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PubMedDate not supplied

Symptomatic dislocation of the anterior horn of the medial meniscus.

Anteromedial joint line pain of the knee represents both a diagnostic and therapeutic challenge. Dislocation of the anterior horn of the medial meniscus as a cause of anteromedial joint line pain is uncommon. O'Connor has reported this finding on internal and external rotation of the tibia during arthroscopy and Dashefsky has demonstrated a shadow sign associated with dislocating anterior horns. We have noted these findings plus anteromedial femoral condylar articular erosion associated with persistent anteromedial joint line pain in 13 patients. All 13 patients had persistent anteromedial joint line tenderness on physical examination present from 3 months to 3 years prior to surgery. Six of the 13 patients had a click in the knee with activity and only 4 of the 13 patients reported "giving away" episodes. Arthroscopic examination demonstrated a complete anterior horn dislocation of the medial meniscus as described by O'Connor and Dashefsky as well as degeneration of the anteromedial femoral condyle. Definitive treatment was performed in the 13 patients after arthroscopic confirmation of the diagnosis of dislocating anterior horn of the medial meniscus. The first four patients had traditional medial meniscectomies, the next four patients had repair of the anterior horn, and the last five patients had partial resection of the meniscus through the arthroscope. Excellent results occurred in three of four patients with repair of the anterior horn, and four of five patients with partial resection through the arthroscope. The one failure of repair subsequently underwent a complete medial meniscectomy with an excellent result.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

New outpatient treatment of recurrent patellar dislocations.

From December 1987 through February 1991, outpatient arthroscopic procedures were done on patients experiencing recurrent dislocations of the patella. A modified Emslie-Trillat procedure was used. Twenty-four patients (27 knees) were available for follow-up. Using the criteria of Cox, excellent results were found in 78% (21 knees), whereas 18% (5 knees) were rated as good. Only 4% (1 knee) was considered fair, and none were rated poor. Most patients (96%) showed improvement. No patient suffered a postoperative dislocation. Based upon the findings of this study, it is concluded that this procedure is an effective method of treatment for patients having recurrent dislocations of the patella.

Adolescent↗
PubMed1999

Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography.

High-quality AP and lateral radiographs of both knees are essential to confirm the diagnosis. Computed tomography may help resolve diagnostic uncertainty and enable earlier closed reduction to be performed. Moreover, CT scans may be more consistently reproducible than the varied quality of emergency radiographs. In this case, the relative severity of the patient's pain and suggestive radiographs led us to obtain CT scans, which confirmed the diagnosis and enabled early successful closed reduction.

Acute Disease↗
PubMed1997

[Osteochondral fractures of the external femoral condyle after traumatic patellar dislocation during physical exercise in children].

PURPOSE OF THE STUDY: Nineteen osteochondral fractures of the lateral femoral condyle associated with acute traumatic patellar dislocation resulting from sport injury in children were studied. The purpose of this study was to specify clinical and radiological features. MATERIAL AND METHOD: This study was led with special care to injury circumstances, fracture visibility on X-rays, size and location of the fracture, treatment delay, presence of femoro-patellar dysplasia signs. Treatment results were evaluated on knee pain, bone consolidation and recurrent dislocation. RESULT: Thirteen boys and six girls aged 8 to 16 years (average 14 years) were included. The injury resulted from a rotatory-compression stress in 75 per cent cases. The patella was always in place at the time of examination. Thirteen fractures were diagnosed within 24 hours and 5 fractures were diagnosed within 1 week after injury. One fracture was not visible on X-rays and was diagnosed 6 weeks after injury. Only the lateral view showed the fracture in more than one case out of two. Seven patients whose fracture was less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, were treated by knee arthroscopy and removal of the osteochondral fragment. Twelve patients were treated by arthrotomy and excision (one case) or replacement of the osteochondral fragment (11 cases). The replaced fracture was fixed with biological glue ten times, and screwed once. The knee was immobilised in a cylinder cast and weight-bearing prohibited for six weeks. Bone consolidation was obtained in 9 cases out of 11, in an average of 8 weeks. Knee pain occurred 5 times. Recurrence of the dislocation occurred 3 times within 6 months. Eighty per cent of these children showed patello-femoral dysplasia. DISCUSSION: This fracture complicated 31.6 per cent of traumatic patellar dislocation resulting from sport injury in children which we observed during the last ten years. It may be overlooked if it is suspected and carefully looked for by radiographic examination including antero-posterior, lateral, oblique and true skyline views of the patella. The presence of fat in the hemarthrosis may help. Early surgery is recommended. Arthroscopy may be performed to evaluate fracture location and size. After ten days, host area begins to fill in and free fragment will not fit back well. Fragments less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, may be removed. CONCLUSION: Lateral femoral condyle osteochondral fractures are associated with nearly one third of traumatic patellar dislocation resulting from sport injury in children. A detailed radiographic examination can help diagnosis. Treatment depends on the delay after injury, the size and location of the fracture.

