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PubMed1978

Sacral agenesis.

Twenty-three patients with sacral agenesis evaluated at Newington Children's Hospital between 1959 and 1977 were classified according to patterns of morphologic deficiency in the bones and articulations. Motor deficit in these patients corresponded, within one level, to vertebral loss; sensory deficit did not correspond. The major orthopaedic problems often associated with sacral agenesis are spinopelvic instability, scoliosis, myelomeningocele, hip dislocation and contracture, knee contracture, and foot deformity. These can be controlled or corrected by proper orthopaedic management.

Abnormalities, Multiple↗
PubMed2006

Primary constrained condylar knee arthroplasty without stem extensions for the valgus knee.

UNLABELLED: Avoiding stem extensions in total knee arthroplasties may decrease operative time, prosthetic cost, and canal invasion at surgery. A constrained condylar knee implant without stem extensions also likely will be easier to revise and will eliminate the risk of end of stem pain. Our hypothesis was that a constrained condylar knee implant for primary severely deformed knees would show excellent midterm results with a low rate of aseptic loosening, even without diaphyseal-engaging stems. We retrospectively reviewed 70 consecutive primary constrained condylar knee implants without stem extensions from 1998 to 2001 in 61 patients with knees in 15 degrees valgus or greater. Forty-nine patients (55 knees) were followed up for 44.5 months (range, 2-6 years). Outcome was assessed using the Knee Society scoring system. Knee Society score and functional scores improved from 34 points and 40 points to 93 and 74 points, respectively. No radiographic loosening or wear was found. There were no peroneal nerve palsies, and no patients had flexion or medial instability. One patient was affected by chronic patellar dislocation. Constrained condylar knee implants in patients with severe valgus deformity resulted in pain relief and improved function, without substantial complications at midterm followup, without diaphyseal-engaging stem extensions. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed1986

Congenital aplasia of the cruciate ligaments. A report of six cases.

Instability of the knee is frequently found in association with congenital leg-length discrepancy. We have studied six such patients clinically, radiologically and arthroscopically. Clinical signs of knee instability and significant radiological changes were present in all, and at arthroscopy the anterior cruciate ligament was completely absent in four patients and functionless in the other two. This deficiency appears to be a congenital condition which may predispose to meniscus injury or retropatellar pain; it may also lead to subluxation or dislocation of the knee during leg-lengthening procedures.

Adolescent↗
PubMed1995

A mother and three daughters with congenital dislocation of the hip and a characteristic facial appearance: a new syndrome?

We describe a mother and her three daughters who all have bilateral congenital dislocation of the hip. The mother has had no other medical problems and is on the 90th centile for height. Her three daughters resemble each other strongly with facial characteristics which include hypertelorism, epicanthic folds, puffiness around the eyes, a flat mid-face and a carp-shaped mouth. All three daughters are on the 3rd centile for height, with their head circumference on a higher centile and all had an ASD. Other features include congenital dislocation of one knee (one), congenital inguinal hernia (one) and vesico-ureteric reflux (one). They also have clinodactyly and hyperextensible finger joints, both features also seen in their father, whose height is on the 3rd centile and who had bilateral congenital inguinal herniae. Collagen studies of skin and ligament were normal. This family does not appear to fit with any of the recognized congenital dislocation syndromes and we suggest that they may represent a previously undescribed syndrome.

Adult↗
PubMed2003

Total knee arthroplasty for neglected permanent post-traumatic patellar dislocation--case report.

Permanent post-traumatic patellar dislocation is a rare entity resulting from recurrent trauma. This uncommon condition is often confused clinically with congenital dislocation of the patella. Treatment options, although not well defined, include observation, various soft tissue and bony procedures for realigning the patella and patellectomy. To our knowledge, this is the first case reporting the use of conventional non-constrained total knee arthroplasty with patellar resurfacing and soft tissue realignment procedure for long-standing patellar dislocation in a single stage. An interesting feature of this case was the patient's ability to function reasonably well for nearly 40 years with a dislocated patella until the development of secondary osteoarthritis, and the surprisingly good recovery after total knee replacement.

Arthrography↗
PubMed2005

Knee injury in patients experiencing a high-energy traumatic ipsilateral hip dislocation.

