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At least 1,063 records · Page 59Linked to original sources
PubMed1983

The role of computed tomography in diseases of the musculoskeletal system.

Computed tomography has added another dimension to the evaluation of musculoskeletal disease. The ability to discern subtle differences in tissue densities and the capability of viewing structures in the axial plane has greatly aided the resolution between normal and pathologic tissue and the appreciation of the anatomic relation between normal and pathologic structures. This paper deals with the application of CT in the evaluation of neoplastic, inflammatory, traumatic, metabolic, and congenital diseases of the musculoskeletal system.

Ankle Injuries↗
PubMed1992

Recurrent atraumatic superior dislocation of the patella: case report and review of the literature.

Recurrent atraumatic superior dislocation of the patella with spontaneous reduction prevented by interlocking osteophytes has not been previously reported. Eight previous case reports were noted in the literature with single episodes of interlocking by osteophytes in a superior dislocation, none with recurrence, and all treated by closed reduction. The presentation of a 60-year-old woman with recurrent atraumatic superior dislocation of the patella on three separate occasions required closed reduction due to interlocking patella and trochlear osteophytes that were preventing spontaneous reduction. Arthroscopic debridement of these osteophytes resulted in no functional limitation or recurrence of dislocation at 28-month follow-up. This case demonstrates successful arthroscopic treatment of this previously unreported condition. In light of the increasingly active aging population with coexistent patellofemoral joint osteoarthritis, this presentation may become more frequent.

Arthroscopy↗
PubMed2005

Anterior tibial subluxation in anterior cruciate ligament-deficient knees: quantification using magnetic resonance imaging.

PURPOSE: The purpose of this study was to quantify anterior tibial subluxation (ATS) at full extension in patients with anterior cruciate ligament (ACL) deficiency using magnetic resonance imaging (MRI), and to elucidate the relation of ATS to the duration of ACL deficiency and the extent of anterior instability. TYPE OF STUDY: Retrospective case series study. METHODS: Ninety-six patients with isolated ACL deficiency and no history of injury in the contralateral knee were studied. We used thick-sliced T1-weighted sagittal MRI to quantify ATS at full extension. To measure ATS, MRIs were loaded into a personal computer, and the contour of the unaffected knee was compared with the affected knee using Photoshop software (Adobe, San Jose, CA). Anterior instability was measured using a KT-1000 arthrometer (MedMetric, Inc, San Diego, CA). RESULTS: The extent of ATS in 96 ACL-deficient knees was 2.1 +/- 1.3 mm (mean +/- SD) and the range was 0 to 4.6 mm. ATS was correlated positively with the duration of ACL deficiency and the extent of anterior instability. CONCLUSIONS: In ACL-deficient knees, tibiofemoral kinematics differ from a normal knee without external force. The extent increases with time and is positively correlated with instability. CLINICAL RELEVANCE: In ACL reconstruction for patients with a long history or gross instability, when the location of tibial bone tunnel is determined, tibial reference points are more reliable than femoral reference points because the femur shifts relative to the tibia.

Adolescent↗
PubMed2005

Evaluation of posterior cruciate ligament healing: a study using magnetic resonance imaging and stress radiography.

PURPOSE: To review a series of tears of the posterior cruciate ligament (PCL) in order to understand its healing process, as well as to identify prognostic factors. TYPE OF STUDY: Prospective study. METHODS: Eighteen patients with isolated or combined PCL tears were evaluated and followed-up for 1 year after their initial injury. Magnetic resonance imaging (MRI) scans and stress radiographs were obtained serially at the time of injury, at 6 months, and at 12 months. RESULTS: Twelve of 18 PCL tears were found to have regained continuity at the 1-year follow-up. These patients complained of an isolated or combined PCL/medial collateral ligament injury at time 0 and all presented a posterior subluxation of less than 8 mm, detected with stress radiographs. The remaining 6 patients had posterior subluxations greater than 12 mm and presented with combined posterolateral corner injuries. CONCLUSIONS: This study underlines the importance of a complete MRI evaluation used in combination with stress radiography to adequately assess the healing process. The results obtained suggest that complete PCL tears with greater than 12 mm of posterior subluxation, as well as combined PLC injuries, are less likely to heal completely. These factors could further aid the surgeon in deciding the need and timing for surgical intervention in the acute setting of a PCL tear. LEVEL OF EVIDENCE: Level II.

