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PubMed1978

[Larsen syndrome--symptomatics and therapy (author's transl)].

We report of three children suffering from Larsen-syndrome with the typical deformity of the face and multiple, mostly bilateral joint-luxations with severe affection of the hip-joints and knee-joints. Two patients had short terminal phalanxes with the typically spatulate terminal phalanxes of the thumb, radiographically visible. One child showed bilaterally dysplastic metacarpophalangeal bones with luxated metaphalanxes. The diagnosis could furtheron be verified by the characteristically twin-formed bone-nucleus of the calcaneus within all patients. Two children early showed a severe, progrediently developing scoliosis of the thoracal spine. The genetic aetiology of this syndrome, caused by a congenital weakness of the connective tissue, is not yet cleared completely. Especially the severe knee-joint luxations are therapeutically a critical problem. The multiple operative interventions which are necessary in the regions of the knee-joint, do not always lead to the expected success of treatment on account of the considerable weakness of the connective tissue. Therefore, additionally orthopaedic remedies are necessary. The already early progrediently developing scoliosis of the spine requires careful treatments with Milwaukee brace. A spondylodesis should be performed in the age from 6 to 8 years on account of the progredience. In any case, it is necessary to investigate carefully for accompanying malformations of the urinary passage.

Abnormalities, Multiple↗
PubMed1980

[Ways of treatment in chronic medial instability of the knee joint (author's transl)].

Especially Grade II and III of chronic anteromedial rotatory instability of the knee should be treated by static and dynamic extraarticular procedures of the medial compartment. For the treatment of deficient anterior cruciate ligament we advise intra-articular replacement with a medial strip of the patella tendon, otherwise we expect meniscal degeneration, osteoarthritis and progressive instability. In patients with considerable instability and in young persons in addition to the cruciate ligament repair a distal iliotibial-band transfer is recommended to avoid attenuation of intra-intraarticular and capsular ligaments.

Adolescent↗
PubMed1989

[Open knee joint injuries (including vascular and nerve lesions)].

Immediate definitive reconstruction of all damaged structures leads to better results than delayed operations. If direct closure of the joint is not possible, local rotational flaps, muscle flaps or free skin-fat tissue flaps (i.e. a scapular flap) may be used. In injuries of the popliteal artery, the interposition of a saphenic vein graft is preferable to local reconstruction of the artery. Nerve injuries are the only exception to comprehensive primary repair. Reconstruction in these lesions is usually done later when all wounds are healed. The postoperative treatment includes the use of continuous passive motion whenever possible.

Fractures, Open↗
PubMed1982

[Injuries of the ligaments of the knee joint; follow-up results (author's transl)].

From 1978 to 1979 87 patients with singular and combined injuries of the ligaments of the kneejoint underwent surgery at the Department for Traumatic Surgery of Mannheim. 62 (71.3%) patients could be examined one to two years after operation. In uncomplicated cases of instability of the kneejoint a good to excellent result could be achieved in 62%. In combined instability only 40% good to excellent results were achieved, due to the higher severity of the injury. The classification was measured according to a modified scheme of Gotzen and co-workers [2a].

Adolescent↗
PubMed1979

Distal iliotibial-band transfer for anterolateral rotatory instability of the knee.

An operative procedure has been developed to prevent anterior subluxation of the proximal end of the tibia in patients with anterolateral rotatory instability of the knee. The results of this procedure in eighteen consecutive patients are reported. Ten (55.6 per cent) had had prior surgery on the involved knee. All patients had an additional pathological lesion and all were incapacitated for their sports prior to reconstruction. The shortest follow-up in this series was thirty-one months and the longest, forty-four months. Forty-four per cent had an excellent result, participating in sports without signs or symptoms, and 39 per cent had a good result, participating but with some modest problem. In 17 per cent the results were unsatisfactory.

Adolescent↗
PubMed1976

Polycentric total knee arthroplasty. A two-year follow-up study.

Polycentric total knee arthroplasty provided significant relief of pain in 86 per cent of 500 knees. The independence and activity levels of the patients increased dramatically. The frequency of major complications as reflected by reoperation was 10 per cent in this series. There was a 2.8 per cent deep infection rate. One-third of the infected knees were salvaged and two-thirds required arthrodesis. Loosening of a component was noted in 2.4 per cent. After operation the average range of motion was from 6 to 101 degrees of flexion, for a range of 95 degrees; this was a 5-degree increase over average preoperative motion. Ninety-six per cent of the patients expressed satisfaction with the surgical result.