BACKGROUND: Traumatic hip dislocation results from the dissipation of a large amount of energy about the hip joint. Clinically, these forces often are first transmitted through the knee en route to the hip. It is therefore logical to look for coexistent ipsilateral knee injury in patients with a traumatic hip dislocation. METHODS: Over a one-year period, we prospectively evaluated the ipsilateral knee of all patients who had a traumatic hip dislocation on the basis of a standardized history, physical examination, and magnetic resonance imaging. RESULTS: Twenty-one (75%) of the twenty-eight knees were painful. Twenty-five (89%) of the twenty-eight knees had visible evidence of soft-tissue injury on inspection. Magnetic resonance imaging revealed evidence of some abnormality in twenty-five (93%) of twenty-seven knees, with effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings. CONCLUSIONS: The present study provides evidence of a high rate of associated ipsilateral knee injuries in patients with a traumatic hip dislocation. Bone bruises may provide a plausible explanation for persistent knee pain following a traumatic hip dislocation. The liberal use of magnetic resonance imaging is recommended for the evaluation of these patients in order to detect injuries that may not be discoverable on the basis of a history and physical examination alone.

Accidents, Traffic↗
PubMed1988

Lateral release and proximal realignment for patellar subluxation and dislocation. A long-term follow-up.

Fifty-two patients (sixty knees) who had a diagnosis of either patellar subluxation or dislocation had an operation consisting of a lateral release and proximal realignment of the patella. The duration of follow-up ranged from two to nine years. At the latest follow-up, forty-two (80.8 per cent) of the patients had a good or an excellent clinical result; only one patient had redislocation of the patella. The results were not affected by the grade of chondromalacia that was present at the time of operation; however, the differences in the results as correlated with the age and sex of the patient were statistically significant, the older patients having poorer results and the male patients, better results. Roentgenographic analysis of the postoperative position of the patella, as seen on the view described by Merchant et al., revealed that centralizing the patella in the intercondylar sulcus yielded the most favorable results.

Adolescent↗
PubMed1994

[Treatment of limb deformities by the Ilizarov method].

INTRODUCTION: The numerous possibilities for adapting the Ilizarov apparatus allows the progressive correction of complex angular deviations, for which flat apparatus are sometimes difficult to adapt and this report describes our experience using the Ilizarov apparatus to treat axial limb deformities. MATERIAL AND METHODS: A total of 48 patients (22 girls and 26 boys aged between 2 and 18 years-old) suffering from 58 angular deformities were treated with an Ilizarov device. 40 of the deformities involved bones: 22 tibias, 13 femurs and 6 radius. The remaining 18 deformities involved joints, (17 knees and 1 elbow), 12 were total ankylosis and 6 were flexion contractures. 31 of the cases involved an isolated deformity (16 bones and 16 joints) and 27 were associated with other orthopedic problems. The cause of the deformities were either malformation or infection in most cases. In 39 cases the angular deformities were deviations in a single plane: 13 in two planes and 6 déformities were complex, involving deviation in all three planes. Correction was progressive in 49 cases and immediate in 9 cases. Unequal limb length was treated in 21 cases: 19 of these were caused by bone deformity. The apparatus should cover the entire bone segment to be corrected, from metaphysis to metaphysis. When the deformity is close to a joint, the joint should be bridged so as to stabilize the brace. The fastening of the sides of the deformity involves a maximum of three pins in two different planes. The apparatus must be absolutely rigid so as to avoid any lateral slipping or any movement of the rings relative to the segments of the limbs. The two parts of the apparatus fixed on either side of the deformity should be linked by two groups of three threaded rods with articulations at the ends. When the correction is in a single plane, it is effected around the axis formed by two threaded rods at the point of the deformity. When the deformity is major, 90 degrees or more, the rings tend to shift under the strain, and this leads to a loss of correction and cutaneous problems on the concave face. This may be avoided by fixing threaded rods to the ring, perpendicular to the plane of the deformity. For knee flexion contractures, the rods should be connected to the ring where it crosses the frontal plane passing through the femoral diaphysis. RESULTS: 48 angular deviations were completely corrected. In 10 cases the deformity persisted, but was less than 20 degrees. The deformity reoccurred in 6 of the children: in 3 cases due to the persistence of muscular imbalance, in two cases by assymetric growth, in the other case by plastic deformation on the insufficiently mineralized regenerated bone tissue formed during lengthening. In one case, the common, motor and sensor peroneal nerve was paralyzed, complicating the correction of an anterior dislocation of the knee. The paralysis occurred at the end of the correction and recovery began after 6 months. One 10 year old child, suffering from nail patela syndrome, was left with a completely immobilized elbow after treatment of a webbed, 100 degrees flexion contracture. A total of 9 epiphyseal separations (Salter I type) occurred during the correction of severe deformities, with little or no displacement, all occurred around the knee. These epiphyseal separations did not interfere with the treatment of the angular deviations in three cases, however, advantage was taken of these events to effect the intended lengthening of the bone. DISCUSSION: The Ilizarov method for correcting joint ankylosis is difficult to perform, and depends on a detailed knowledge of the apparatus and braceing system, and requires rigourous installation of the pins, ring, joints and rods. Whatever the position of the two rings in relation to each other, it is always possible to link them by a system which can be adjusted. This is not possible with other external braces which have only a single plane.

