Transection of the popliteal artery whilst trampolining.
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Foot drop resulting from subluxation of the superior tibio-fibular joint is described in a female dancer. Spontaneous resolution of the nerve injury occurred over two months with no residual joint instability. Expectant management is recommended for this injury. The potential for this unusual injury, in a wide variety of sports, is pointed out.
Acute traumatic proximal tibiofibular joint dislocation is an exceedingly rare injury. This is a case report in a rare horizontal type joint variant, following a long jump injury. The diagnostic approach when this injury is suspected is described.
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We prospectively studied the characteristics and early recovery of an unselected population of patients who had acute first-time lateral patellar dislocation. The recovery program used standardized rehabilitation, emphasizing range of motion, muscle strength, and return of function. Patients returned to stressful activities including sports as tolerated when they regained full passive range of motion, had no effusion, and when quadriceps muscle strength was at least 80% compared with the noninjured limb. Seventy-four patients met the enrollment criteria; 37 men and 37 women. The average age was 19.9 years, and preinjury sports participation was similar to that of ligament-injury patients. Four percent of patients (N = 3) had a history of birth complications, 3% (N = 2) had a history of lower extremity problems as an infant or child, and 9% (N = 7) had a family history of patellar dislocation. Radiographs revealed a 50% incidence (N = 37) of patella alta; all patients demonstrated lateral patellar overhang. Patients regained range of motion (mean, 0 degrees to 132 degrees) by 6 weeks. Sports participation remained significantly reduced throughout the first 6 months after injury, with the greatest limitations in kneeling and squatting. At 6 months, 58% of patients (N = 43) noted limitation in strenuous activities. The patients who had acute primary patellar dislocation were young and active. Most injuries occurred during sports, and few patients had abnormal physical features, contradicting any stereotype of an overweight, sedentary, adolescent girl whose patella dislocates with little or no trauma.
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1. The anterior drawer is a test of anterior cruciate ligament integrity. 2. The anterior cruciate ligament is composed of two parts: the anteromedial band and the posterolater bulk. 3. The anteromedial band is the primary check against anterior drawer. 4. Other structures may contribute to the resistance of anterior drawer only if the anteromedial band has been injuried. 5. The posterior cruciate ligament is a check against posterior drawer. 6. In long term follow-up, the presence of anterior drawer is associated with poor overall results.
The Elmslie-Trillat procedure involves lateral retinacular release, medial capsular reefing, and medial transposition of the anterior tibial tubercle hinged on a distal periosteal attachment. It is an easily performed procedure and is an excellent method for realignment of the extensor mechanism in cases of dislocation and subluxation of the patella. In our series of 52 cases with 6-24 months postsurgical evaluation, 46 cases, or 88 percent were rated as good or excellent. It must be emphasized that this technique is used only if the epiphyseal plates are closed.
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