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PubMed1983

[Differential diagnosis of post-traumatic hydrarthrosis of the knee joint].

You can diagnose the post-traumatic effusion in a knee-joint generally without difficulty. The fresh effusion is very often bloody. Reflections concerning differential diagnosis are necessary to recognize heavy injuries of soft-tissue and bony injuries. For the diagnostic special X-rays are useful, the arthroscopy and the arthrography. The joint must immediately be unburdened because the effusion can take a negative effect on the articular.

Adolescent↗
PubMed1994

[Post-traumatic knee joint arthroscopy in children and adolescents].

In a retrospective study we analyzed the arthroscopic findings of 166 knee-arthroscopies performed in children and young people up to the age of 16 years. A sports related trauma was present in 54%, a traffic injury in 15% and in 11% an other casualty. In 4% the precise injury was not sure and 16% did not refer any injury. Among the sports injuries (n = 90) ski injuries were the most frequent with 30% of all, followed by gymnastic injuries in 28%, soccer in 25% and other indoor sport injuries in 12%. 57% of all arthroscopies presented a hemarthrosis. The main finding of all arthroscopies was an cartilage lesion. The anterior cruciate ligament was torn in 30% and a dislocated patella was established in 22% of the arthroscopy while a meniscus injury was found in 17%. The injury of the collateral ligaments or of the retinaculum was found in 22%. In all cases of hemarthrosis origin of bleeding was found and only in 6% (n = 10) of all arthroscopy no pathological finding was established.

Adolescent↗
PubMed1994

Complications of internal fixation of tibial plateau fractures.

All cases of displaced tibial plateau fractures treated by open reduction and internal fixation at two university hospitals over a 3-year period were retrospectively reviewed. There were 47 fractures in 45 patients. Rigid fixation to allow early motion was the goal in all cases. There were 3 AO type I (wedge) fractures, 20 AO type III (wedge/depression) fractures, and 24 AO type IV (comminuted/bicondylar) fractures. Cases were classified into three groups depending on the amount of hardware used to obtain fixation (a single buttress plate, group 1; a buttress plate and interfragmentary lag screws, group 2; or medial and lateral buttress plates with or without lag screws, group 3). In group 1, there were 20 fractures and no instances of deep-wound infection or postoperative ankylosis. In group 2, infection occurred in 6 of 19 fractures (32%), all of which also developed significant ankylosis including 1 patient who underwent arthrodesis. In group 3, 7 of 8 (87.5%) knees became infected, and the patients experienced other devastating complications, including ankylosis (n = 3), arthrodesis (n = 2), knee disarticulation (n = 1), and above-knee amputation (n = 1). Patients whose knees became infected underwent an average of five subsequent surgical procedures. These results suggest that patients with comminuted tibial plateau fractures requiring either two buttress plates or a single plate with additional interfragmentary lag screws would probably be better managed by either non-operative treatment or limited internal fixation.

Adult↗
PubMed1978

Athletic injuries in adolescents.

In a survey of adolescent patients treated in the University of Rochester Section of Athletic Medicine, injuries to adolescent athletes comprised 12 per cent of all athletic injuries during an 18-month period. The incidence among boys was much greater than among girls, and injuries to the lower extremity--particularly the knee--were most common. Sprains and strains, fractures, chondromalacia of the patella, contusions, and internal derangements of the knee accounted for 80 per cent of the 161 injuries studied. Participation in athletic events has many positive aspects for the adolescent, but it does carry the risk of injury. It is important for the pediatrician to promptly determine the nature and extent of the injury so that appropriate care can be given and the risk of permanent disability lessened.

Adolescent↗
PubMed2000

Imaging of the multiple-ligament-injured knee.

Imaging of the multiple-ligament-injured knee requires a comprehensive assessment of ligaments, cartilage, bone, peripheral nerves, and vascular anatomy. It is imperative that the radiologist be a crucial part of the trauma team, to provide prompt diagnostic assistance without unnecessary delays in patient management. MR angiography remains a promising modality to detect vascular injury and provides arteriographic assessment with little risk to the patient in a more expeditious fashion than conventional contrast angiography.

