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At least 1,081 records · Page 60Linked to original sources
PubMed2001

Arthroscopic reduction and fixation of osteochondral fracture of the patellar ridge.

A method of arthroscopic reduction and anterograde fixation of osteochondral fracture of the patella ridge is described. This type of fracture was previously treated through arthrotomy. An arthroscopic approach is possible using manipulation of the patella in a loosened medial retinaculum. This method was used in a 14-year-old patient with an osteochondral fracture following the dislocation of the patella.

Absorbable Implants↗
PubMedDate not supplied

Posterior tibial subluxation and short-term arthritis resulting from failed posterior cruciate ligament reconstruction.

Posterior tibial subluxations because of combined or isolated posterior cruciate ligament (PCL) injuries require detailed evaluation. PCL reconstructions are difficult procedures because of the low rate of such injuries and the complex anatomy of the ligament. We report on 2 cases of failed PCL reconstruction because of malpositioned femoral tunnels. These 2 cases support the existing biomechanical evidence that the correct placement of the tunnels, especially in the femur, is a major factor in defining the outcome. It seems that the drilling of the tunnels, especially in the femur, during PCL reconstruction must be performed with accuracy and always be evaluated in cases of graft failure. In addition, failed PCL reconstructions are usually accompanied by a short-term excessive arthritis that results in poor functional outcome.

Achilles Tendon↗
PubMedDate not supplied

Magnetic resonance measurements of the deviation of the angle of force generated by contraction of the quadriceps muscle in dogs with congenital patellar luxation.

OBJECTIVE: To measure the quadriceps angle (Q-angle) in dogs with congenital patellar luxation using magnetic resonance (MR) methods. STUDY DESIGN: Prospective clinical study. ANIMALS: Thirty-eight client-owned dogs. METHODS: Thirty-eight dogs were examined and placed into the following groups based on the degree of patellar instability: normal, grade I, grade II, and grade III. MR images of 37 pelvic limbs without patellar instability, 33 pelvic limbs with patellar luxation, and 6 limbs with cranial cruciate ligament (CrCL) rupture were made. The Q-angle was calculated using trigonometric methods based on MR images. Limbs with patellar luxation were compared with normal stifles and stifle with other disorders. RESULTS: The average Q-angle of the normal group was 10.5 degrees (24.9 degrees to -2.0 degrees ). The grade I group had an average Q-angle of 12.2 degrees (28.8 degrees to 2 degrees ), the grade II group 24.3 degrees (44.6 degrees to 7.7 degrees ), and the grade III group 36.6 degrees (51.4 degrees to 15.6 degrees ). The average Q-angle of limbs with an isolated CrCL rupture was 19.3 degrees (34.7 degrees to 3.9 degrees ). CONCLUSION: MR images can be used to make exact calculations of the Q-angle. CLINICAL RELEVANCE: MR images can be used to quantify the degree of patellar luxation.

Animals↗
PubMed1996

[Differential indications for so-called "lateral release" in treatment of chondropathia patellae].

The success rate of the operation of lateral release for pain caused by the patella is reported as being between 14% and 99%. The choice between arthroscopic or open procedures does not seem to affect the results. The wide ranges of results probably reflects differences in patients selection or the method and investigations of follow up. The early term outcome usually show better results than long term follow up. This study evaluates the indications for the operation of lateral releases and discusses the result of 36 out of a total of 42 patients who were follow up for 3 years later surgery. We found that an insufficiency of dysplasia of the vastus medialis, the laxity of the capsule and soft ligaments, and a strong lateral retinaculum were important factors in the indication for this procedure. The quadriceps angle was also of prime importance, but the minor forms of patellar dysplasia played only a minor role. In the so-called hyperpression syndrome, where the patella has a strong tendency to move laterally, the simple lateral release is the single most successful operation. The indication for procedures additionally to the lateral release is examined. We found that in a case with an insufficiently guided patella, a weak capsule and ligaments, an additional capsule roughing should be performed. The presence of early degenerative changes in the joint predisposes to poor results in operations such as abrasion and pride drilling. The results in our study were assessed using the Lysholm score. Our results show that the most successful technique was the combination of an arthroscopy and an extraarticular open operation controlled by arthroscopic means. This technique was not associated with major complications such as haemarthrosis and consecutive prolonged postoperative rehabilitation. Overall we achieved a rate of 83% of good or satisfactory results at more than 3 years using the indications and techniques described above.

Adult↗
PubMed1991

[The renaissance of simultaneous tomography with the fluorescent-film storage system].