Adolescent↗
PubMed2005

In vivo contact areas of the knee in patients with patellar subluxation.

OBJECTIVE: Ex vivo studies have suggested that cartilage contact areas and pressure are of high clinical relevance in the etiology of osteoarthritis in patients with patellar subluxation. The aims of this study were therefore to validate in vivo measurements of contact areas with 3D open magnetic resonance imaging (MRI), and to study knee joint contact areas in patients with patellar subluxation at different angles of knee flexion in comparison with healthy subjects. METHODS: 3D-MRI data sets of 12 healthy volunteers and eight patients with patellar subluxation were acquired using a standard clinical (1.5 T) and an open (0.2 T) MRI scanner. We compared femoro-patellar and femoro-tibial contact areas obtained with two different sequences from open MRI [dual-echo-steady-state (DESS) and fast-low-angle-shot (FLASH) sequences] with those derived from standard clinical 1.5 T MRI. We then analyzed differences in joint contact areas between healthy subjects and patients with patellar subluxation at 0 degree, 30 degrees, and 90 degrees of knee flexion using open MRI. RESULTS: The correlation of the size of contact areas from open MRI with standard clinical MRI data ranged from r = 0.52 to 0.92. Open-MRI DESS displayed a smaller overestimation of joint contact areas (+21% in the femoro-patellar, +12% in the medial femoro-tibial, and +19% in the lateral femoro-tibial compartment) than FLASH (+40%, +37%, +30%, respectively). The femoro-patellar contact areas in patients were significantly reduced in comparison with healthy subjects (-47% at 0 degree, -56% at 30 degrees, and -42% at 90 degrees of flexion; all p < 0.01), whereas no significant difference was observed in femoro-tibial contact areas. CONCLUSIONS: Open MRI allows one to quantify joint contact areas of the knee with reasonable accuracy, if an adequate pulse sequence is applied. The technique permits one to clearly identify differences between patients with patellar subluxation and healthy subjects at different flexion angles, demonstrating a significant reduction and lateralization of contact areas in patients. In the future, application of this in vivo technique is of particular interest for monitoring the efficacy of different types of surgical and conservative treatment options for patellar subluxation.

Adult↗
PubMed1990

Frequency of vascular injury with blunt trauma-induced extremity injury.

Vascular injury associated with select blunt trauma-induced orthopedic injuries is thought to occur frequently enough to require angiography in most cases. We sought to establish the actual frequency of such vascular injuries by reviewing all orthopedic and vascular patients seen during 4 years at one institution. A total of 569 at-risk parajoint fractures or dislocations were seen with a 1.5% incidence of vascular injury; all were recognized on clinical examination and vascular consultation then obtained. Vascular injury in this setting is uncommon, associated with particular clinical presentations, and recognized by the orthopedic surgeon, without need for routine angiography or vascular consultation.

Arm Injuries↗
PubMed1994

Case report: humero-spinal dysostosis.

We report a case of humero-spinal dysostosis which is only the fourth reported in the literature. The condition is characterized by distal bifurcation of humeri, elbow joint dislocation, spinal malformation, widened iliac bones and talipes equinovarus.

Child↗
PubMed1977

Fractures and dislocations encountered by the general surgeon: general principles.

The definitive treatment selected for the care of a fracture is dependent upon what will offer the best cosmesis and function for the individual patient. Closed reductions and immobilization which require the joints to be in abnormal positions may offer an anatomic reduction but after the fracture is healed, joint function may be poor. Consequently, immobilization in the functional position with early motion and acceptance of some deformity is often better in terms of the ultimate use of the extremity. Traction treatment which requires prolonged recumbency is dangerous in the elderly because of the threat of thromboembolic phenomena and pneumonia. Therefore, open reduction and internal fixation with early mobilization of such patients is preferred. The type of treatment used is based on an evaluation of the entire patient and not just the radiographic interpretation of the fracture.