Diagnosis, Differential↗
PubMed1993

Patellar tilt and subluxation in total knee arthroplasty. Relationship to pain, fixation, and design.

Two hundred thirty-four primary total knee prostheses were evaluated with a 45 degrees merchant view to examine patellar position and fixation. Despite a standardized technique for obtaining roentgenographs, patellar position varied with leg position. Overall, 54.7% tracked centrally, 31.2% tilted, and 14.5% displaced. The incidence of these findings was the same whether the patella was domed or congruent. Neither pain scores nor fixation were affected by position. Postoperative tilt and displacement were more common in patellae that were tilted preoperatively. The incidence of postoperative tilt or displacement was not significantly different in knees in which a lateral release was performed. Patellar tilt in some patients seems inevitable despite careful technique because intraoperative tests are static and postoperative function is dynamic. This does not bode well for wear in a metal-backed patella. Tilt caused increased loading at the periphery of the component where most metal-backed prostheses have thin polyethylene.

Aged↗
PubMedDate not supplied

Medial subluxation of the patella as a complication of lateral retinacular release.

We examined 54 patients (60 knees) referred to us because of their failure to improve, or because of a worsening of their preoperative symptoms, following an arthroscopic lateral retinacular release. Thirty knees developed medial subluxation of the patella postoperatively. This disabling condition is new to us. It is previously unreported as a complication of arthroscopic lateral retinacular release. Anterior knee pain was the only reported preoperative symptom in 14 knees. Sixteen knees had a preoperative diagnosis of lateral patellar subluxation on the basis of a positive apprehension sign only. Eighteen of 30 knees had no surgery of the extensor mechanism other than the arthroscopic lateral release. The remainder additionally underwent varying types and numbers of operations in an attempt to resolve their disability. CAT scan evaluation of three patients who volunteered for the procedure demonstrated severe atrophy and retraction of the vastus lateralis. Loss of this dynamic lateral stabilizer contributed to the medial subluxation of the patella.

Adolescent↗
PubMed1998

Anterior cruciate ligament deficiency accompanied by patellar subluxation treated by reconstruction with lateral retinacular release.

Five patients with an anterior cruciate ligament (ACL) deficiency accompanied by patellar subluxation who were treated by ACL reconstruction with lateral retinacular release (LRR) are reported. In two patients, the LRR was performed at the same time as the ACL reconstruction, and in three patients, the LRR was performed secondarily. The three patients requiring the secondary LRR needed the procedure to recover knee stability to return to sporting activities. In all patients, the apprehension sign of the patella was subsequently improved. When managing ACL deficiencies in a young athletic population, patellar subluxation should be suspected. In our patients with patellar subluxation accompanying an ACL deficiency, ACL reconstruction with LRR was effective in relieving their instability.

Adolescent↗
PubMed1997

Acute arthroscopy.

The role and significance of acute arthroscopy have been evaluated in the treatment of knee joint injuries on the basis of findings during 59 arthroscopic operations which were conducted within two weeks after the accident. The injuries developed isolated in more than half of the cases (65%) whereas they appeared in a combination of two or more in 26% and in 9%, respectively. Injuries requiring operation were found in 91.5%, most of which were ruptures of the ACL (33 cases) and menisci (23 cases). In the case of ACL rupture, in the acute phase on sportsmen and physical workers primary arthroscopically assisted transligamental replacement was performed with patellar graft while in the case of proximal rupture of the ACL reinsertion and augmentation were carried out with semitendinosus tendon. The ruptures of dislocated eminentia were refixed in each case. In the case of the rupture of meniscus the refixation of the meniscus of resection of the ruptured part was attempted. By means of acute arthroscopy the lesion of the intraarticular structures or that of their combinations can be exactly diagnosed. Depending on the findings of arthroscopy the injuries can be treated immediately or operated on at a later time, thus preventing the joint from further deterioration.

Adolescent↗
PubMed1989

Patellar tracking abnormalities: clinical experience with kinematic MR imaging in 130 patients.

