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PubMed1987

[Bone dynamics of the acetabulum in experimental subluxation of the hip joint and its repair process].

Subluxation of the hip and subsequent acetabular dysplasia were experimentally produced by fixing the knee of young rabbits in extension position. Changes of the acetabulum during the repair process after reduction were investigated radiologically, histologically and histomorphometrically. Radiologically, subluxation and acetabular dysplasia appeared two weeks after fixation and disappeared as the knee became flexible after removal of fixation. Histologically, abnormalities of growth cartilage and hypertrophy of trabeculae in the secondary spongiosa were prominent two weeks after fixation. Histomorphometrically, the bone area, osteoid surface and mineral appositional rate increased at this time. The above findings, however, were normalized as concentric reduction of the hip was achieved. Abnormal stress acting on the acetabulum caused hypertrophy of trabeculae, and this may result in the development of osteoarthritis. In order to prevent such a pathologic process, it is important to normalize the hip mechanically from the view point of bone dynamics.

Acetabulum↗
PubMed1997

[Successful surgical revascularization after 18 hour ischemia below the knee due to complete avulsion of the popliteal artery].

We report the case of a 33-year-old man after knee luxation and disruption of a popliteal artery, which was missed after repositioning at the first clinic. Eighteen hours later complete discontinuity of the popliteal artery was confirmed by arteriography and an immediate reversed, end-to-end auto-venous graft was interposed under general anesthesia with anterior and posterior fasciotomy prior to blood flow restoration. Forced diuresis with a diuretic mixture and balanced fluid intake were used, and the patient was discharged from the intensive care unit on the 10th postoperative day in good condition with normal diuresis.

Acute Kidney Injury↗
PubMed1989

Lateral facet syndrome of the patella. Lateral restraint analysis and use of lateral resection.

Thirty-eight knees in 34 patients with an average age of 22 years were diagnosed as having lateral facet syndrome (LFS), a painful compressive arthropathy of the lateral facet of the patella. This diagnosis was based on the physical findings of tenderness at the lateral patellofemoral joint line, tenderness over the vastus lateralis obliquus (VLO) tendon just above the patella, a positive medial apprehension test, and marked resistance to medial patellar displacement with the knee flexed 30 degrees. The most common complaints were patellar pain with activity, pain with prolonged knee flexion, intermittent knee swelling, and giving way. At surgery, the VLO, the lateral retinaculum (LR), and the anterior fibers of the iliotibial tract (ITT) were sequentially divided from the lateral border of the patella. Each was temporarily reattached to a cuff of soft tissue left on the patella using surgical clamps to determine its contribution to lateral restraint. The VLO was found to be the primary restraint in one-half of the knees. In one-third of the knees, all three of the structures contributed equally. In six knees, the primary restraint was the anterior fibers of the ITT, whereas the LR was the primary restraint in only two. The distal ends of these three structures were then resected to prevent rescarring and retethering. At a minimum follow-up period of two years, 87% had satisfactory relief of their patellar pain, had returned to normal activities, and had no or minimal physical findings of LFS. The procedure is recommended for patients who have failed other procedures and in those whose symptoms cannot be controlled by activity modification, exercises, bracing, or medication.

Adolescent↗
PubMed1976

A comparison of four models of total knee-replacement prostheses.

Twenty-nine knees with unicondylar, sixty-four with duocondylar, fifty with Guepar, and fifty with geometric prostheses were studied. The follow-up ranged from two to three and one-half years. The unicondylar prosthesis was used in the mildest cases and gave the least complications, but the quality of results was not superior to that achieved with the other prostheses. The duocondylar model was best suited for knees with rheumatoid arthritis and mild deformity. The geometric prosthesis was the best condylar prosthesis for osteoarthritis with moderate to severe deformity, but gave the worst results in knees with rheumatoid arthritis. The Guepar prosthesis was used in the worst knees and gave the best results, but it had the highest infection rate and was the most difficult to salvage. A radiolucency was observed in about 60 per cent of the condylar replacements around the tibial component and in 45 per cent of the Geupar replacements around the femoral component. The significance of this cannot yet be determined but it suggest that the fixation may not be ideal. In all types, residual pain was most frequently attributed to the patellar compartment. Patellectomy was not a solution.