Adolescent↗
PubMed1998

Dislocating anterior horn of the medial meniscus.

Dislocating anterior horn of the medial meniscus was found in 15 knees of 13 patients during arthroscopic examinations done between 1992 and 1995. All of them were available for follow-up evaluation (4 by telephone). There were 11 men and 2 women (average age, 28 years; range, 17 to 49 years). Nine knees had a history of trauma. Only 1 knee had had trauma in two bilateral cases. Duration of symptoms was an average of 3.3 years (range, 3 months to 10 years). The knees were stable clinically. Arthroscopy revealed associated lesions in 13 knees; hypertrophic medial plicae, meniscal, chondral and anterior cruciate ligament (ACL) lesions predominated. Three knees had unusually hypertrophic ligamentum mucosum. Eleven of 13 knees had more than one associated lesions. Only 2 knees (2 patients) had isolated dislocating anterior horn of the medial meniscus. Only the associated lesions were treated (except for ACL lesions) and dislocating anterior horns of the medial menisci were left alone. Follow-up averaged 21 months (7 to 40 months). At follow-up, 11 knees were graded as excellent, 3 as good, and 1 as fair according to the Lysholm scale. Eight knees had minor symptoms and 6 were asymptomatic; no improvement was noted in 1 knee. Overall, 12 patients (14 knees) were satisfied with their treatment. Dislocating anterior horn of the medial meniscus is a normal anatomic variant with little or no clinical significance. When seen during arthroscopy, a significant lesion should be looked for. It is an incidental finding and should be left alone.

Adolescent↗
PubMed1989

Vascular injury associated with fracture-dislocations of the lower extremity.

Vascular damage occurring in conjunction with orthopedic injury of the lower extremity is uncommon. This relative rarity is further complicated by the potentially subtle nature of vascular injury. Doppler signals and even palpable pulses do not exclude vascular damage. Missed or delayed diagnosis with a subsequent avoidable amputation is a too-frequent result. Displaced fractures of the distal femur and proximal tibia and particularly dislocation of the knee are associated with the highest risk of concomitant vascular injury and the poorest collateral circulation to support the distal limb. Optimal management of such injuries requires a high index of suspicion, aggressive use of angiography, and close cooperation among all members of the trauma team. With proper care, few extremities will be lost to ischemia alone. Limb loss should result only when the extremity has been too badly damaged to justify salvage efforts.

Arteries↗
PubMed1989

[Injuries of major blood vessels of the lower extremities as a complication of fractures and dislocations].

Surgical treatment was applied in 46 patients with simultaneous injury of great vessels of the lower extremities and fractures of the long bones or dislocations of the knee joint. The authors have determined the best in their opinion sequence of surgical procedure. They think that external fixation gives better bone stabilization and is more favorable than internal stabilization. They also recommend lavage of the peripheral vascular bed of the ischemic lower extremity, which prevents post-traumatic insufficiency of the kidneys. They think that early fasciotomy of the crus or fibulectomy is important for the good result of the operation.