A kinematic magnetic resonance (MR) imaging technique for assessment of malalignment of the patella, involving the acquisition of multiple sequential axial images of the patellofemoral joint during the early increments of passive knee flexion, was used to evaluate 130 patients (235 symptomatic patellofemoral joints) showing clinical evidence of having patellar tracking abnormalities. Twenty-three of the patellofemoral joints had undergone previous surgical procedures for patellar realignment. In addition, 14 (28 patellofemoral joints) asymptomatic control subjects were studied. Normal patellar tracking was observed in all of the asymptomatic subjects and in 43 (17%) of the 260 patellofemoral joints in the patient population, 18 (7%) of which were symptomatic. Sixty-nine (26%) of the patellofemoral joints had lateral subluxation of the patella, 106 (41%) had medial subluxation of the patella, 21 (8%) had excessive lateral pressure syndrome, 19 (7%) had lateral-to-medial subluxation of the patella, and two (1%) had dislocation of the patella. Of the 235 patellofemoral joints with suspected abnormalities, 217 (93%) had patellar malalignment. Of the 23 patellofemoral joints that had undergone prior surgery, 20 (87%) had abnormal patellar tracking. Thirteen of 14 (93%) patellofemoral joints that had undergone a prior arthroscopic lateral retinacular release had a medially displaced patella.

Adult↗
PubMedDate not supplied

Congenital dislocation of the patella. Part II: orthopaedic management.

Five patients (eight knees) with diagnosed congenital dislocation of the patella and well-documented charts were reviewed. Age at diagnosis ranged from 4 days to 6 years. A flexion contracture of the knee and femorotibial rotatory dislocation of varying degrees were present in all the cases. The quadriceps was active in all the cases, producing knee flexion in four cases. Foot deformity was associated in all the cases (clubfoot, calcaneovalgus, or congenital vertical talus). Gradual correction of knee flexion contracture with serial casting was attempted in five cases leading to an almost complete extension in two cases. Treatment of patellar dislocation was surgical in all the cases, consisting in extensive quadriceps release (seven knees) or V-Y lengthening (one knee), division of lateral soft tissues, and reefing of the medial retinaculum and capsule. Intraoperative anomalies were recorded. At an average follow-up of 6.9 years, all the patients are able to walk on their operated limb, and the patella is centered in the trochlea in all the cases. Knee mobility, rotatory dislocation, and daily function were improved in seven cases.

Child↗
PubMed1984

A technique for difficult arthrodesis of the knee.

Twenty knees, in which a total of 32 previous operations had been performed, were arthrodesed by the Charnley compression technique combined with intramedullary nailing. Patients with previous infection were excluded from the series, but three neuropathic knees were included. Bony union was evident after an average of six months in all but one patient who died three months after operation. One patient developed deep infection that resolved after removing the nail. The combined technique is simple and only limited bone resection is needed; it gives immediate stability and relief of pain with minimal morbidity.

Adult↗
PubMed1982

Evaluating acute knee injuries.

The diagnosis of acute knee injuries should be as precise as possible. A wait-and-see attitude is condemned. A complete diagnosis cannot always be made on the basis of history, physical examination and x-rays. Additional aids, such as stress films, joint aspiration, arthrography, examination under anesthesia and arthroscopy, increase diagnostic accuracy to nearly 100 percent. Only then can the physician properly manage the patient so that long-term disability is minimized.

Acute Disease↗
PubMedDate not supplied

Differential diagnosis in patients with disorders of the patellofemoral joint.

Anterior knee complaints are difficult diagnostic problems. It cannot be overstated that the most important information available is to be found in the patient's history. Onset, quality, and quantity of symptoms must be assessed. This information is then synthesized to determine the specific functional disabilities resulting from the patient's anterior knee disorder. Once a history is obtained, a consistent, methodical physical examination can be performed to narrow the differential diagnosis. Radiographic evaluation is used to further hone the differential or to confirm the most likely diagnosis. Ultimately, a specific working diagnosis is selected and treatment is tailored to changing the underlying structural or biomechanical abnormalities that led to the patient's complaints.

Cumulative Trauma Disorders↗
PubMed1987

The quadriceps function in patellofemoral disorders. A radiographic and electromyographic study.

