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PubMed2006

An unusual rugby injury.

We describe an unusual sports injury in a young man, a combination of obturator hip dislocation with an ipsilateral anterior cruciate ligament injury. Traumatic non-prosthetic hip dislocations, particularly obturator hip dislocations, are extremely rare sports injuries and have not previously been reported in conjunction with a knee ligament injury. The severe pain and obvious deformity from the hip injury can distract from other injuries, particularly to the ipsilateral knee. This case reinforces the need for a thorough assessment of the knee joint, before hip reduction if possible and certainly after reduction of the dislocation.

Adult↗
PubMed1991

Hereditary onycho-osteodysplasia (nail-patella syndrome). A three-generation familial study.

Hereditary onycho-osteodysplasia or nail-patella syndrome is an uncommon familial musculoskeletal condition that is primarily seen initially in orthopaedic clinics. This three-generation familial review identifies three affected family members, one of whom demonstrated spondylolisthesis, a condition not previously associated with nail-patella syndrome. All affected family members demonstrated the typical radial nail dysplasias, hypoplastic patellae, iliac horns, and posterior dislocation of the radial heads. Overgrowth of the medial femoral condyles caused valgus deformities of the knees that necessitated orthotic treatment in the youngest affected family member. Although this syndrome has classic common musculoskeletal anomalies, the lumbar spine should also be carefully examined for the presence of spondylolysis and for signs of potential spondylolisthetic development.

Adult↗
PubMed2006

Arthroscopic release of the vastus lateralis tendon for recurrent patellar dislocation.

BACKGROUND: Arthroscopic release of the vastus lateralis tendon for treatment of recurrent patellar dislocation has been criticized on the grounds that it may weaken the quadriceps. HYPOTHESIS: Quadriceps strength and outcome measures improve after arthroscopic release of the vastus lateralis tendon in patients with documented patellar dislocation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty patients who had recurrent patellar dislocation underwent arthroscopic lateral retinacular release that included a complete release of the vastus lateralis tendon from the superior pole of the patella and were observed prospectively. Bilateral quadriceps strength was tested preoperatively and at follow-up with an isokinetic dynamometer. Patients also completed the International Knee Documentation Committee Subjective Knee Form and the Short Form-36 preoperatively and postoperatively. RESULTS: Follow-up averaged 27 months (range, 24-43 months). There were no redislocations. Mean quadriceps strength improved by a mean of 28% (from 32.3 to 41.4 N x m). The mean quadriceps torque ratio (involved/uninvolved) improved significantly from a preoperative value of 63% (31/51 N x m) to 80% (42/52 N x m) at follow-up (P = .017). Fourteen patients (70%) increased quadriceps torque, and 6 patients (30%) decreased quadriceps torque. Only 1 patient failed to improve on International Knee Documentation Committee and Short Form-36 scores. The International Knee Documentation Committee scores improved from 45 points preoperatively to 76 points at follow-up (P = .001). The Short Form-36 physical component summary scores improved from 38 points preoperatively to 50 points at follow-up (P = .007), and the Short Form-36 physical functioning subscale scores improved from 53 points to 86 points (P = .015). CONCLUSION: Arthroscopic release of the vastus lateralis tendon and lateral patellar retinaculum in patients with recurrent patellar dislocation can improve quadriceps strength and knee function.

Adolescent↗
PubMed2003

Patient with trisomy 9p and a hypoplastic left heart with a tricentric chromosome 9.

We present a patient with a hypoplastic left heart (HLH), dislocations of the hips and knees, and minor dysmorphic features, who had an abnormal karyotype that resulted in trisomy for 9p and a portion of 9q: 46,((, dic(or tri?)(9)(9pter --> 9q34::9q21 --> 9pter).ish(WCP9++).ish(D9Z5X4 +/+++). The derivative chromosome consisted of an additional copy of the proximal q arm and p arm attached to 9qter in an inverted fashion. Fluorescence in situ hybridization (FISH) using a chromosome 9 beta-satellite probe revealed three signals on the abnormal chromosome 9, suggesting the presence of 3 pericentromeric regions on the der(9). The 9q subtelomere was present on both the normal and derivative chromosome 9, suggesting that very little material, if any, is deleted.

