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PubMed2001

Knee joint injuries as a reconstructive factors in car-to-pedestrian accidents.

Knee joint injuries were found in 214 out of 357 fatal pedestrian victims of traffic accidents (60%). The cross-sections of tibial and femoral epiphyses revealed bone bruises (due to compression and avulsion) and the percentage of victims with knee injuries increased to 80% (in the group of lateral impacts - 94%). The bone bruises in the central tibial and femoral condyles were observed only in victims hit in an upright position. There was a strong correlation between the side of impact on the extremities in medium sized pedestrians (from the front, back, lateral and medial side) caused by passenger cars and the mechanism of knee injuries (hyperextension, anterior dislocation of the proximal tibial epiphysis in relation to the femoral condyles, valgus and varus flexion). In the cases of very low impacts (e.g. in very tall victims hit by rapidly breaking wedge-shaped cars) or very high impact (e.g. in very short victims or truck hits) the "reversed" complexes of injuries were found (lever principle). These findings showed that knee joint injuries are useful for determining the car-pedestrian location on collision and the type of vehicle (in hit-and-run accidents).

Accidents, Traffic↗
PubMed2006

In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament.

This study compares the effects of two different techniques of medial patellofemoral ligament (MPFL) reconstruction, and proximal soft tissue realignment on patellar stabilization against lateral dislocation. Eight human cadaver knee specimens with no radiological pathomorpholgy on a straight lateral view, contributing to patellofemoral instability, were mounted in a kinematic knee simulator and isokinetic extension was simulated. Patellar kinematics were measured with an ultrasound positioning system (zebris) while a 100 N laterally directed force was applied to the patella. The kinematics were compared with intact knee conditions under MPFL deficient conditions, as well as following dynamic reconstruction of the MPFL using a distal transfer of the semitendinosus tendon, following static reconstruction by a semitendinosus autograft, and following proximal soft tissue realignment of the patella (Insall procedure). Dynamic reconstruction of the MPFL resulted in no significant alteration (P = 0.16) of patellar kinematics. Static reconstruction of the MPFL significantly medialized (P < 0.01) the patellar movement without, but restored intact knee kinematics under the laterally directed force. In contrast, following proximal soft tissue realignment, the patellar movement was constantly medialized and internally tilted (P = 0.04). Dynamic and static reconstruction of the MPFL create sufficient stabilization of the patella. Following proximal soft tissue realignment, the patellar position was over-medialized relative to intact knee conditions, which could lead to an overuse of the medial retropatellar cartilage.

Aged↗
PubMed1985

Recurrent dislocation of the patella treated by the modified Roux-Goldthwait procedure. A prospective study of forty-seven knees.

We studied the results in forty-seven knees in thirty-seven patients - ten male and twenty-seven female - who had recurrent dislocation of the patella and were treated by a modified Roux-Goldthwait procedure (lateral retinacular release, medial transfer of the lateral patellar tendon without advancement, plication of the medial retinaculum, and advancement of the vastus medialis). Ten of the female patients had bilateral dislocation. The results were analyzed after follow-ups ranging from 3.0 to 16.3 years (average, 5.8 years). The study confirmed that a tangential radiograph of the patellofemoral joint, made with the knee in 20 degrees of flexion, is reliable in determining patellar displacement. The results were excellent in twelve knees, good in thirty-one, fair in one, and poor in three. The fair and poor ratings were due to pain caused by severe chondromalacia patellae. The patient with a fair result had had recurrent dislocations after the Roux-Goldthwait procedure due to a very lax synovial and capsular sac. Reoperation with tightening of the sac medially and laterally eliminated hypermobility of the patella in this patient and established straight patellar tracking. There was one serious complication, a large subcutaneous hematoma with necrosis of a skin flap. The patients with mild chondromalacia improved and showed no progressive patellofemoral arthritis after simple realignment, while those with severe chondromalacia were not improved by shaving, drilling, and realignment. Preliminary results indicated that a modified Maquet procedure, in addition to realignment, may be indicated for patients with severe chondromalacia. This study demonstrated that the modified Roux-Goldthwait procedure, without advancement of the tibial attachment of the patellar ligament, can stabilize the patella without increasing patellofemoral compression. The procedure does not relieve the symptoms of severe chondromalacia of the patella but realignment is the first step in treatment of any form of patellofemoral arthrosis.

Adolescent↗
PubMed1987

The clinical features of Ehlers-Danlos syndrome type VII due to a deletion of 24 amino acids from the pro alpha 1(I) chain of type I procollagen.

The clinical features and progress of a child with the type VII form of Ehlers-Danlos syndrome due to a deletion in the pro alpha 1(I) of type I procollagen were studied. The child was born with bilateral dislocations of hips and knees and all other joints were markedly hypermobile. Persistent severe joint instability was the major clinical abnormality. She had a depressed nasal bridge with prominent paranasal folds and deeply set eyes with mild hypertelorism and micrognathia. The skin was soft, moderately hyperelastic, and sagged over the face and knees. Skin fragility and easy bruising appeared when she started walking. Electron microscopy of the dermis showed irregular collagen fibrils.