The influence of quadriceps contraction on patellar alignment was investigated in tangential views of 31 patients with patellofemoral complaints and compared with 25 controls. The congruence angle decreased significantly following quadriceps contraction in patients with patellar subluxation in contrast to those with chondromalacia and normals. Electromyography (EMG) of the vastus lateralis (VL) and vastus medialis obliquus (VMO) during maximal quadriceps contraction was obtained prior to and after 3 months of isometric quadriceps exercises in 15 knees with patellar subluxation and in 11 with idiopathic chondromalacia of the patella. The EMG after 3 months revealed an increase in the activity of both VL and VMO only in patients with patellar subluxation, but the muscular balance of the patella remained unchanged. Only seven patients were improved after 3 months. A more selective training of the VMO is proposed.

Adolescent↗
PubMedDate not supplied

[Patellar malposition, its incidence in patellar chondropathy and in a control population].

Patellar disequilibrium consists of either external malpositioning of the patella (EMP) or external hyperpression (EHP), which are clearly visible on a 30degrees axial radiograph of the knee. Does this disequilibrium play a role in the development of patellar chondropathy? The authors have based their comparisons on a series of 40 subjects more than 60 years of age (average age: 68 years) who were free from pain and arthrosis of the knee. In this group they found 2 cases of EMP (5 percent) and 3 of EHP (7.5 percent). In their series of cases of patellar chondropathy (43 cases) there were, after correction for the cases with a double etiology, 8.5 cases of EMP (20 percent) and 7 of EHP (16 percent). The differences between these figures and those for the control series are statistically significant for the number of cases of EMP (P less than 0.05), but not for the number of cases of EHP, the etiological role of which is probable but for which proof would require a larger series of patients. From this work the following findings emerge: (1) The frequency of latent patellofemoral arthrosis in the aged control subjects with knee problems. 7 cases out of 47, or 12.5 percent. (2) The frequency of patellar chondropathy apparently associated with the two etiological factors: out of 43 patients, 22 suffered from patellar disequilibrium (10 EMP and 12 EHP) but in 13 cases there was another associated possible cause of deterioration: traumatism or stress on the knee associated with work or sport. This methodological difficulty is discussed and resolved empirically. The importance of patellar disequilibrium in the development of degenerative patellofemoral affections derives not from the etiological importance but from the fact that they represent the only factor for which therapy may be given: elective internal rehabilitation or surgery (section of the external wing of the patella or transposition of the anterior tuberosity of the tibia).

Aged↗
PubMed1986

Computed tomographic classification of patellofemoral pain patients.

A preliminary study was undertaken at the University of Connecticut Sport Injury and Knee Clinic to evaluate a small series of patients with peripatellar pain as well as a group of asymptomatic controls. With the encouragement of the initial results, this experience has been expanded to include a larger number of patients. Based on CT criteria of subluxation and tilt, it has become possible to categorize patellofemoral tracking abnormalities. The purpose of this article is to clarify further a classification system for patellofemoral pain patients.

Adolescent↗
PubMedDate not supplied

Surgical correction of medial subluxation of the patella.

We evaluated the results of a surgical procedure to correct medial subluxation of the patella in 63 patients (65 knees), most of whom had undergone a lateral retinacular release. We performed a direct repair or a reconstruction of the lateral patellotibial ligament using locally available tissue such as strips of iliotibial band or patellar tendon. Followup averaged 53.7 months (range, 24 to 99). Outcome was based on the examiner's inability to clinically reproduce the patient's painful medial subluxation and on the patient's general impression of his or her improved functional status. Forty-four patients (68%) reported improvement in their functional levels and 49 (75%) reported that they were subjectively improved by the procedure. Overall, 50 patients (80%) had a rating of good or excellent. Six knees required a second surgical reconstruction because of failure to improve or because of a reinjury. Analysis of overall clinical outcome revealed no significant relationships based on the patient's age at the time of the initial procedure, sex, or length of followup (P > 0.10). Reconstitution of the lateral patellotibial ligament effectively corrected medial subluxation of the patella and long-term results of this salvage procedure were satisfactory.

Adolescent↗