Aged↗
PubMed1989

Three-dimensional motion analysis of clinical stress tests for anterior knee subluxations.

The three rotations and three translations that comprise total knee motion were simultaneously measured in cadaveric knees during the commonly employed clinical tests for anterior cruciate injury. A second study determined the three-dimensional motions that occurred when known forces and moments were applied. A total of eight whole lower limbs were studied. A 6 degree-of-freedom instrumented linkage (3-D electrogoniometer), rigidly mounted to the tibia and femur, was used. The ligaments sectioned included the lateral extraarticular restraints (iliotibial band, lateral capsule) and the anterior cruciate ligament, both separately and in combination. After sectioning the anterior cruciate ligament alone, anterior displacement of both the medial and lateral tibial condyles increased markedly during the flexion rotation drawer and pivot shift tests. At 30 degrees knee flexion, total anterior-posterior displacement increased 100 percent, but internal-external tibial rotation increased only 15 percent. In all the anterior displacement type of clinical tests (including Lachman's test), there was not a true rigid coupling of knee motions because the examiner controlled the amount of internal tibial rotation and anterior tibial translation. After anterior cruciate sectioning alone, both the lateral and medial tibial condyles displaced anteriorly. Sectioning the medial structures caused additional anterior translation of the medial and lateral tibial condyles. We measured many different combinations of motions that depend on the ligament and capsular structures injured, the clinical test used, and how the clinician performed the test. Differing types of anterior subluxation require that the separate subluxations of the medial and lateral tibial condyles be determined during each stress test.

Cadaver↗
PubMed2000

Reproducibility of patellofemoral CT scan measurements.

At least seven parameters have been described for the measurement of patellofemoral malalignment on CT scanning; three of which measure lateral patellar tilt, two lateral patellar shift and two femoral trochlear dysplasia. We studied 22 knees in 18 patients complaining of patellofemoral pain in order to investigate the reproducibility of these methods. CT scans of the patellofemoral joint were performed in each knee at 0 degrees and 20 degrees of flexion. The seven parameters were recorded from each scan by three independent observers in a blind study. The reproducibility was studied by means of the intraclass correlation coefficient (ICC). Parameters measuring lateral patellar tilt showed excellent reliability (ICC>75%). The measurements of lateral patellar shift and femoral trochlear dysplasia showed a fair or poor correlation (ICC<75%). We suggest that parameters for measuring lateral patellar tilt only should be used from CT scanning when planning treatment for patello-femoral malalignment.

Adolescent↗
PubMed1991

Localised mastocytosis at the bone and porous coated interface of a knee prosthesis.

A porous coated tibial plateau component, which was not loose, was removed 6 weeks after operation. An absence of bony ingrowth was demonstrated by histological and microradiographic examination. The radiolucent space was filled by young connective tissue and inflammation was indicated by the presence of a few macrophages or foreign body giant cells; there was also an increased number of mast cells near the metallic beads. Such inflammatory cells have not previously been reported around a firmly fixed joint prosthesis, but they have been associated with metallic particles. Since accumulations of mast cells can interfere with the process of bony ingrowth, further studies of removed porous coated prostheses should be made with adequate histological techniques so that the clinical significance of these cells can be better understood.

Aged↗
PubMed1986

Anterior tibial tubercle elevation in the young adult.