Amino Acid Sequence↗
PubMedDate not supplied

[Dwarfism and hyperlaxity, facial dysmorphism and multiple dislocations. Larsen's syndrome?].

Five similar cases of children ranging from 6 months to 6 1/2 years of age are reported. The presented with dwarfism, generalized hyperlaxity, characteristic facial appearance, constant dislocations of elbows and knees. Bone-age was advanced and bones were slender and osteoporotic with metaphyseal thickening. All the cases appeared separately in normal families. These associated malformations resembled Larsen's syndrome, in spite of some different features.

Abnormalities, Multiple↗
PubMed2002

Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella.

We examined 39 patients (45 knees) who had undergone an Elmslie-Trillat procedure for recurrent or habitual dislocation of the patella with a follow-up of more than ten years. The mean age at the time of surgery was 18.4 years; the mean follow-up was 161 months (120 to 238). Using Fulkerson's functional knee score, 41 knees (91%) had an excellent or good result at a mean follow-up of 45 months, and this was maintained in 29 (64%) at the final review. The main cause of deterioration in the clinical results was the onset or worsening of patellofemoral joint pain, not patellar instability.

Adolescent↗
PubMedDate not supplied

Bilateral congenital dislocation of the patella.

A 19-month-old nonambulatory child with knee flexion contractures was found to have dislocated patellae. Only three previous cases of bilateral congenital dislocated patellea have been reported. Surgical treatment rationale and technique are reviewed.

Child↗
PubMed1994

Ankle dislocation.

From 1980 to 1991, 14 patients with pure ankle dislocation unassociated with fracture were identified. All patients were young adults (18-41 years of age) with a male preponderance (11 of 14). The cause of injury in nine of the 14 cases was a motor vehicle accident and in the remainder, sporting events or fall from a height. Thirteen of the 14 injuries were open, and 12 patients underwent lateral ligamentous repair. Twelve of the 14 patients were available for follow-up, which ranged from 15 to 122 months. Two patients had poor results; the remainder (10 of 12) had good and excellent results. Interestingly, no patient had signs or symptoms of instability. One patient required immediate below-the-knee amputation for open dislocation associated with avulsion of soft tissue and neurovascular structures.

Adolescent↗
PubMed1986

Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis.

The Oxford method of knee arthroplasty replaces the femoral condyles with convex spherical metal components and relines the tibial plateaus with flat metal components. Free meniscal bearings of polyethylene, spherically concave above and flat below, lie between the fixed metal components, held in place by their geometry and ligamentous tension. Advantages of the design include: congruity of the articulating surfaces; unconstrained tibiofemoral movement; preservation of all the ligaments with facility to tension them accurately from a range of bearing thicknesses; minimal bone excision; applicability to unicondylar use. Laboratory studies showed that combined rolling and sliding at meniscofemoral and meniscotibial interfaces mimic normal joint kinematics and mechanics. One hundred twenty-five bicompartmental implants were followed for two to six years. Pain was relieved in 90%; mean flexion limit was 99 degrees and mean flexion deformity 7 degrees. Stability and alignment were recovered in nearly all joints. Six knees failed and were successfully arthrodesed (two) or converted to another prosthesis (four). Eight knees required revision to replace a dislocated bearing (five) or to recement a loose component (three). In knees with an intact anterior cruciate ligament, there were no failures and a low revision rate (4.8%). The prosthesis is proposed as a reliable and safe alternative to more invasive prostheses in rheumatoid and osteoarthritic joints in which the disease is still limited to the articular surfaces.

Aged↗
PubMed1997

Total knee arthroplasty in the young rheumatoid patient.

Thirty-four total knee arthroplasties were performed for severe rheumatoid arthritis in 25 patients younger than 45 years. All patients were available for follow-up evaluation at an average of 7.2 years. According to the Knee Society scoring system, the knee score improved from an average of 21 points preoperatively to 85 points at follow-up (p < 0.001). The average functional score improved from 23 points to 87 points (p < 0.001). Average range of motion improved from 71 degrees to 93 degrees (p < 0.001). Nonprogressive radiolucencies less than 1-mm thick were observed in 6 knees. One knee was revised for severe polyethylene wear; another case was revised for chronic patellar dislocation. Actuarial survivorship analysis estimates a 97% survivorship after 5 years and 90% after after 10 years. In young rheumatoid patients, total knee arthroplasty can therefore be considered as a reliable procedure, with satisfactory results during at least the first 5 to 10 postoperative years.

Actuarial Analysis↗
PubMed1982

Results of untreated peripheral nerve injuries.

