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A case of complete posterior displacement of a Salter-Harris Type III distal medial femoral epiphysis fracture with posterior subluxation of the knee is reported. Invagination of the gastrocnemius muscle by the displaced fragment was blamed for failure of closed reduction. No significant ligamentous injury of the joint occurred.
Knee locking is a highly incapacitating condition attributable to mechanical or functional factors. Pain, mostly of capsuloligamentous or intraosseous origin, is the cause of functional locking. Meniscal injuries are the most frequent arthroscopic finding in the locked knee, due to mechanical factors. We describe a patient experiencing locking during extension whose history and examination suggested a tear of the anterior horn of the lateral meniscus of the right knee; a diagnostic/therapeutic arthroscopy revealed an intraarticular gouty tophus growing from the anterior horn of the lateral meniscus.
Recurrent anterior subluxation of the lateral tibial plateau is a common type of chronic knee instability resulting from trauma. It can be reproduced by the clinical test described and corrected by a surgical procedure called the sling and reef operation, in which a strip of iliotibial tract is used to create a sling and to reef the posterolateral capsule. From 1971 to 1978, eighty-four patients were operated on, of whom fifty had been evaluated at one to six and one-half years after operation. The results were: forty-one good, six fair, and three poor. The lesions found in the thirty-seven knees in which arthrotomy was performed included a tear of the anterior cruciate in every case, a tear of the medial meniscus in fifteen and of the lateral meniscus in eleven, a notch in the articular surface of the lateral femoral condyle in fifteen, and a lateral marginal tibial (Segond) fracture in three. No definite lateral capsular tears were visualized--only stretching comparable to that seen in recurrent dislocation of the shoulder.
OBJECTIVE: To develop a radiographic grading scheme for osteoarthritis of the knee that would relate to arthritic progression and deformity. METHODS: The scheme of Scott, et al was revised to include new fields of Tibial Erosion and Subluxation; the fields of Tibial Osteophytes and Sclerosis were removed. The worst affected compartment only was scored on frontal Standardized Knee Images, which were used to define knee alignment variables. RESULTS: The interreader reliability (kappa = 0.92) and correlation for total scores (r = 0.94) were both excellent (p < 0.001). Individual field scores and total knee scores both correlated well with most limb alignment variables, especially the hip-knee-ankle angle (r = 0.77, p < 0.001). CONCLUSION: These findings encourage further evaluations for outcome measurement, diagnostic sensitivity, and sensitivity to define arthritic change over time.
Forty young adult males were somatotyped according to the Health-Carter Modified Method and were separated into 2 groups. One group was a meso-endomorphic body type (5-6-1) and the other was ectomorphic body type (3-2-4). Measurement of rotational laxity of the knee in 90 degrees flexion showed a statistically significant increase (p less than .001) in external rotation and total rotation in ectomorphs compared to meso-endomorphs. Rotational laxity of the knee is associated with body type. Lateral radiographs were used to measure patellae alta in each group. No statistical difference was found, and patellae alta does not appear to be associated with body type.
Sixteen patients with a clinically diagnosed chronic ACL deficient knee on one side and a contralateral ACL intact knee were evaluated by arthrometry and simultaneous radiography after epidural anesthesia was induced. The posterior cruciate ligament was intact in all knees. This paper reports only the anterior position of the tibia at the 89 N anterior force level of the KT-1000 arthrometer (as read from the dial) and the anterior tibial position recorded simultaneously by radiography at the 89 N dial tone. A 3 mm difference in anterior tibial position between the two knees of the same patient was considered diagnostic for ACL deficiency. Arthrometrically, 13 of the 16 patients were diagnosed accurately; radiographically, 13 of the 16 met the criterion. Moderately high significant positive correlation of paired values was obtained in ACL deficient knees by the two methods (correlation, 0.58 and two-tail probability, 0.02). In ACL intact knees there was no correlation of paired values (correlation, 0.01 and two-tail probability, 0.98). We found no numerical equivalency between the measurements obtained by the KT-1000 and simultaneous radiography. Neither did we find an apparent pattern to the differences, or formula we could use to interpolate findings of anterior tibial position from one measurement system to the other. We conclude that an examiner can substantiate a clinical diagnosis of chronic ACL deficiency with both methods. Arthrometry alone may be used to repeatedly follow conservatively treated ACL deficient knees without exposing the patient to radiation. Radiographs obtained under known anterior force levels provide a retrievable record to document the exact tibial position in relation to the femur.
The efficiency of a knee brace with a 0 degree-30 degrees range of motion was studied in 17 patients with anterior knee pain. Eighteen patients with identical symptoms served as controls. The brace was worn for 6 weeks. Follow-up was performed after 6 weeks and 3 and 12 months. After 6 weeks, 82% of the patients treated with the brace were classified as improved, compared with 44% without it, according to a strict evaluation system. However, after 12 months only 35% of the patients treated with the knee brace could be rated as improved. Despite this marked deterioration, the brace should be considered an alternative to immobilization, because it minimizes the load on the patellofemoral joint and prevents atrophy of the quadriceps muscle.
Acute and chronic nonligamentous problems of the athlete's knee are outlined, emphasizing diagnosis and treatment. Most such problems can be managed by the family physician or general practitioner, and recommendations are made for the referral of more complex problems.