A modification of Maquet's procedure, longitudinal proximal tibial osteotomy, was performed on 36 adults under the age of 40. The tibial tubercle was elevated between 2.0 and 2.5 cm. Fourteen were operated on for significant osteochondral injury to the underside of the patella, including patellar fracture; 16 were operated on because of osteoarthrotic change in the patellofemoral joint secondary to recurrent subluxation. Six were operated on because of pain persisting after previous patellectomy. Follow-up ranged between 2 and 5 years, was at least 2 years, and averaged 3.53 years. A good result was determined to be one in which the patient had no pain requiring medication or activity limitation; a poor result was designated when the patient had pain requiring medication or activity limitation. The success rate among the trauma or fracture group was 94 per cent, among the subluxation group 88 per cent, and among the postpatellectomy group 66 per cent. Failures included unrecognized osteoarthrosis of the tibiofemoral joint, psychiatric problems, a reflex sympathetic dystrophy, a compensation neurosis, a failure to correct excessive knee valgus with recurrent subluxation, and a fall displacing the operation. Serious complications, osteomyelitis and a displaced graft resulting from a postoperative fall, occurred at a rate of 5 per cent; minor complications, tenuous skin healing and tibial tubercle shingle fractures, occurred at a rate of 19 per cent. This operation is indicated only for patients with osteoarthrosis of the patellofemoral joint and is contraindicated in the presence of tibiofemoral osteoarthrosis. High success rates are attributed to careful attention to indications and contraindications and to the design and details of performing the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Synovial fluid cytokines and proteinases as markers of temporomandibular joint disease.

PURPOSE: In this article, biochemical markers in the synovial fluid (SF) for detecting intraarticular inflammation and early cartilage degradation of the temporomandibular joint (TMJ) disease were examined. PATIENTS AND METHODS: SF was obtained from 25 TMJs in 22 patients with internal derangement (ID) or osteoarthritis (TMJ-OA), 15 asymptomatic TMJs in 11 normal volunteers, and 10 osteoarthritic knee joints (KNEE-OA). Cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA), and the proteinase activities were detected by enzymography. RESULTS: SF from TMJs with ID and OA showed higher (P < .05) levels (330.1 +/- 347.7 pg/100 microg SF protein) of IL-1beta than the asymptomatic control TMJs (76.7 +/- 95.3 pg/100 microg of SF protein). SF from TMJs with OA contained significantly (P < .05) higher levels of IL-1beta (531.8 +/- 379.6 pg/100 microg of SF protein) and IL-6 (979 +/- 552 pg/100 microg SF protein) than those with ID (IL-1beta: 216.7 +/- 280.1 pg, IL-6: 293 +/- 434 pg). Two matrix metalloproteinases (MMPs) with gelatinolytic activities at 92 kDa and 72 kDa were consistently detected in both the TMJ-SF (either normal or disease) and SF from KNEE-OA. Also detected were weak bands with molecular weight of 83 and 66 kDa. These bands were clearly shown, particularly in knee joints with advanced stages of OA. Western blot analysis delineated that these were active forms of MMP-9 (83 kDa) and MMP-2 (66 kDa). The same bands were also detected in TMJs with OA that showed high levels of IL-1beta and IL-6. CONCLUSION: These findings suggest that concomitant increases in the levels of cytokines (IL-1 and IL-6) and active forms of MMPs could be potential catabolic markers for cartilage degradation in the TMJ.

Adolescent↗
PubMed2004

[Arthroscopically assisted refixation for avulsion fracture of the intercondylar eminence with Fiber-Wire cerclage].

Avulsion fracture of the intercondylar eminence is a rare knee injury. It is found either isolated or connected to other bone or intra-articular injuries. Arthroscopically assisted treatment is nowadays the most common procedure. The refixation of the fragment is technically sophisticated and usually requires a longer period of immobilization. In two patients we used a suture cerclage with extreme tensile strength (Fiber-Wire, Arthrex Inc.) placed through a tibial guide. Using this procedure we combined the advantages of easy implantation, sufficient retention, and thereby the possibility of forced follow-up treatment. The present results are promising.

Adolescent↗
PubMed1995

[MRI of the knee joint: first results of a comparison of 0,2-T specialized system and 1,5-T high field strength magnet].