The handling, technical and exposure details of digital simultaneous tomography are explained, while particular emphasis is placed on image quality. Selected case reports demonstrate the application of this technique by using the digital storage fluorescent system (Fa. Siemens, Erlangen). Simultaneous tomography with storage fluorescent screens is particularly suitable to demonstrate or exclude osseous findings at the skull, the column and large joints.

Adult↗
PubMed2000

Vastus lateralis fibrosis in habitual patella dislocation: an MRI study in 28 patients.

We studied 28 patients with habitual or recurrent dislocation of the patella with MRI of both thighs. Apart from the 2 patients whose dislocation could be related to trauma, we found signs of fibrosis of the vastus lateralis muscle in all the affected limbs of the 26 patients with an insidious onset of dislocation. This was seen as low signal intensity cords in the muscles in the T2 weighted image. Muscle degeneration was seen as high intensity signals in the T1 weighted image. In patients with unilateral disease, the vastus lateralis muscle of the affected side was hypotrophic, compared to that of the normal side. 2 patients underwent a biopsy of the affected muscle area. Histopathological examination revealed inflammatory cell infiltration, fibrosis, and muscle fiber degeneration. Fibrosis of the vastus lateralis muscle appears to be common in patients with habitual patella dislocation in our population, and may be the cause of the dislocation. Since release of such a contracture may be of value, MRI study of the thigh muscles is helpful in the evaluation of patients with this disorder.

Adolescent↗
PubMed2005

Femoral lengthening over an intramedullary nail using the external fixator: risk of infection and knee problems in 22 patients with a follow-up of 2 years or more.

BACKGROUND: The time for femoral lengthening is shortened if external fixation is combined with intramedullary nailing. However, several complications have been reported with this procedure. PATIENTS AND METHODS: We retrospectively reviewed the outcome of femoral lengthening performed over an intramedullary nail using external fixation in 22 patients. These patients were followed for a mean of 3.2 (2-5.2) years. The mean age was 22 (13-35) years at the time of the index procedure. The mean lengthening was 5 (2.7-8.1) cm and the external fixator was removed after median 20 (8-30) weeks. The mean external fixation index was 24 (11-35) days/cm and the mean consolidation index was 43 (26-55) days/cm of lengthening. RESULTS: 3 patients who had a past history of infection or open trauma developed osteomyelitis which required removal of the nail. There were 4 knee joint complications when the lengthening was over 20%, including posterior knee subluxation and patella subluxation. In 1 patient, the lengthened segment collapsed with breakage of locking screws. INTERPRETATION: Although lengthening over a nail can reduce the duration of external fixation, caution is required to prevent major complications.

Adolescent↗
PubMed1980

Patellar malalignment: a treatment rationale.

A general review of present-day treatment for patellofermoral malalignment is presented. These regimens are viewed in light of known anatomical, biomechanical, and pathophysiological principles. We stress the need for a sound knowledge of biomechanical and pathophysiological principles prior to the initiation of surgical or rehabilitative techniques. Three major categories of surgery are discussed: 1) simple lateral release, 2) proximal "dynamic" realignment, and 3) distal patellar tendon realignment. A comprehensive rehabilitation program is presented based on sound biomechanical principles and known surgical techniques. We wish to stress the "non-surgical," conservative approach to patellofemoral malalignment through the use of a well-orgainzed and structured rehabilitation program.

Biomechanical Phenomena↗
PubMed1975

Thromboembolic complications of cast immobilization for injuries of the lower extremities.

Six cases of thromboembolic complications in patients being treated with plaster cast immobilization for a variety of injuries to the lower extremity were encountered over a four month period on an Air Force orthopaedic service. These injuries, consisting of three ruptures of the tendo achillis, two fractures of the tibia, and a sub-talar dislocation of the foot, resulted in one death from pulmonary emboli and three other serious complications of pulmonary emboli. The literature on thromboembolic complications following lower extremity injuries (including information of pathogenesis, clinical characteristics and epidemiology of venous thromboembolism and the hazards of lowere extremity cast immobilization in an individual susceptible to his complication) suggests that prophylaxis against thrombosis should be instituted in high risk individuals who must undergo case immobilization for injuries to the lower extremity.

Achilles Tendon↗
PubMedDate not supplied

Irreducible lateral dislocation of patella due to an intact retinaculum.

Lateral dislocation of the patella is a common injury that can be treated successfully nonoperatively. The authors present a patient with lateral dislocation of the patella in which the patella rotated 90 degrees about its vertical axis. The retinaculum had been avulsed from the anterior aspect of the patella but was otherwise intact. Because the intact retinaculum prohibited closed reduction, open reduction was performed. The patient has returned to full, unrestricted activities.

Adolescent↗