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At least 1,549 records · Page 86Linked to original sources
PubMed2004

Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up.

PURPOSE: Reconstruction of the posterior cruciate ligament (PCL) using the tibial inlay fixation has been reported as an alternative to the transtibial tunnel technique. Previous failures in PCL reconstruction and early reports raising potential biomechanical and clinical advantages have spurred interest in this technique. The purpose of this study was to evaluate the minimum 2-year results of PCL reconstruction using a single-bundle bone-patellar tendon-bone graft and tibial inlay fixation. METHODS: The authors prospectively studied 44 patients having isolated or combined PCL reconstruction using the direct tibial inlay fixation technique. The study period was from 1991 to 2001. Two-year minimum follow-up was 93% (41/44) and averaged 39.4 months. These 41 patients comprised the study group. Thirty-one patients were male and 10 patients were female; average age was 28 years. There were 35 primary and 6 revision reconstructions. Surgery was performed in the acute or subacute setting (<8 weeks) in 34% (14/41) and chronic setting in 66% (27/41). Combined reconstructions involving the posterolateral corner, anterior cruciate ligament (ACL), or medial collateral ligament (MCL) were done in 85% (35/41). In all patients, preoperative posterior drawer (PD) examination demonstrated greater than 12 mm posterior translation. All PCL reconstructions were performed with bone-patellar tendon-bone graft, which was 12 to 18 mm in width (16 autograft; 25 allograft). Wider tendon grafts were prepared from the allografts and tubularized to fit through an 11-mm tunnel. All patients were evaluated with preoperative and postoperative examination and x-rays. Final follow-up International Knee Documentation Committee (IKDC) subjective evaluation, final follow-up IKDC objective evaluation, and final follow-up Telos stress radiography were performed in all patients. RESULTS: Postoperative PD examination demonstrated the following: 0 (normal) in 9 patients, 1+ in 25 patients, 2+ in 7 patients, and none >2+, as compared to preoperative PD 3+ or greater in all patients in this report. No patient had <12 mm PD preoperatively. Mean improvement in PD was >2 grades of translation as compared to preoperative exam. Forty of forty-one demonstrated a solid endpoint on clinical PD testing. Final follow-up Telos stress radiography with 25 kg posterior load applied at 80 degrees to 90 degrees of flexion demonstrated average side-to-side difference of 4.11 mm (-2 to 10 mm). Average flexion loss was 4 degrees (0-15 degrees ). None lost extension. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. Final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 24 knees; C, 11 knees; and D, 2 knees, as compared to all 41 D preoperatively. Average final follow-up IKDC subjective score was 75.1 (20-100). When assessing final follow-up stability with Telos stress radiography, primary cases were significantly more stable than revision cases (P <.05). There was no difference in stability when comparing allograft versus autograft, but improved IKDC scores were seen with allograft (P <.05). There was a trend for combined reconstructions to be more stable than isolated reconstructions. All patients evaluated their knee as improved or greatly improved and would repeat the procedure. CONCLUSIONS: Reconstruction of the PCL-deficient knee with severe posterior laxity is a challenging surgical problem, as combined instability patterns frequently coexist (85% in this study). When appropriate combined reconstructions or primary repair is used, PCL reconstruction with autologous or allograft bone-patellar tendon-bone graft using tibial inlay fixation was shown to be a successful technique at 2- to 10-year follow-up. Based on their initial experience with this technique and previous experience with open and arthroscopic techniques using a transtibial tunnel, the authors continue to use the tibial inlay technique as their preferred technique for isolated or combined reconstruction of the PCL.

Adolescent↗
PubMed2005

Effect of patellar tendon shortening on tracking of the patella.

BACKGROUND: Although 10% postoperative patellar tendon shortening after bone-patellar tendon-bone autograft reconstruction of the anterior cruciate ligament has been reported, there are no published studies assessing the effect of shortening on patellofemoral joint biomechanics under physiological loading conditions. PURPOSE: To investigate the influence of patellar tendon shortening on patellofemoral joint biomechanics. STUDY DESIGN: Controlled laboratory study. METHODS: The authors evaluated the patellofemoral contact area, the location of contact, and the patellofemoral joint reaction force and contact stresses in 7 cadaveric knees before and after 10% patellar tendon shortening. Shortening was achieved using a specially designed device. Experimental conditions simulating those occurring during level walking were employed: physiological quadriceps loads and corresponding angles of tibial rotation were applied at 15 degrees , 30 degrees , and 60 degrees flexion of the knee. Patellofemoral joint contact areas were measured before and after shortening using the silicone oil-carbon black powder suspension squeeze technique. RESULTS: After patellar tendon shortening, patellofemoral joint contact areas were displaced proximally on the patellar surface and distally on the femoral surface. Although the contact area increased by 18% at 15 degrees of knee flexion (P = .04), no significant change occurred at 30 degrees or 60 degrees of knee flexion (P > .05). Patellofemoral contact stress remained unchanged after patellar tendon shortening (P > .05) at each flexion angle. CONCLUSION: Our results suggest that a 10% shortening of the patellar tendon does not alter patellar contact stresses during locomotion. It is not clear whether apparent changes in contact location in all positions and contact area at 15 degrees would have clinical consequences.

Aged, 80 and over↗
PubMedDate not supplied

Stress fracture of the patella.

Stress fractures are rarely an indication for surgical treatment. In our case we decided to operate on the patient because of distraction of the fragments. Solid bony healing took longer than in traumatic fractures, but the good functional result confirmed our regimen.

Adult↗