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PubMed1983

Patellar pain and incongruence. I: Measurements of incongruence.

In 150 normal asymptomatic knees, the average Q angle was 15 degrees. The patellar length was equal to the patellar ligament length, and the average congruence angle was -8 degrees. In 53 knees with recurrent subluxation, the patella was high-riding (TP, 1.23), the sulcus angle was shallow (147 degrees), and the average congruence angle was +16 degrees. In 53 knees with "chondromalacia," the Q angle was increased (20 degrees), and the average congruence angle was -2 degrees.

Adolescent↗
PubMed1987

Extensor mechanism complications following total knee arthroplasty.

Extensor mechanism complications following 281 knee arthroplasties that included patellar resurfacing, performed by two surgeons in one hospital over a 6-year period, were reviewed. The mean follow-up period was 42 months. There were 28 (10%) extensor mechanism complications: 3 quadriceps tendon ruptures, 5 patellar fractures, 4 patellar tendon ruptures, 11 recurring patellar subluxations, 4 cases of patellar pain, and 1 malrotated patella. Nine (3%) required further surgery. Surgical technique may have contributed to the tendon ruptures; patellar fractures occurred mainly in patients who had rheumatoid arthritis. Patients with patellar subluxation had abnormal preoperative valgus deformities of their knees and presented with this subluxation problem an average of 4 months after surgery, but it appeared to cause them less discomfort with time. Patellar resurfacing as part of a knee arthroplasty procedure is recommended but should be performed with care to the integrity and vasculature of the extensor mechanism.

Aged↗
PubMed1987

Unicondylar knee arthroplasty. 2-10 years of follow-up evaluation.

One hundred fifty-nine Mod II unicompartmental knee arthroplasties were reviewed. The follow-up period ranged from 2 to 10 years (average, 4 years and 6 months). Osteoarthritis was the most common reason for arthroplasty (108 cases). The patients' age at the time of operation averaged 72 years (range, 28-92 years). The diagnosis directly influenced the quality of the final results, which were assessed according to pain, range of motion, stability, and function. Patients with osteoarthritis and medial condyle osteonecrosis had the best results. The average flexion angle obtained was 115 degrees, and the average residual axial deviation was 6 degrees for varus deformities and 8 degrees for valgus deformities. Nine failures, including two deep infections, four femorotibial subluxations, two cases of deterioration of the opposite compartment, and one loosening, required eight revision procedures. Knee instability due to bony loss, much more frequent in osteoarthritis than pure ligamentous laxity, was regularly corrected with this procedure.

Adult↗
PubMed1992

[The femoropatellar gliding motion during active knee stretching. Imaging using motion-triggered MR tomography].

By means of motion-triggered MRT it has been possible for the first time to demonstrate movements in the patello-femoral joint by means of MRT. Patello-femoral movement was studied during active extension of the knee between 30 degrees flexion and complete extension. The knees of 5 normal females and 7 normal males were studied together with 2 women with recurrent lateral patellar luxation. In normal women there was an average 16 degrees (10 to 18 degrees), in men an average of 12 degrees (10 to 14 degrees) of lateralisation of the patella during complete extension of the knee. In 1 patient there was 10 degrees medial displacement of the patella before extension. In 2 knees with recurrent lateral subluxation there was a 20 and 24 degrees displacement of the patella.

Adolescent↗
PubMed1993

Long-term complications after total knee arthroplasty with or without resurfacing of the patella.

The long-term complications related to the patella were retrospectively evaluated for 891 knees (684 patients) that had had a total arthroplasty, with or without resurfacing of the patella, with use of an unconstrained, condylar, posterior-cruciate-preserving prosthesis. The study population comprised two groups of patients who were similar in size, age, sex distribution, and diagnosis. One group (396 knees [303 patients]) had had a total knee arthroplasty with patellar resurfacing and the other group (495 knees [381 patients]) had had the same procedure without resurfacing. The average duration of follow-up was six and one-half years (range, two to fifteen years). The decision to resurface the patella was based on subjective inspection of the articular surface and on assessment of patellar tracking at the time of the operation. Resurfacing was performed if there was loss of cartilage, exposed bone, gross surface irregularities, or tracking abnormalities. Complications occurred an average of three years (range, immediately postoperatively to nine years) after the operation in the group that had had resurfacing and an average of four years (range, immediately post-operatively to ten years) postoperatively in the group that had not had resurfacing. In the group that had had resurfacing, there was loosening of the patellar component in five knees, patellar subluxation in four knees, fracture of the patella in three knees, rupture of the patellar tendon in three knees, and chronic peripatellar pain in one knee. In the group that had not had resurfacing, the complications included patellar subluxation in five knees, rupture of the patellar tendon in two knees, and chronic peripatellar pain in fifty-one knees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Impact of diagnostic arthroscopy on the clinical judgement of an experienced arthroscopist.