Centromere↗
PubMed2004

Majewski osteodysplastic primordial dwarfism type II (MOPD II): natural history and clinical findings.

A description of the clinical features of Majewski osteodysplastic primordial dwarfism type II (MOPD II) is presented based on 58 affected individuals (27 from the literature and 31 previously unreported cases). The remarkable features of MOPD II are: severe intrauterine growth retardation (IUGR), severe postnatal growth retardation; relatively proportionate head size at birth which progresses to true and disproportionate microcephaly; progressive disproportion of the short stature secondary to shortening of the distal and middle segments of the limbs; a progressive bony dysplasia with metaphyseal changes in the limbs; epiphyseal delay; progressive loose-jointedness with occasional dislocation or subluxation of the knees, radial heads, and hips; unusual facial features including a prominent nose, eyes which appear prominent in infancy and early childhood, ears which are proportionate, mildly dysplastic and usually missing the lobule; a high squeaky voice; abnormally, small, and often dysplastic or missing dentition; a pleasant, outgoing, sociable personality; and autosomal recessive inheritance. Far-sightedness, scoliosis, unusual pigmentation, and truncal obesity often develop with time. Some individuals seem to have increased susceptibility to infections. A number of affected individuals have developed dilation of the CNS arteries variously described as aneurysms and Moya Moya disease. These vascular changes can be life threatening, even in early years because of rupture, CNS hemorrhage, and strokes. There is variability between affected individuals even within the same family.

Abnormalities, Multiple↗
PubMed1976

Partial and complete trisomy 9: delineation of a trisomy 9 syndrome.

Two infants with trisomy involving chromosome 9 are described. One had complete trisomy 9 and the other karyotype 47,XX,+der(9),t(7;9) (p22;q32)mat. A trisomy 9 syndrome is delineated, consisting of features of the trisomy 9p syndrome and various other malformations. These include abnormalities of the cardiovascular and urogenital systems, cranial suture anomalies, dislocation of the hips and knees and early death. A possible relationship of some of these findings to regions of 9q involved in cases of partial trisomy 9 is suggested.

Abnormalities, Multiple↗
PubMed2000

A patient with mitochondrial myopathy associated with isolated succinate dehydrogenase deficiency.

We report on a boy with normal mental development who had muscle hypotonia and congenital dislocation of the hip and knee joints. Histochemical and biochemical examinations of his muscle specimen revealed no succinate dehydrogenase (SDH) activity. Since the NADH cytochrome c reductase and cytochrome c oxidase activities were normal, we concluded that he had an isolated SDH deficiency. Our patient provides further evidence for the clinical variability of this disorder.

Biopsy↗
PubMed1998

Emergent musculoskeletal magnetic resonance imaging.

The role of emergent musculoskeletal magnetic resonance (MR) imaging has expanded in recent years and now includes assessment of the extent and severity of musculoskeletal infection, diagnosis of occult fractures, characterization of complex fractures, and identification of selected vascular and nerve injuries associated with hip, knee, and elbow fractures and dislocations. In the elite athlete, emergent MR assessment of musculoskeletal injury allows prompt recognition of the nature of the injury, informed decision-making regarding the need for modification of competitive activity, and early institution of therapy. When surgical intervention is required, MR imaging facilitates preoperative planning.

Abscess↗
PubMed2001

Larsen syndrome associated with severe congenital hydrocephalus.