Adolescent↗
PubMed2001

[The origin of femoral trochlear dysplasia: comparative anatomy, evolution, and growth of the patellofemoral joint].

We performed a comparative analysis of the femoropatellar morphology examining the evolutionary aspects to search for the origin of trochelar dysplasia. Trochlear dysplasia is frequent in the human population and, when associated with morphological and positional abnormalities of the patella, can lead to patellar pain syndrome in minor cases or patellar dislocation in severe cases. There is no strict relationship between the observed anomalies and clinical expression. The shape of the articular surfaces is variable in mammals depending on their type of locomotion: unguligrade, digitigrade, plantigrade. In greater apes, the femoral diaphysis is straight and the trochlea is flat and symmetrical. The patella does not tend to dislocate laterally since the knee under load is always flexed. In human adults, the femoral diaphysis has a valgus obliquity angle of 8 degrees to 10 degrees. Consequently, the trochlea has a deepened sulcus and an elevated lateral lip, avoiding lateral patellar dislocation, especially during initial knee flexion. In the human newborn, the femoral diaphysis is vertical. As the child starts walking, the femoral obliquity angle develops between 1 and 7 years of age, inducing a secondary valgus of the extensor apparatus. This obliquity does not develop in non-walking children. Fossil femurs of australopithecus demonstrate that a high obliquity angle had appeared more than 3 million years ago, but also exhibit a poorly deepened trochlea and a slight elevation of the lateral facet. At 1.8 million years, the fossils have the oblique diaphysis, the strongly deepened sulcus and the strongly elevated lateral facet. The obliquity angle of the femoral diaphysis is the leading feature which initiated the later modifications of the patellofemoral joint that over 3 million years were never inscribed in the human genoma. Lateral trochleal lip and deep sulcus are features that were first acquired, then once selected, genetically assimilated, and now appear on the fetal cartilaginous epiphysis.

Adult↗
PubMed1979

Semitendinosus tenodesis for recurrent subluxation or dislocation of the patella.

In 26 knees treated by semitendinosus tenodesis, there was no recurrence of dislocation, but fair and poor results totaled 38% due to persistent pain because of chondromalacia of the patella. Poor results are also more common in the patients with generalized ligamentous laxity. Postoperative complications in wound healing suggest that the medial parapatellar skin incision is less than adequate. Semitendinosus tenodesis with or without modifications is a useful procedure to prevent recurrent dislocations and subluxation during the growth period.

Adolescent↗
PubMed1991

Restoration of patellofemoral congruity by combined lateral release and tibial tuberosity transposition as assessed by MRI analysis.

Twelve knees in eleven patients with subluxation or dislocation of the patella were assessed by MRI at 0, 10, 20 and 30 degrees of knee flexion, before and after vastus lateralis release and medial transplant of the tibial tuberosity. The preoperative position of the patella deviated the greatest from normal in 0-20 degrees of knee flexion. The operations were found to correct the lateral patellofemoral angle and the lateral patella tilt with or without quadriceps muscle contraction, but did not completely correct the marked preoperative lateral patellar displacement and tracking.

Adult↗
PubMed1981

Werner's mesomelic dysplasia with ventricular septal defect and Hirschsprung's disease.

A child with Werner's mesomelic dysplasia is presented. She has five fingers on each hand with absent thumbs and seven toes on each foot. There is posterior dislocation at the knees and mild tibial dysplasia. The child also has a ventricular septal defect (VSD) and Hirschsprung's disease. This is the first case reported of Werner's mesomelic dysplasia associated with systemic malformations.

Abnormalities, Multiple↗
PubMed1996

Avulsion of the femoral attachment of the anterior cruciate ligament in a 3-year-old boy.

The incidence of anterior cruciate ligament injury is rare in children. Deficient or absent cruciate ligaments have previously been described as the cause for congenital dislocation of the knee in newborns. We report a case of a 3-year-old boy who presented with a swollen left knee, which did not resolve over a 10-day period. He would not bear weight or extend the knee beyond 45 degrees, and had significant pain with passive extension. Arthroscopy revealed an anterior cruciate ligament that appeared to have been sheared off its attachment to the lateral femoral condyle. This is the youngest patient reported with traumatic disruption of the anterior cruciate ligament.

Anterior Cruciate Ligament↗