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PubMed1987

Cervical myelopathy complicating multiple joint replacement in rheumatoid disease.

The incidence of cervical myelopathy and subluxation was investigated in 48 patients with rheumatoid disease who had three or more major lower limb joint replacements. Eight (17%) developed cervical myelopathy requiring cervical fusion. This was the subsequent cause of death in two. Four further patients demonstrated clinical features of myelopathy. Cervical subluxation was present in 29 of 44 (66%) in whom adequate radiographs were available. The development of cervical symptoms and signs could not have been predicted from the sex, age of onset, duration of disease or steroid therapy. Radiographic changes in the cervical spine were independent of major lower limb joint destruction and were often not present when planning a programme of joint replacement. Fifty-one control patients were studied. Cervical myelopathy occurred in 2 (4%) and subluxation in 24 (47%). The development of rheumatoid changes in the cervical spine was unrelated to involvement of the hip or knee joints in the control group. There was a significant (p less than 0.05) increase in the incidence of cervical myelopathy in patients with multiple lower limb joint replacements compared with the control population.

Adolescent↗
PubMed1994

Knee instability after total knee arthroplasty.

From 1986 to the present, 126 total knee revisions were performed by the authors. Twenty-five cases (20%) were revised for instability of the tibiofemoral articulation. Patellofemoral instability and those patients treated conservatively were excluded from this subset of patients. All patients were clinically evaluated using the Hospital for Special Surgery knee rating system and radiographically rated using The Knee Society scoring system. The average follow-up period was 28 months. Preoperative synovial fluid analysis showed a predominance of red blood cells (average, 64,000). Reasons for instability were ligamentous imbalance and incompetence, malalignment and late ligamentous incompetence, a deficient extensor mechanism, inadequate prosthetic design, and surgical error. All patients currently have stable knees with an overall improvement in clinical and radiographic scores. When evaluating a patient with a painful knee after total knee arthroplasty, this diagnosis should be considered. Careful physical examination, dynamic radiographs, and synovial fluid analysis should help to make a proper diagnosis. Treatment should aim to correct the cause of instability. The prosthesis chosen should compensate for the specific ligamentous deficiency present.

Follow-Up Studies↗
PubMed1990

[Results of treating recurrent dislocation of the patella by the Garlick-Salamon method].

The Garlicki-Salamon method consists in isolation of the patella ligaments, loosening of the lateral pulleys, medial and downward transposition of the patella ligament insertion, wrapping of the medial joint capsule, and transfer of the m. vastus medialis insertion to the medial-upper quadrant of the patella. The late follow-up (at least 5 years of observation) was carried on in 26 knees. 4 results were excellent, 10 -- good, 8 -- fair, 4 -- poor. In nine cases (35 per cent) development osteoarthritis of the patello-femoral joint was found. Recurrence of dislocation was found in 4 cases.

Adolescent↗
PubMed1994

Posteromedial pivot shift of the knee: a new test for rupture of the posterior cruciate ligament. A demonstration in six patients and a study of anatomical specimens.

A new test--the posteromedial pivot-shift test--was used to demonstrate a rupture of the posterior cruciate ligament of the knee in six patients. An anatomical study of seventeen specimens showed that in order for the posteromedial pivot shift to occur, the posterior collateral ligament, the medial collateral ligament, and the posterior oblique ligament must be cut; if one of these three ligaments is intact, the subluxation will not occur.

Adolescent↗
PubMed2006

Patella maltracking in posterior-stabilized total knee arthroplasty.

Maltracking of the patella component in total knee arthroplasty usually leads to complications such as subluxation, dislocation, fracture, excessive wear, or implant failure. After using a new posterior-stabilized total knee arthroplasty and a specific protocol for the patellofemoral articulation we determined the incidence of lateral retinacular release and patella complications. We retrospectively reviewed 255 consecutive primary posterior-stabilized total knee arthroplasties with an anatomic femoral component and a three-peg offset-dome patella. Component alignment was achieved using Whiteside's lines for the femoral component, the medial border of the tubercle for the tibial component, and previously reported techniques for the patella. Lateral release was performed in 15 knees (6.2%), most of which had excessive preoperative valgus (mean, 15 degrees). There were no reoperations for the patellofemoral joint at a mean followup of 3.7 years (range, 2-7 years). Two patients had asymptomatic osteonecrosis of the patella with complete radiolucent lines, and one patella fracture was treated with immobilization. We believe patella maltracking a largely avoidable problem in total knee arthroplasty. We found a low incidence of lateral retinacular release and patella complications using these components and this protocol for the patellofemoral articulation.

Aged↗
PubMed2000

A locked knee in extension: a complication of a degenerate knee with patella alta.