Adult↗
PubMed1983

Replacement of the knee in rheumatoid arthritis using the Imperial College London Hospital prosthesis (ICLH) 1977-1979.

The Imperial College London Hospital (ICLH) technique and prosthesis for the total replacement of the knee was evolved over the period 1968 to 1977. The results now reported were obtained at The London Hospital on rheumatoid knees operated upon in the period 1977 to 1979. These knees were reviewed and the results published with a one to 2 year follow-up in 1981. In the present paper this review has been extended to 3 to 5 years. We find that in successfully replaced knees the quality of the clinical result has remained unchanged over the extended period of review. Certain further complications have been encountered which are described. These complications have led us to the conclusion that whereas we previously accepted post-operative alignments between one and 10 degrees of valgus, we should now adjust these limits. We now regard a knee having anything less than 5 degrees of valgus post-operatively as having been incorrectly replaced. The limits of valgus can perhaps be extended to 15 degrees. Experience over the period 1977 to 1980 suggested the possibility of further improvements in both the operative technique and the prosthesis. Accordingly the ICLH prosthesis has now been modified. The modified prosthesis (the Freeman-Samuelson prosthesis) is described in this paper but results with it are not reported.

Adult↗
PubMed1978

Anterolateral rotatory instability of the knee joint. An early analysis of the Ellison procedure.

Our experience with the Ellison procedure for the control of anterior subluxation of the lateral tibial plateau includes fifty-two knees in which we used this procedure either alone or in combination with other reconstructive procedures. The results directly attributable to the Ellison procedure itself after follow-ups of six months or more could be evaluated in fifteen patients who had only the Ellison procedure for anterolateral instability and in thirteen who had both this procedure and a pes anserinus transfer for combined anterolateral and anteromedial instability. Of the twenty-eight patients so evaluated, only sixteen (57 per cent) had good or excellent results. The pivot-shift phenomenon, present in all twenty-eight knees preoperatively, had been eliminated in only four at follow-up. A positive anterior drawer sign was present in all patients both before operation and at follow-up. The subjective and functional improvement did not correlate well with the clinical and roentgenographic findings. From this study it is our impression that the results of this operation are disappointing and that it should be used only as an adjunctive procedure in lateral reconstruction in young patients.

Adolescent↗
PubMed1977

A clinical and stress radiographical follow-up investigation after Jones' operation for replacing the anterior cruciate ligament.

Measurements have been made on knee radiographs exposed during stress displacement by controlled hydraulic forces using a specially designed apparatus. This accurately records the amount of anterior and posterior tibial displacement (drawer sign) and the degree of medial and lateral collateral ligament laxity on radiographs. The findings in 25 patients have been analysed following the Jones' procedure for the repair of the anterior cruciate ligaments. The operative results were judged to be completely successful in 72% of patients and the value of stress radiographic measurements is discussed.

Adolescent↗
PubMedDate not supplied

Chondromalacia induced by patellar subluxation: morphological and morphometrical aspects in rabbits.

The purpose of this study was to describe morphologically and quantify the changes of the articular cartilage in chondromalacia, concerning both the chondrocytes and extracellular matrix. Eight rabbits were submitted daily to patellar subluxation, causing chondromalacia after two weeks. The knee fragments obtained were processed by the standard methods. These experimental conditions caused degenerative alterations of the articular cartilage, varying from a slight decrease of proteoglycans, to fibrillations, clefts, and horizontal splitting. The results showed a significantly increase number of chondrocytes (p < 0,000139), although smaller in size (p < 0,000109). The immobilization for 2 weeks and the intermittent passive daily motion afterwards for a period of 2 weeks, was effective to cause patellar chrondomalacia in rabbits.

Animals↗
PubMedDate not supplied

Surgical treatment of patellar instability: indications and results.

The purpose of this study was to evaluate a consecutive series of 465 patients with patellar subluxation. Both knees were involved in some patients. Therefore, 557 knees were studied. The average age was 24 years. Specific symptoms and signs were reviewed. Instability, swelling, and patella alta were more common in the group requiring surgery. All patients were treated conservatively with specific exercises initially. Failure of this conservative treatment to significantly improve the symptoms, inability to do the activities of daily living, or expected associated pathology were indications for surgery. Surgery was required in 139 patients (27%). Some patients had surgery on both knees. Therefore 149 knees were repaired. The surgical technique consisted of an extensor mechanism realignment. This consisted of release of the lateral patellofemoral ligaments, advancement of the vastus medialis obliquus muscle and, in some cases, transfer of the tibial tubercle. Arthrotomy was done in all cases. Results were evaluated in terms of pain, function, and patellar instability. Signs evaluated preoperatively and postoperatively were tenderness of the retinaculum or bone, patellar mobility, effusion, muscle atrophy, and tone. Range of motion was also evaluated. The average followup lasted three years.