Adolescent↗
PubMed2001

Mobile-bearing knee replacement: clinical results: a review of the literature.

Mobile-bearing knee replacements have been implanted for more than 20 years. The Oxford unicompartmental replacement and the LCS (low contact stress) total knee system have been studied extensively. Ninety-five to 97% 10-year survivorship rates of the Oxford unicompartmental replacement have been reported. Low contact stress meniscal-bearing survivorship rates of 98% at 6 years and 94.6% at 8 years have been reported. Ninety-five to 100% survivorship rates at the 11- and 12-year followup have been reported for low contact stress rotating platform knee replacements. Complications with the Oxford unicompartmental replacement include an increase in bearing dislocation and an increase in loosening rate when the components were placed in knees that had anterior cruciate ligament deficiency. Complications with the low contact stress total knee system include bearing dislocation (meniscal, rotating platform, and patellar), bearing breakage, and polyethylene wear. If mobile-bearing knee replacements are inserted with the same precision as fixed-bearing knee replacements, the results should at least be comparable. There may be some potential for an increase in durability, compared with fixed-bearing knee replacements, especially those of a modular design.

Biomechanical Phenomena↗
PubMed1985

Popliteal artery damage in closed injuries of the knee.

Injury to the popliteal artery is reported in two patients with closed ligament injuries of the knee, and no fracture or dislocation. The importance of careful assessment of the circulation in this type of patient is emphasised.

Adult↗
PubMed1999

Intra-articular dislocation of the patella: two cases and literature review.

Intra-articular dislocation of the patella remains uncommon and is generally thought to be a problem of young adolescent males. This report reminds emergency physicians that it can occur in the arthritic knee, and it should be considered in the differential diagnosis of locked knee in the elderly. Closed reduction should be attempted in these cases, because the dislocation is liable to be held in place by osteophytes rather than impaction of the patella deep in the intercondylar notch and a good functional outcome can be expected.

Age Distribution↗
PubMed1969

Injuries to hip joint in car occupants.

Four varieties of fracture, of dislocation, or of fracture dislocation of the hip are described that occur in car occupants after road accidents. It is suggested that, whereas most hip injuries to car occupants are produced by application of force to the knee, one important variety (central fracture dislocation) is the result of the direct application of force to the great trochanter. Central fracture dislocations might be prevented, or their severity minimized, by strengthening the sides of cars and of car doors and by improving the energy absorption characteristics of the facia panel.

Accidents, Traffic↗
PubMed1989

Arthroscopy in the diagnosis of occult dislocation of the patella.

The authors investigated the incidence of acute patellar dislocation by clinical and radiologic examination and by arthroscopy. Acute patellar dislocation represented 2.44% of all knee injuries in their series, and only 25% of the former were evident at the initial examination.

Arthroscopy↗
PubMed2006

Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella.

Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.

Adolescent↗
PubMed1993

The role of radiography and computed tomography in the diagnosis of acute dislocation of the proximal tibiofibular joint.

A cadaveric study was undertaken to determine the best radiographic method of diagnosing dislocation of the proximal tibio-fibular (PTFJ) joint. Three pairs of cadaver knees were used, the right side serving as a control in each case. Plain radiographs, antero-posterior (AP) lateral and 45 degrees oblique films, and axial computed tomography (CT) scans were obtained with the joints in each of three positions: (1) anatomical, (2) dislocated anteriorly and (3) dislocated posteriorly. Similar views were obtained in the control joints with the PTFJ undisturbed. The radiographs were assessed by eight independent observers and the results were analysed. The diagnostic accuracy with plain AP and lateral radiographs was 72.5%. This was unchanged with the addition of oblique views, but improved to 82% with the control films and 86% with the axial CT scans. The authors conclude that in the diagnosis of suspected dislocation of the PTFJ, axial CT scanning is the investigation of choice. Plain AP, lateral and comparison views are useful but less accurate, while oblique views are unhelpful and unnecessary.

Acute Disease↗
PubMed1989

[Transposition of the tibial tuberosity in recurrent dislocations and painful femoro-patellar syndromes. Study of a continuous series of 140 operated knees].

Surgical displacement of the tibial tuberosity has been performed in 140 cases over a 10-year period. Medial displacement with or without ventralization of the tuberosity gave excellent results in all 11 cases presenting with recurrent patellar dislocation. Anterior displacement of the tuberosity using a modified Maquet procedure was performed in 129 knees presenting with femoro-patellar pain (chondromalacia patellae, femoro-patellar osteoarthritis). Indication for surgery was intractable femoropatellar pain. Surgical technique (isolated anterior translocation or anterior and internal translocation of the tuberosity) was selected according to clinical and radiological examination. Results were very good in 50% of cases, good in 30%, poor in 20%. No patient was made worse after the procedure. The complication rate was acceptably low, due to meticulous surgical technique. The overall good results in this series are related to strict selection of patients.

Adolescent↗