We present a case of superior dislocation of the patella trapped by interlocked osteophytes. Unlike previous reports, in which the mechanism resulted from a blow to the inferior pole, it is postulated that increased load on the extensor mechanism, combined with patella alta and patellofemoral osteophytes, caused locking of the knee in extension.

Accidents, Occupational↗
PubMed2004

Medium-term results of the AMC-unicompartmental knee arthroplasty.

This study presents the outcome of patients treated by AMC-unicompartmental knee arthroplasty (UCA). The prosthesis was implanted in 361 cases for the medial or lateral compartment arthritis. The mean follow-up period was 5.5 (range: 2.3-12.5) years. Mean age at surgery was 69.5 (range: 46.3-88.6) years. Six knees were lost to follow-up (1.6%). Patients were assessed by an independent clinical observer and results were standardised using the Knee Society Rating System. The roentgenographic analyses were performed according to the Knee Society Evaluation System. Ninety-five percent of patients had no pain or slight pain at the latest follow-up, 92% had a good or excellent clinical outcome. Three knees were revised for mobile bearing dislocation after medial UCA and three for lateral mobile bearing dislocation after lateral UCA. Five revisions were necessitated by component loosening and there was one case of deep infection. The clinical results of the investigated patients demonstrate that the AMC-UCA is a successful concept with safe fixation of the prosthesis and good durability of the mobile bearings.

Aged↗
PubMedDate not supplied

Acute combined posterior cruciate and posterolateral instability of the knee.

This report concerns 13 consecutive patients (13 knees) who underwent operative treatment for acute combined posterior cruciate and posterolateral instability due to combined injury to the posterior cruciate ligament and the arcuate ligament complex. Our purpose was to examine the method of diagnosis and the results in these patients. There were 12 males and 1 female (average age, 26 years). Five patients were injured in a motor vehicle accident, four in sports activities, and four in nonsports activities. The mechanism of injury was an anteromedial blow to the flexed knee in six patients, a fall onto the knee in two, and unknown in five patients. Eleven patients were available for follow-up evaluation (average, 56 months), and in each the result was rated as good, fair, or poor. In 10 patients (90%) the results were rated as good subjectively, in 11 (100%) as good functionally, and in 8 (73%) as good objectively. Injury to both the posterior cruciate ligament and the arcuate ligament complex can result from rotational force that can be due to a blow to the anteromedial aspect of the knee. Diagnosis can be made by a combined positive response to the posterior drawer test, the anterior drawer test performed with the tibia in internal rotation, the abduction and adduction stress tests performed with the knee in full extension, the posterolateral drawer test, and the external rotation-recurvatum test. In a knee with concomitant injury to the posterior cruciate ligament and the arcuate ligament complex that requires surgical repair, all injured structures should be explored and repaired to ensure a subjectively, objectively, and functionally good result.

Accidents, Traffic↗
PubMed1997

The Rotaflex total knee replacement--a 5 year review.

We report the results of a retrospective analysis of 43 patients who received 56 Rotaflex total knee arthroplasties, with a mean follow-up of 55.7 months. The British Orthopaedic Association (BOA) knee assessment protocol was used in evaluating the clinical results. Two patients could not receive post-operative scores. In the remaining 54 knees, the mean pre-operative score was 25.6, improving to 30.8 post-operatively. Ten knees showed a decrease in knee score, two were unchanged and 42 improved. The greatest improvements were in pain relief and maximum flexion. Wound infection and dehiscences were common, the latter requiring further surgery in five cases. Later, there were eight fractures involving the prosthesis, seven dislocated or subluxed patellae, two deep infections and three cases of severe aseptic loosening. A common feature was severe patellar wear, due to the design fault of an absent femoral groove. The high rate of complications and poor functional result of the Rotaflex knee preclude its use in current practice.

Activities of Daily Living↗
PubMed1989

[Post-traumatic dislocation of the upper tibiofibular joint. Review of the literature apropos of 6 cases].

This study reviewed 6 cases of post-traumatic dislocation of the superior tibia-fibular joint. It was associated 5 times over six to a tibial fracture or major ligament lesion of the knee. The authors have made a review of the literature on this rare injury. The purpose of this paper is to insist on the necessity of an early diagnosis allowing a simple treatment and good results.

Adolescent↗
PubMed1985

Combined intra-articular and extra-articular reconstructions for anterior tibial subluxation.

This article describes several procedures that combine intra-articular techniques with extra-articular techniques to stabilize the knee with anterior tibial subluxation. The procedures detailed are reconstruction using the semitendinosus tendon and the iliotibial tract; tenodesis using a strip of iliotibial tract combined with intra-articular reconstruction of the anterior cruciate ligament with the central third of the patellar tendon; "mini-reconstruction"; and a procedure utilizing a vascularized patellar tendon graft plus "dynamic" augmentation.