Adult↗
PubMed1992

Isolated anterolateral proximal fibular head dislocation.

A 28-year-old woman fell and sustained an isolated anterolateral dislocation of the proximal fibula. This injury generally presents with a characteristic history and associated physical examination and radiographic findings, but the subtle nature of the salient findings contributes to a high degree of misdiagnosis. Emergency physicians should be familiar with this injury because early reduction reduces long-term morbidity.

Adult↗
PubMedDate not supplied

Failure of heat shrinkage for treatment of a posterior cruciate ligament tear.

Incomplete tears or traumatic elongations of either the native cruciate ligaments or cruciate ligament reconstructions represent a therapeutic dilemma for orthopaedic surgeons. We report a case of a partially torn posterior cruciate ligament that was treated unsuccessfully with an electrothermal shrinkage procedure. Although the use of thermal energy to selectively shrink tissues may ultimately prove to be an invaluable tool, the lack of well-designed, randomized controlled studies to firmly establish its efficacy in the treatment of partial cruciate injuries mandates cautious use of this technique at this time.

Adult↗
PubMed1986

The correlation between arthroscopic findings and the patellofemoral pain syndrome.

For this study, 1,784 arthroscopies were analysed. Abnormalities of the patellofemoral joint consisting of patellar malalignment and/or patellar chondral damage were present in 175 (10%). Two types of lesion were identified, distinguished by the alignment of the patellofemoral joint, namely, subluxation with or without chondral damage (group I) and chondral damage without subluxation (group II). Group I (mean age, 25 years) included a greater proportion of women than group II; in 72%, the predominant clinical feature was patellofemoral pain syndrome (PFPS). Group II (mean age, 43 years) included fewer women; PFPS was found in only 32%, but in 82% there were signs of degenerative joint disease, which could explain the symptoms. Patellar subluxation was correlated to the PFPS, whereas chondral damage alone was not.

Adult↗
PubMed1996

Simple and safe arthroscopic placement and removal of cannulated screw and washer for fixation of tibial avulsion fracture of the anterior cruciate ligament.

Avulsion of the tibial insertion of the anterior cruiciate ligament can be managed by arthroscopic reduction and fixation. Anterograde and retrograde fixation with screws has been reported. Anterograde fixation using cannulated screws is technically less demanding and allows for stable fixation even with thin fragments. Additional use of a washer affords safe fixation of comminuted avulsion fractures. Removal of the screw and washer is mandatory but sometimes problematic. A simple and safe technique of arthroscopic placement and removal of a screw and washer used for fixation of an avulsion fracture of the tibial insertion of the anterior cruiciate ligament is presented. The same technique can be used for placement and removal of a cannulated screw and washer used in other joints.

Anterior Cruciate Ligament↗
PubMed1998

Arthroscopic treatment of voluntary superior dislocation of the patella.

The patient, a 45-year-old woman who complained of crepitation and locking of her patella, had a voluntary superior dislocation of the patella and was arthroscopically treated. Radiography showed patella alta and osteoarthrosis in the patellofemoral joint. Fluoroscopy showed that, during active contraction of the quadriceps muscle, the tip of the osteophyte on the inferior edge of the patella was positioned at the same level as the osteophyte on the superior margin of the articular surface of the medial femoral condyle. The inferior edge of the patella could be made to catch on the femoral osteophyte by application of slight pressure to the patella. Arthroscopic resection of the osteophte was performed, and the postoperative course was uneventful. The patient reported no difficulty when she was last seen 1 year after the operation.

Arthroscopy↗
PubMed2003

Theoretical use of 3D CT to predict method of patella realignment.

Procedures for the treatment of patello-femoral malalignment are grouped into two categories, proximal realignment and distal realignment. However, no clear indications in respect of these realignments have been reported. We have tried to evaluate patello-femoral alignment three-dimensionally using CT. The results lead us to group patients with recurrent patella dislocation into three types. Type 1 comprises patients with normal patello-femoral alignment. Type 2 comprises patients whose patella only deviates laterally and who need proximal realignment. Type 3 comprises patients whose patella and tibial tuberosity both deviate laterally and who need both proximal and distal realignment.

Adolescent↗