Larsen syndrome associated with severe congenital hydrocephalus: Larsen syndrome (LS) is characterized by the association of flattened facies with a prominent forehead, a depressed nasal bridge and hypertelorism, dislocation of hips, elbows and knees, equinovarus or valgus deformities of the feet, long and tapering fingers, normal intelligence. Hydrocephalus has rarely been reported in association with LS. In this article, a newborn infant with the classical features of LS and severe congenital hydrocephalus is presented. Our purpose was to emphasize the importance of congenital hydrocephalus in infants with LS and to highlight the management of cases of LS associated with congenital hydrocephalus.

Abnormalities, Multiple↗
PubMed1987

[Examination of the injured knee joint].

Examination of the knee joint and the assessment of capsular ligament lesions require profound anatomical and biomechanical knowledge. Particular importance attaches to detailed information about the mechanism of the accident and to stability testing; these allow the establishment of diagnosis in the majority of cases. The diagnosis should take account of the anatomical structures damaged, thus defining both the location and the functional significance of the lesion, which are also important for therapeutic strategy. Arthroscopy makes it possible to solve almost all diagnostic problems and also to apply adequate therapeutic measures. This has necessarily had a considerable influence on strategies for the management of patients with knee injuries. Therapeutic considerations should include the critical evaluation of indications for surgery.

Arthroscopy↗
PubMed1980

[Diastrophic dwarfism (author's transl)].

On the basis of their own patient the authors discuss clinical and radiological features of diastrophic dwarfism. In this rare disorder the infant is dwarfed, the limbs are shortened. It is associated with marked talipes equinovarus, limited movements and contractures of other joints. Dislocation in the hip or knee and development of kyphoscoliosis leads to furhter deformity. As aetiopathogenesis the authors consider the role of infection in the mother during her early pregnancy or teratogenic aspects of some drugs (tetracyclines, septrim).

Abnormalities, Drug-Induced↗
PubMed1975

Restoration of function in the knee and elbow with a hinge-distractor apparatus.

External hinged distraction devices using transosseous pins and adjustable attachments were applied to mobilize joint contractures; to reduce old dislocations; and to reduce, immobilize, and compress ununited para-articular fractures. Once these procedures were accomplished the devices were then used to maintain the joint surfaces separated at predetermined distances while kinematically normal joint motion was gradually restored, first passively and then actively. The results in thirty-one knees and twenty-eight elbows treated with these devices were encouraging after follow-ups of one to six years.

Adolescent↗
PubMed1988

Classification of patellofemoral disorders.

Patellofemoral disorders represent a large portion of the average orthopedist's practice. Despite the improvements in patellofemoral radiographs and arthroscopic diagnostic techniques, these disorders are too frequently misunderstood and frustrating to treat. This report proposes a clinical classification for patellofemoral disorders that, it is hoped, will aid our understanding and improve our results of treatment. A major feature of this classification is the recognition that a developmental and familial abnormality, patellofemoral dysplasia, is the etiology for most patellofemoral disorders. Equally important is the assignment of chondromalacia patellae to a secondary position for the most part. Other causes of anterior knee pain and disability are included to complete the classification.

Adolescent↗
PubMed1985

Diagnosis of chronic injury to the anterior cruciate ligament.

The diagnosis of chronic injury to the anterior cruciate ligament is proved by accurate interpretation of its visualization at arthroscopy, arthrotomy, or necropsy. Chronic injury is suspected if the history indicates an original trauma with an episode of swelling or hemarthrosis followed by a temporary period of disability and a subsequent report of repeated limb collapse. Positive functional tests such as the crossover, leaning hop, and deceleration tests support the diagnosis, as does the radiographic presence of a Segond's fracture or a notch in the lateral femoral condyle. The diagnosis is confirmed by the combined presence of positive laxity and instability tests. The laxity tests employed are the drawer tests with the knee in 15 and 90 degrees of flexion and the flexion-rotation drawer test. In diagnosing chronic injury to the anterior cruciate ligament, I place most reliance on the presence of positive pivot shift tests that demonstrate instability. Occasionally, a direct radiograph of the subluxated knee joint or double contrast arthrography is employed to confirm the diagnosis.

Biomechanical Phenomena↗