This study explores the impact of a careful analysis of 1000 consecutive cases of diagnostic arthroscopy conducted by the author. The cases are evaluated to determine whether there is a tendency to clinically misdiagnose certain lesions. The findings furthered knowledge in regards to other possible diagnoses for specific symptom complexes. Diagnostic arthroscopy has allowed surgeons to " fine tune" their preoperative diagnostic ability and can be a very useful enhancement to the armamentarium of clinical evaluations, laboratory tests, plain radiographs, and double contrast arthrograms as diagnostic tools for knee problems. An "audit" procedure is outlined that could benefit any surgeon who is concerned about increasing their diagnostic ability.

Adolescent↗
PubMed1980

[Femoro-patellar joint. Advantages of axial projection in external rotation of the knee (author'r transl)].

The classical technic for radiological examination of femoro-patellar joint cannot visualize a lot of real chondromalacia. Their diagnosis, and, therefore, their treatment, usually surgical, rely on doubtful results of clinical examination. Axial projections combined with external rotation of the knee is not perfect, but it is a good improvement. It reveals many femoro-patellar syndroms without any radiological expression until this time.

Femur↗
PubMed1980

Anterolateral rotatory instability of the knee.

We have achieved excellent short-term results (full return to competitive sports) by using the MacIntosh procedure. Patient selection, surgical technique, postoperative care, and rehabilitation are all important factors determining the ultimate success or failure of this surgery.

Humans↗
PubMed1986

Knee problems in children.

The paper describes physical examination of the knee and some of the knowledge functional anatomy necessary for diagnosis and management of knee disorders that occur in children. It includes brief descriptions of the diagnostic features of these conditions, as well as principles of conservative and surgical management.

Cartilage Diseases↗
PubMed2000

Operative treatment of combined anterior and posterior cruciate ligament injuries in complex knee trauma: can the cruciate ligaments be preserved?

A retrospective study was performed focusing on operative treatment after combined anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) injuries. The operative treatment included the preservation of one or both cruciate ligaments. Twenty-eight patients, average age 30 years (range: 12-55 years), were evaluated 5.4 years (range: 1-14 years) postoperatively. Twenty-two operations were performed in patients with acute injuries (<30 days after trauma) and 6 operations in patients with chronic instabilities (>30 days after trauma). Both cruciate ligaments were preserved by suture or refixation in 16 patients. Suture of one and reconstruction of the other cruciate ligament with autologous tendon graft was performed in 12 cases. In addition, 61 procedures (meniscal suture/resection, medial/lateral reconstruction, tendon suture, and open reduction and internal fixation were performed. Postoperative treatment included continuous passive motion and protected weight bearing. Eleven (27% acute, 83% chronic) patients required revision (ACL/PCL reconstruction, osteotomy, and meniscal repair). At follow-up, 43% of the patients were very satisfied and 46% were satisfied. Seventy-one percent (89% preinjury) of the patients were able to maintain intensive and moderate International Knee Documentation Committee (IKDC) activity levels. The IKDC evaluation of the patients (acute %/chronic cases %) was graded for symptoms: A 39% (45/17), B 35% (27/67), C 15% (18/0), and D 11% (9/17); for range of motion: A 42% (36/67), B 42% (50/17), C 16% (14/17), and D 0%; and for ligaments: A 21% (18/17), B 33% (45/0), C 42% (32/83), and D 4% (5/0). Radiographic findings were A 18%, B 41%, and C 41%. Primary repair of acute injuries was superior to the delayed repair of chronic instabilities. Preservation of cruciate ligaments in acute combined ACL/PCL tears results in a satisfying knee function despite distinct residual ligament instability. Although suture of the cruciate ligaments in open technique is a therapeutic option in acute multiligamentous knee injuries, it is not recommended for the treatment of chronic instabilities.

Adult↗
PubMed2000

Emergency department evaluation and treatment of knee and leg injuries.

The knee is one of the most commonly injured joints in the human body, and, largely because of athletic injuries, they are increasing in frequency in the United States. This article provides a brief overview of knee anatomy, examines radiographic imaging techniques and arthrocentesis of the knee, and discusses injuries specific to the knee. An overview of leg anatomy is also presented, along with discussions of specific fractures common to the leg.

Anterior Cruciate Ligament Injuries↗
PubMed1993

The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survivorship analysis.

From 1983 to 1987, 82 unicondylar arthroplasties were performed for primary unicompartmental osteoarthrosis. Seven knees had lateral compartment arthroplasties and 75 had medial unicompartmental knee arthroplasties (UKA). At a minimum follow-up period of four years, eight patients had been revised, one patient was scheduled for revision, and one patient had died with a failed UKA, for a total failure rate of 12%. Reasons for failure were progression of tricompartmental arthritis in two patients (2.4%), polyethylene wear in two (2.3%), component failure in two (2.3%), component loosening in three (3.5%), and technical error in one (1.6%). Furthermore, 14 (17%) patients showed roentgenographic evidence of impending failure and an additional 12 (15%) patients showed a gradual decline in Hospital for Special Surgery knee scores. Unicondylar knee arthroplasty does not appear to provide as reliable pain relief as total knee arthroplasty. Progression to tricompartmental arthritis, polyethylene wear, and component loosening were seen to limit the usefulness of this arthroplasty. Unlike total knee arthroplasty, factors affecting the success or failure of UKA cannot be predictably controlled by the surgeon.