Injuries to the knee and tibial/fibular shafts are extremely common, with knee injuries alone accounting for over 1.3 million emergency department visits yearly in the United States. Many of these injuries will present with straightforward radiographic findings, but others will have a subtle or complex appearance. This article reviews injuries of the knee and proximal tibial/fibular shaft with emphasis on normal anatomic features that, when disrupted, indicate the presence of subtle but important bone or soft tissue trauma. Although the emphasis is on plain radiography, magnetic resonance (MR) and computed tomographic (CT) findings are discussed where appropriate.
On the basis of review of results of 60 kinematic condylar knee replacements in 49 patient and the literature the principles of surgical techniques in varus and valgus deformities of the knee and patellar subluxation have been presented. The authors substantiated their opinion of contraindication for patellar replacement. Tibial components (AJ, PCR, Total Condylar) have been discussed and data on frequency of their use provided. Instrumentation supplied does not guarantee the precision desired, the surgeons experience is indispensable.
Twenty-one patients with leg-length inequality underwent femoral lengthening using the Wagner technique. When reviewed, seven were found to have varying degrees of posterior subluxation of the knee. Critical assessment demonstrated that each of these was associated with a hypoplastic femur. It is postulated that posterior displacement of the tibia on the femur occurred as a result of the distal femoral and intraarticular bony deficiencies.
Disturbance of the patellofemoral mechanism is the most common cause of dysfunction in the knee, especially in athletes of all age groups. This is primarily a congenital familial abnormality due to poor development in the vastus medialis. The patella develops in the line of maximum pull of this muscle group; in this congenital condition it develops in line with the stronger antagonist to the vastus medialis, the vastus lateralis muscle. Therefore, the position in the extremity that the patella assumes is the result of abnormal muscle development. This brings about other changes in the lower extremity that increase the tendency of the patella to migrate laterally. This condition, hypoplasia of the vastus medialis muscle, exists in a large number of people (about 40% of my patient population) in an asymptomatic form that predisposes them to degenerative changes of the patellofemoral articulation later in life, even without symptoms related to dysfunction of the patellofemoral mechanism. These individuals are also predisposed to disturbances of the patellofemoral mechanism which may cause symptoms, that is, the painful knee for which they seek medical attention. The symptomatic types of dysplasia of the quadriceps mechanism are usually brought on by injury to the medical quadriceps retinaculum that stretches or tears it, allowing the lateral migration to increase and producing pain in the inner aspect of the knee. Disuse atrophy of the vastus medialis accentuates the clinical picture as the condition worsens. As the asymptomatic type may progress into the midly symptomatic variant and eacy may worsen into a more serious disabling variety as reinjury occurs, it is important to recognize each type and to treat them properly.
Knee injuries are the main reason for premature retirement from contact and rotational sports in the young healthy individual. They cause significant interference with employment, particularly tradesmen or persons with labouring jobs. These injuries may cause persisting disability and predisposition to early degenerative changes, if not recognised and appropriate treatment commenced early.
We studied 32 patients who presented to the Accident and Emergency Department of Toa Payoh Hospital with injuries sustained while roller-blading (in-line roller skating). This sporting activity carries risk of injuries, often fractures, due to 3 principal mechanisms of injury. The first and main mechanism of injury is that of a forward fall with the arms outstretched as a protective gesture. This is associated with fractures of the distal radius in the majority of cases, although other injuries to the upper limb can occur. The second important mechanism is that of a backward fall with resulting injury to the back of the head. Lastly, the patient may fall sideways, often together with a twisting force to the lower limbs, resulting in ankle sprains and meniscus injuries to the knee. The vast majority of patients are young teenagers who are beginners and had not been properly clad in protective gear. Roller-blading therefore carries a very real risk of sporting injury.
The authors present a clinical study on twenty six cases of a painful syndrome affecting the distal quadriceps tendon complex, popularly known as "jumper's knee". They review the diagnostic aspects and discuss the treatment. In particular, they suggest a surgical approach that is not limited to the inflammatory or degenerative component of the syndrome, but also aims to correct imbalance of the extensor apparatus.
Ten subjects with unilateral posterior cruciate ligament-deficient knees were studied, comparing the knee mechanics of the affected knee with the mechanics of the opposite normal knee. The static squat test was used to determine knee forces and moments through measurements made on roentgenograms. Statistically significant increases occurred in posterior translation of the tibia in all knees at high knee flexion angles, but not uniformly at low knee flexion angles. The results suggest that posterior tibial subluxation occurs in vivo during certain activities of daily living. Posterior tibial subluxation occurred in positions of knee flexion near 70 degrees, establishing a new equilibrium for the system where tibiofemoral joint compression force (approximately four times one-half body weight) remained an order of magnitude greater than tibiofemoral shear forces (approximately 10% of one-half body weight).
High-resolution real-time ultrasonography (5 MHz linear and 7.5 MHz sector) was used to examine patients with knee injuries. The posterior horn of the medial meniscus was easily demonstrated. With the knee in a special position (70 degrees flexion and internal-rotation) it was possible to visualize latent tears. Effusion escapes between the two parts of the injured meniscus; therefore, the space between the meniscus fragments was hypoechoic and the surface of the fragment had increased echogenicity.
Tibial pin placement and 90--90 traction may lead to serious knee difficulties. Not only proximal tibial epiphyseal insult, but also serious displacement of the tibia on the femur may occur. In light of these potential complications, distal femoral pin placement should always be preferable for 90--90 traction in treatment of fractured femurs in children.