PURPOSE: Diagnostic accuracy and image quality of a specialised system for MR examinations of peripheral joints were evaluated. MATERIALS AND METHODS: 20 patients with acute or chronic injuries of the knee were examined using a low-field MR system (0.2 T). For comparison, all patients were also studied with a 1.5 T high field strength magnet and all diagnoses were correlated with arthroscopic findings. RESULTS: We found compatible diagnostic accuracies (cruciate ligaments 90%, menisci 75-90%) and good image quality ratings for the low field system ("good" and "excellent" image quality in 83% of cases). CONCLUSION: The low-field MR-system offers low-cost MR examinations of peripheral joints with good image quality and reliable diagnostic information.

Adult↗
PubMedDate not supplied

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

In an attempt to correct anterolateral rotatory instability of the knee, 30 consecutive patients underwent a surgical procedure similar to that described by Ellison (Ellison AE: A modified procedure for the extra-articular replacement of the anterior cruciate ligament. American Orthopaedic Society for Sports Medicine Symposium, New Orleans, LA, July 15, 1975), called the iliotibial band transfer. Fashioning the passageway for the transfer closer to the attachment of the fibular collateral ligament on the femur and meticulous fascial closure over the transplant were not found to be crucial to success. Twenty-nine of the 30 patients were injured during athletic activities, and the remaining patient was injured in a motorcycle accident. They often complained of an unstable knee with symptoms of pain and giving way. Twenty-eight patients with a minimum followup of nine months (the average followup was 25 months) were evaluated subjectively by an interview and by objective clinical examination. Subjective results (including asymptomatic return to their previous level of athletic activity) and clinical improvement of anterolateral rotatory instability (based on the flexion-extension-valgus test or the Slocum anterolateral rotatory instability test) were encouraging. Areas of concern were that a small number of patients developed asymptomatic varus instability and a few had relative strength deficits which may or may not have long-term significance.

Accidents, Traffic↗
PubMedDate not supplied

Concomitant meniscal and articular cartilage lesions in the femorotibial joint.

The frequency of concomitant meniscal and articular cartilage lesions in the femorotibial joint was analyzed in a retrospective study of 1740 knee joints examined arthroscopically with the objective of determining possible correlations between the two knee joint abnormalities. Articular cartilage lesions were found in 81.4% (N = 1416) of femorotibial joints examined and meniscal derangements were noted in 72.8% (N = 1268). In the medial compartment, concomitance was noted in 76.3% (821 of 1076) on the femoral condyles and in 48.6% (523 of 1076) on the tibial plateau. In the lateral compartment, 43.1% (212 of 492) of the knees with deranged menisci had femoral and 55.1% (271 of 492) had tibial articular lesions. Medial meniscal lesions were more frequently associated with femoral and tibial chondral degeneration than lateral meniscal derangements (P < 0.001). Longitudinal, bucket-handle, and complex tears of the medial meniscus were significantly more often associated with articular cartilage damage than horizontal cleavage, flap, or radial tears. Degeneration of the meniscus was highly correlated with chondral destruction in both compartments. No cause-and-effect relationship could be established, but practical implications of these findings are discussed.

Adolescent↗
PubMed1994

The value of computed tomography for the diagnosis of recurrent patellar subluxation in adolescents.

OBJECTIVE: To determine if computed tomography of the patellofemoral joint has any advantage over standard radiologic techniques in the evaluation of recurrent patellar subluxation. DESIGN: A case series. SETTING: A tertiary children's hospital out-patient clinic. PARTICIPANTS: Forty consecutive adolescents with a clinical diagnosis of recurrent patellar subluxation (study group) and 14 volunteers with normal knees (control group). INTERVENTIONS: A standardized radiologic protocol, including axial views of the patella at 30 degrees of knee flexion, with and without external torsion of the tibia, and computed tomography (CT) of the patella at 15 degrees of knee flexion. MAIN OUTCOME MEASURES: The lateral patellofemoral angle on the axial views and on the CT scan and patellar centralization on the CT scan. RESULTS: In the control group, no radiologic evidence of recurrent patellar subluxation was found. In the study group, an abnormal lateral patellofemoral angle was found in 25% of axial views; this rate increased to 42% with external rotation and 86% on the CT scan. Patellar centralization was abnormal in 79% of cases. CONCLUSIONS: CT of the patellofemoral joint is more sensitive than standard radiographs for the diagnosis of recurrent patellar subluxation. The use of CT is recommended when standard radiographs appear normal.