Closed injuries involving peripheral nerves are likely to occur in a severely comminuted fracture, a dislocated or stretched joint, or a fracture adjacent to a joint. Peripheral neuropathy associated with fractures are usually neurapraxia lesions and have an excellent prognosis for spontaneous recovery. Peripheral neuropathy associated with open injuries has a prognosis related to the etiology; lacerations are usually neurotmesis lesions and should be completely examined, explored, and sutured; shotgun wounds demand debridement and visualization of involved peripheral nerves; high-velocity missile wounds often create axonotmesis lesions, and involved peripheral nerves have a better prognosis for spontaneous recovery than peripheral neuropathy associated with low-velocity missile wounds. Complete and precise physical examination of peripheral nerve function at the time of injury is the best baseline for management. Electrodiagnostic studies should be initiated after one month and recorded periodically to evaluate the course of clinical recovery. It is appropriate to explore at three to four months the total nerve lesion associated with missile and shotgun wounds above the elbow or knee, stretch injuries from dislocated joints, and fractures that are severely comminuted or adjacent to joints. Many of these nerves will have a neuroma-in-continuity, and precise techniques for evaluation of nerve conduction must be utilized.

Electromyography↗
PubMed2003

Locked knee caused by meniscal subluxation: magnetic resonance imaging and arthroscopic verification.

Subluxation or dislocation of an intact lateral meniscus is a controversial and rarely reported cause of knee pain and locking. We report a case of knee locking caused by lateral meniscal subluxation in the absence of a meniscal tear or true discoid meniscus, with both magnetic resonance imaging (MRI) and arthroscopic verification. A 9.5-year-old child experienced multiple episodes of locking in full flexion of the knee. After 6 months of symptoms, arthroscopy was performed and showed no meniscal tear or a discoid meniscus. The patient's knee locking recurred after arthroscopy. MRI was performed when the patient presented acutely with the knee locked. MRI showed anterior dislocation of the posterior horn of the lateral meniscus with the knee in the locked position. The MRI was immediately repeated after the author reduced (manipulated) the locked knee into extension. On the repeat MRI, the lateral meniscus had returned to a normal position. On repeat arthroscopy, the posterior horn of the lateral meniscus was hypermobile and could be displaced into the notch and did not show a frank tear. The meniscus was repaired to the capsule with sutures. At the 2-year follow-up evaluation, the patient had no complaints and no clinical signs of locking.

Arthroscopy↗
PubMed2006

[Traumatic dislocation of the hip in a 3-year-old boy with a painful knee].

A 3-year-old boy had pain on the medial side of his left knee after his father fell on him. When the pain still persisted 4 days later, further diagnostics revealed dislocation of the hip. The pain disappeared and function was restored after closed reposition under fluoroscopic control followed by immobilisation with a plaster cast. Traumatic dislocation of the hip in childhood is a relatively rare injury, but may have far-reaching consequences. As the sensitivity to pain in children differs from that in adults, an examiner must be on the alert for a traumatic dislocation of the hip whenever a child presents with a fitting history and dysfunction ofthe leg, regardless of the localisation of the pain. Pain in the knee is often reported in case of hip disorders. Avascular necrosis of the caput femoris is a well-known and dreaded complication of traumatic dislocation of the hip in children. The risk of complications is certainly increased sharply if the hip luxation goes unnoticed and reposition takes place after more than 6 hours. Closed reposition as rapidly as possible or alternatively open reposition of the dislocated hip under general anaesthesia is the indicated treatment.

Child, Preschool↗
PubMed1976

Recurrent dislocation of the patella. Relation of treatment to osteoarthritis.

Eighty-one knees surgically treated and twenty-six conservatively treated for recurrent dislocation of the patella in seventy-eight patients were studied. The average follow-up on the surgically treated knees was eight years and on the conservatively treated knees, sixteen years. In the non-surgical group dislocations tended to become less frequent with advancing age and there was very little evidence of osteoarthritis. After the sixty-nine tibial tubercle transfers there was a 20 per cent recurrence rate; further procedures were often needed, and the incidence of late osteoarthritis was disturbingly high. After the twelve soft-tissue corrections without movement of the tibial tubercle, dislocation recurred in three, but late osteoarthritis was not seen.

Female↗
PubMed2004

Lateral retinacular release: a survey of the International Patellofemoral Study Group.

PURPOSE: The purpose of this investigation was to determine current views regarding lateral release among experienced knee surgeons with a specific interest in the patellofemoral joint. TYPE OF STUDY: Scientific survey. METHODS: A questionnaire was developed and mailed to all members of an international group with a specific interest in disorders of the patellofemoral joint. Frequencies and percentages of responses were calculated for each question to determine surgeon consensus. We measured agreement among responses using the kappa statistic. This provided an indication of consistency for each question as well as correlation among the responses to different questions. RESULTS: The survey response rate was 60%. Isolated lateral release was estimated to account for only 1 to 5 surgical cases per respondent per year, or 2% of cases performed annually. In the setting of arthroscopy or exploration, 74% of respondents believed that lateral release calls for specific informed consent. Strong consensus was found that objective evidence is needed to justify lateral release, but agreement was poor as to what clinical evidence provides the most appropriate indication for the procedure. CONCLUSIONS: Even among experienced knee surgeons with a special interest in diseases of the patellofemoral articulation, isolated lateral release is rarely performed. Strong consensus was found that isolated lateral release should not be undertaken without prior planning in the form of objective clinical indications and preoperative informed consent. LEVEL OF EVIDENCE: Level V.

Arthroscopy↗