain.

Adolescent↗
PubMed1978

Osteochondral fractures: mechanisms of injury and fate of fragments.

Osteochondral fractures, although relatively common, are frequently misdiagnosed by both clinicians and radiologists. In many of these cases positive radiographic findings are present although subtle. This paper reviews the mechanisms of injury by which osteochondral fractures occur and discusses the radiographic features of such fractures. An analysis of 43 surgical cases of osteochondral fractures in different sites was undertaken with respect to the radiographic, surgical, and histopathologic findings. Fragments consisting of cartilage alone or cartilage and bone were analyzed in terms of their radiographic features acutely and chronically after the trauma. The pathologic changes occurring within the original fragments are differentiated from those of surface growth in the older loose bodies. Attached fragments react differently than loose fragments. Typical cases from the knee joint are illustrated.

Adolescent↗
PubMed1964

RHEUMATOID ARTHRITIS. PHYSICAL MEASURES IN TREATMENT OF CHILDREN.

Prognosis in rheumatic arthritis in children is good, provided total care is given, deformity prevented and function maintained. Bed rest is desirable until active inflammation of the joints has subsided. During convalescence a balance between rest and exercise must be maintained to avoid recurrence of inflammation of the joints. When there is progressive deformity or disabling pain in the wrist, a molded leather wrist-cuff splint can control the deformity, decrease or abolish pain and lessen swelling. If there is valgus deformity of the knee or external rotation of the tibia, with no more than ten degrees of knee flexion deformity, correction can be obtained by simple manipulations.

Adolescent↗
PubMed1986

Patellofemoral incongruence in chondromalacia and instability of the patella.

We measured the patellofemoral congruence in tangential radiographic projections according to Merchant in 64 patients with unilateral patellar pain. The congruence angle was usually within normal limits. However, compared with the asymptomatic side, the angle was increased in chondromalacia and instability of the patella. A comparison of congruence angles of the two knees seems more valuable than a comparison with normal values.

Adolescent↗
PubMed1988

Subluxation of the patella. Computed tomography analysis of patellofemoral congruence.

Fifty patients who had patellar subluxation and thirty control subjects were examined using axial roentgenograms of the patellofemoral joint that were made with the knee in 30 and 45 degrees of flexion, as well as computed tomography scans that were made with the knee in full extension. The amount of lateral patellar tilt was quantitatively assessed using the lateral patellofemoral angle, as described by Laurin et al., and the congruence angle, as described by Merchant et al. In both the control subjects and the patients, the angle of Laurin et al. changed significantly when the knee was flexed from full extension to 30 degrees. The difference between the groups was statistically significant at each angle of flexion of the knee, and the difference between the groups was most prominent on the computed tomography scans that were made with the knee in full extension (p less than 0.001). In the patients, the average congruence angle (as described by Merchant et al.) was 5 degrees and in the control subjects, -10 degrees. This indicated that, in our patients, the extent of the patellar subluxation was less than that in previously reported series, and, as a result, the sensitivity of the congruence angle in diagnosing patellar subluxation was only 0.30. In contrast, the sensitivity and specificity of the computed tomography scans for diagnosing patellar subluxation were 0.96 and 0.90, respectively--that is, they were higher than the values that were obtained using any axial roentgenograms. Thus, our results indicated that patellar subluxation can be detected more accurately by using computed tomography with the knee in full extension than by using conventional axial roentgenograms.

Adolescent↗
PubMed1985

[Femoropatellar joint. Aspects of anatomy, physiology and pathophysiology].

The variety of anatomic conditions is critically confronted with the so-called dysplasias of the patella. Is chondromalacia or anterior knee pain a clinical diagnosis? The physiological aspects of the tension forces acting on the patella with its position in the midst of tendons and ligaments in valgus and in varus knees are discussed. What may the automatic rotation in extension effect on the patellofemoral joint-compartment?

Biomechanical Phenomena↗
PubMed2001

Total knee arthroplasty in an adult with congenital dislocation of the patella.

This article reports the use of total knee arthroplasty with release of the lateral retinaculum, proximal extensor mechanism realignment, and patellar resurfacing as a valid treatment option for adult patients with congenital dislocation of the patella who have absence of the femoral sulcus and associated osteoarthritis. The patient presented in this case report had improvement of his Knee Society knee score and function score from preoperative levels of 8 and 45 to 77 and 80 postoperatively.

Arthroplasty, Replacement, Knee↗