Adolescent↗
PubMed1991

Use of carbon fibers in the reconstruction of knee ligaments.

Carbon fibers were used to reconstruct the anterior cruciate ligament and other knee ligaments in a consecutive series of 26 (mostly acute) patients who had suffered serious occupation-related injuries. After an average follow-up time of 52.4 months (one patient lost, one patient refused follow-up examination), the anterior drawer at 30 degrees was less than 5 mm (side-to-side difference) in 14 patients, 5-10 mm in six patients, and greater than 10 mm in four patients. Of 24 evaluatable patients, 22 returned to work, including 20 patients who work underground. Chronic pain, recurrent effusion, infection, and tender nodes did not occur in the series. Arthroscopic examination of five patients revealed minimal intraarticular debris.

Acute Disease↗
PubMed1984

The diagnosis of knee injuries in casualty--a prospective study.

A prospective study of all knee injuries seen at a Casualty Department was organized. A clinical diagnosis was made in each case, based on standardized criteria, and the subsequent progress followed. Meniscal tears tended to be over-diagnosed clinically. Many injuries thus classified settled in three to four weeks without further sequelae. Conversely, complete ligament tears were under-diagnosed and in particular these tended to be missed in the presence of a haemarthrosis. Examination under anaesthesia is recommended if there is any doubt concerning ligamentous stability and all unexplained haemarthrosis should have early examination under anaesthesia and arthroscopy. Among those injuries initially regarded as less serious e.g. traumatic synovitis, no serious pathology subsequently emerged.

Adolescent↗
PubMed1992

Patellar complications after knee arthroplasty. A prospective study of 56 cases using the Kinematic prosthesis.

A prospective study on 56 knees was performed to analyze the incidence and cause of patellar complications following total knee arthroplasty with the Kinematic prosthesis inserted with the Universal Instrumentation system. Patellar complications occurred in 23 cases: 15 had anterior knee pain. There was 1 case of patellar fracture. Subluxation of the patella occurred in 13 cases, of which 6 were painful. Although the mechanical alignment was correctly reconstructed to neutral in all but 2 cases, the instrumentation tended to allow malpositioning of the components into excessive femoral valgus and compensatory excessive tibial varus that predisposed to patellar subluxation. With this prosthesis and instrumentation, patellar stability is hindered by a very short anterior femoral flange, a shallow patellar groove, and insertion of the components at 3 degrees to the mechanical axis. It should be ensured that the components are correctly positioned, that patellar stability is carefully checked before closing the capsule, and that lateral release is performed more often.

Aged↗
PubMedDate not supplied

MR findings in patients with acute tibial plateau fractures.

OBJECTIVE: The purpose of this study was to demonstrate the MRI findings associated with acute tibial plateau fractures. MATERIALS AND METHODS: MR scans of 29 patients with acute tibial plateau fractures were analyzed retrospectively. The images were evaluated for the presence of injuries involving the menisci, cruciate and collateral ligaments. The presence of a lipohemarthrosis or a simple joint effusion was also noted. The tibial plateau fractures were classified according to the scheme devised by Schatzker. RESULTS: Evidence of internal derangement of the knee was found in 28 (97%) patients. Tibial collateral ligament (55%) injuries and lateral meniscus (45%) tears were noted most frequently. Medial meniscus tears were seen in 21% and fibular collateral ligament injuries were diagnosed in 34%. Forty-one percent had anterior cruciate ligament injuries while the posterior cruciate ligament was injured in 28%. Twelve (41%) patients demonstrated the characteristic MRI features of a lipohemarthrosis. Simple joint effusions were found in the remaining 17 (59%) patients. CONCLUSION: MR imaging in patients with acute tibial plateau fractures commonly demonstrates associated ligamentous and meniscal injuries. By imaging in multiple planes, MRI can aid in the accurate characterization of tibial plateau fracture patterns and severity.

Adult↗