Aged↗
PubMed1993

Patellar tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging.

To evaluate the critical range of the patellofemoral joint motion from 30 degrees of knee flexion to full extension, motion-triggered cine magnetic resonance (MR) imaging was performed during active extension in 13 patients with confirmed patellar maltracking and 15 healthy subjects. Cine MR images were compared with static MR images obtained during incremental extension of the knee joint. To evaluate the patellar tracking pattern, the same imaging parameters (patellar tilt angle, bisect offset, and lateral patellar displacement) and section locations were used in the static and motion-triggered studies. Statistically significant differences between the passive and active knee motions were found in all three parameters in the group of patients and in the bisect offset in the control group. The comparison between patients and healthy subjects yielded statistically significant differences for all parameters in actively extended knees but not in passively extended knees. The results demonstrate the importance of dynamic patellar motion studies for diagnosis of patello-femoral maltracking.

Adolescent↗
PubMed1993

Dislocation following primary posterior-stabilized total knee arthroplasty.

From 1981 through 1991, 3,032 primary total knee arthroplasties were performed using the Insall-Burstein Posterior Stabilized Condylar Prosthesis (IB-I, IB-II, and IB-II modified) (Zimmer, Warsaw, IN). Fifteen posterior dislocations occurred: 4 with the IB-I system occurring 2 or more years after surgery, 10 with the IB-II system (8 occurring 6 months after surgery and 2 occurring 2-3 years after surgery), and 1 with the IB-II modified system occurring 9 months after surgery. Statistically significant differences for the rate of dislocation between both the IB-I and IB-II modified arthroplasties versus the IB-II arthroplasties were found (P < .001). In an attempt to identify a cause for these dislocations, the authors retrospectively assessed the 15 dislocated cases with respect to sex, age, weight, height, preoperative and postoperative Hospital for Special Surgery scores, preoperative and postoperative alignment, preoperative versus postoperative reconstruction dimensions, patellar thickness and height, and postoperative flexion and compared the results with those patients who did not experience dislocation. Possible etiologies and mechanisms of dislocation were sought. There were no significant differences between the control and study groups for any variable assessed, with the exception of postoperative flexion, which averaged 118 degrees for the study group and 105 degrees for the control group (P < .001). Conservative management was successful in 11 cases. In September 1988 the IB-II system was introduced; modification of the tibial insert was made in January 1990.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Hemophiliac arthropathy of the elbow with bilateral luxation of the head of the radius. Hemophiliac arthropathy of the knee at the stage of arthrosis].

The paper report on the case of a patient, who on the background of an A type hemophilia, suffering from hemophilic arthropathy, of the elbow and knee, presents bilateral luxation of the radius head. The major difficulties of the surgical treatment, the risks of the haemorrhagic complications and the long postsurgery evolution are discussed.

Adult↗
PubMed2003

Posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection.

BACKGROUND: We report a rare complication of posterior dislocation of a cruciate-retaining total knee arthroplasty following an acute bacterial infection. The mechanism of dislocation proved to be septic loosening of the femoral component and a tear of the posterior cruciate ligament near to the femoral insertion site. The tear arose during the treatment of acute septic arthritis following total knee arthroplasty when the patient attempted full weight-bearing with the affected limb in a semiflexion position and twisted the knee. METHODS AND RESULTS: Successful treatment was provided with subsequent surgical debridement, removal of the loosened prosthesis, the application of systemic antibiotics, and a revision total knee arthroplasty utilizing a posteriorly stabilized prosthesis after adequate control of the infection. CONCLUSION: Soft-tissue protection from full weight-bearing of the knee during the treatment of an acute infection following total knee arthroplasty and timely removal of the loosened total knee prosthesis are recommended in order to prevent such a complication.

Arthritis, Infectious↗
PubMedDate not supplied

The anterior horn of the medical meniscus. An anatomic study of its insertion.

A morphologic study of 48 cadaveric knees was performed to more accurately define the osseous and soft tissue anatomy of the insertion of the anterior horn of the medial meniscus. Soft tissue relationships of the anterior horn of the medial meniscus to the anterior cruciate ligament and the lateral meniscus were examined. Four tibial insertion locations of the medial meniscus were identifiable by bony landmarks. Type I insertions were located in the flat intercondylar region of the tibial plateau; type II occurred on the downward slope from the medial articular plateau to the intercondylar region; type III occurred on the anterior slope of the tibial plateau; there was no firm bony insertion of the anterior horn in type IV. The occurrence for type I was 59% (20 of 34); type II, 24% (8 of 34); type III, 15% (5 of 34); and type IV, 3% (1 of 34). The variance in insertion patterns may have clinical applications for patients with atypical anterior knee pain and for performing meniscal allograft. Type III and type IV insertions may be unable to resist peripheral extrusion of the loaded meniscus, placing it at risk for anterior subluxation and causing anterior knee pain in specific cases. Awareness of these patterns may be valuable in medial meniscus harvest and transplantation.

Aged↗