Athletic Injuries↗
PubMed1993

Radiographic analysis of patellar tilt.

We describe the radiographic measurement of the angle of tilt of the patella and relate it to malalignment of the extensor mechanism. The tilt angle is defined as the angle subtended by a line joining the medial and lateral edges of the patella and the horizontal. The radiograph (Merchant type) is taken with the foot pointing up, the lower edge of the film parallel to the ground, and the knee at 30 degrees flexion. The mean tilt angle of a group of patients with signs and symptoms suggesting patellofemoral malalignment was 12 degrees (+/- 6 degrees); in a similar group of control subjects it was 2 degrees (+/- 2 degrees) (p < 0.01). Tilting of 5 degrees was taken to be the limit of normal. For the detection of patellar malalignment, the tilt angle was almost as specific as the congruence angle (92% v 99%) but more sensitive (85% v 25%) and more accurate (89% v 62%).

Humans↗
PubMed1989

[Recent ligament lesions of the knee].

In every case knee injury, it is imperative not to miss a possible lesion of the ligaments and, when such a lesion is present, to evaluate its severity. The practitioner who examines the injured knee in an emergency therefore plays a crucial role in taking a definite attitude when faced with lesions. Before any treatment is envisaged the lesion must be precisely diagnosed. This requires a very strict examination based on the patient's history and on clinical tests that are often simple. At the slightest suspicion of severe lesion of the ligaments, a specialist must be called in to complete the investigation, if necessary by testing under general anaesthesia and/or by performing an arthroscopy.

Humans↗
PubMed1985

Knee injuries in gymnastics.

A review of injury patterns to the knee joint in gymnastics seen at our sport medicine clinic over a six and one-half year period reveals the patellofemoral pain syndrome to be more than twice as frequent as any other type of injury. Sprains are second in frequency but first in order of problems requiring emergency surgical treatment. The intensity of training correlates with the various overuse syndrome encountered, and the perfection of intricate routines and tricks can lead to significant injury of ligaments and menisci.

Adolescent↗
PubMed1977

[Patellar imbalance and external rotary instability of the knee].

The importance of external hyperrotation and external rotary instability in patellar imbalance is examined. In view of the progressive nature of patellar imbalance and of the predominant part played by the muscular and capsulo-ligamentous elements in the stability of the extensor apparatus, the authors advocate an earlier and more radical surgical approach with a view to improving the patellar medialization forces (transplantation of the intermediate great muscle and retension of the lateral patellar retinaculum) as well as the elements of active internal rotation of the tibia (modified version of Slocum's operation and transfer of the internal third of the patellar tendon).

Adolescent↗
PubMed1978

Instability of the proximal tibio-fibular joint.

The proximal tibio-fibular joint consists of a joint cavity surrounded by a joint capsule (diarthrosis) forming a rather rigid joint. In patients who complain of pain and instability in the knee, the cause may sometimes be found in laxity of the proximal tibio-fibular joint. In these cases the abnormal movements of the fibular head are palpable and visible and can be demonstrated on X-ray films. The disease is not well known and is often overlooked. It can be differentiated by palpating the fibular head. In two patients the pain and disability were so severe that fusion of the proximal tibio-fibular joint was undertaken. This treatment seems to have been successful.

Adolescent↗
PubMed1975

[Surgical repair of chronic instabilities of the cruciate ligaments of the knee].

The authors have developped a technique aiming at replacing the anterior cruciate ligament by the tendon of gracilis muscle derouted through the intercondylar region and acting as an active transplant in 32 cases. In 20 other cases replacement of the posterior cruciate ligament was obtained by the use of the tendon of semi tendinosus muscle acting as a passive neo-ligament. The follow-up study demonstrated 87 p. 100 of good results after isolated tears of the anterior ligament and 83 p. 100 after isolated tears of the posterior ligament. 21 times an additional plasty of the medial ligament had to be performed. In these combined lesions results were less favourable.

Elasticity↗