Humans↗
PubMed1983

Patellofemoral disorders treated by operations.

Thirty-six patients with patellofemoral disorders treated with various operative procedures were evaluated after an average follow-up period of 29 (6 to 72) months. Instability of the patella, either recurrent dislocation or subluxation, was present preoperatively in 27 knees (Group A). Twelve patients (Group B) were operated on for chondromalacia, which was not combined with a history of instability. Good results were obtained in 15 cases in Group A and in only three cases in Group B. Simple procedures, lateral release alone and medial duplication alone appeared to be ineffective methods.

Femur↗
PubMed2001

MR imaging of patellar dislocation and relocation.

Patellar dislocation and relocation (PDR) typically occurs suddenly after trauma or torsional stress on the extensor mechanism. Clinical evaluation after patellar dislocation/relocation usually reveals a swollen knee that is difficult to examine. Radiographs may show hemathroses and a minority of patients will have a chip fracture of the patella. Magnetic resonance (MR) imaging features seen with PDR include disruption or sprain of the medial retinaculum, lateral patellar tilt or subluxation, lateral femoral condylar and medical patellar osseous contusions, osteochondral injury, damage to Hoffa's fat pad, and joint effusion. Up to one third of patients will also show concomitant injury to the major ligaments of the knee or menisci. Without repair of the primary injury, redislocation occurs in greater than one half of patients. Consequently, surgical correction is often advocated. This article reviews the factors predisposing to PDR, the activities associated with PDR, the clinical, radiographic, and MR imaging features of PDR, and (briefly) therapy for this injury.

Humans↗
PubMedDate not supplied

Fixed tibial subluxation after successful anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction results in improved function and stability in many patients. However, it is not known whether the improved stability is associated with an improved tibiofemoral relationship. We used stress radiographs to determine not only stability but also the tibiofemoral relationship in 15 patients who had a clinically successful anterior cruciate ligament reconstruction. Their results were compared with those of 14 volunteers with normal knees. The average Lysholm score for the patients was 94. None of the patients had more than 3 mm of side-to-side difference on KT-1000 arthrometer testing. Maximal anteroposterior tibial translation as measured by stress radiography was slightly increased in the reconstructed knees but was not statistically significantly different (6.6 +/- 3.2 mm versus 5.0 +/- 3.3 mm). However, with a posteriorly directed stress the tibia in the reconstructed knees did not translate posteriorly to the same extent as did the control knees, resulting in a significant difference in tibial position (-1.2 +/- 3.0 mm versus -4.0 +/- 3.3 mm). Surgical anterior cruciate ligament reconstruction may result in reduced anteroposterior tibial translation, accomplished, in part, through restraining posterior translation, leaving the tibia with persistent subluxation. Fibrosis and contracture of the posterior structures may explain this phenomenon.

Anterior Cruciate Ligament↗
PubMed1989

Patellar complications in total knee arthroplasty. A literature review.

Increased implant longevity, improved range of motion, and the use of total knee arthroplasty in younger and more active patients have placed greater demands on the patella component. Commonly observed complications of the patellofemoral joint are crepitation, subluxation, excessive wear, loosening, and persistent patient discomfort. These complications have been attributed to inadequate prosthetic design, fixation techniques, anatomic abnormalities, and surgical error. This paper reviews the most prevalent complications and discusses their causes and prevention.

Biomechanical Phenomena↗
PubMed1985

Associated joint pathology in the anterior cruciate ligament-deficient knee with emphasis on a classification system and injuries to the meniscocapsular ligament-musculotendinous unit complex.

This article defines the anterior cruciate ligament-deficient knee in terms of capsular instabilities. This definition lends itself to a better assessment of the associated pathology consisting of torn capsular ligaments, torn medial and lateral menisci, chondral fractures, subluxation of the patella, and acute contusion of the peroneal nerve. The specific incidence of torn medial meniscus was 70 per cent, with a torn lateral meniscus identified 77 per cent of the time.

Humans↗
PubMed1989

Arthroscopy update #5. Rehabilitation after arthroscopic lateral retinacular release.

This study compares postoperative quadriceps strength with functional results in a homogeneous population with isolated anterior knee pain and patellofemoral instability. Although several factors may interfere with the success of lateral retinacular release, this study suggests that poor quadriceps rehabilitation is the single factor preventing total return to athletic participation in patients with lateral subluxation. Many patients seem to adopt changes in life-style in order to accommodate weakened quadriceps and remain symptom free.

Adolescent↗