The Knee
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The KT-1000 arthrometer is one of very few instruments currently available for measurement of anterior cruciate laxity, and is widely held to be accurate. We present data from laboratory tests that show that the machine has a significant inbuilt error, even when functioning perfectly.Accurate measurements were made of displacements produced in a bench setting using vernier calipers and a dial test...
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Lateral to medial maltracking of the patella is a subgroup of patellar maltracking where the patella is laterally subluxed in extension and medially subluxed in flexion. It was first described with kinematic magnetic resonance imaging. This type of maltracking can only be suspected with computed tomography if lateral patellar subluxation in extension is associated with medial facet chondral changes...
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We studied 104 patients undergoing primary anterior cruciate ligament reconstruction who were prospectively randomized into receiving either an intravenous pethidine infusion or a continuous bupivicaine infusion to the lumbar plexus via the femoral sheath, for postoperative analgesia. No difference was found between the two methods in terms of their analgesic effect (P > 0.1) and both were well...
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Avulsion of the patellar ligament from the inferior pole of the patella is an uncommon cause of extensor mechanism disruption in childhood, thought to be confined to children aged 10 years or more injured in high energy sports events. We report a case in a 9-year-old boy following an apparently trivial injury presenting with a haemarthrosis, and outline a rationale for treatment of this condition.
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The myth of diagnostic arthroscopy still remains with us. Trainees going through this unit have been known to list patients with a knee problem for arthroscopy without making a clear clinical diagnosis.To improve this situation, a prospective consecutive series of 130 arthroscopies took place. Each patient was clinically assessed preoperatively and a diagnosis was committed to paper. This was compared...
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All revision total knee arthroplasties for failure of a metal-backed patellar component during a 4-year period were reviewed. Twenty-five revisions, representing six designs, were performed in 24 patients. The failure mode included wear or fragmentation of the patellar polyethylene in 20 knees, polyethylene separation from the metal baseplate in 3, and metal peg-baseplate fracture in 2. Time to...
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A case of tuberculosis of the patella presenting as an osteolytic lesion without synovial involvement is described. Delay in diagnosis resulted in progression to generalized tuberculous synovitis. Clinicians should consider the possibility of a diagnosis of tuberculous osteomyelitis of the patella in patients presenting with an osteolytic patellar lesion in areas where tuberculosis is pandemic or...
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Continuous instability and repetitive pivoting in chronic anterior cruciate ligament (ACL) deficient knees results in impingement of the tibial eminence on the femoral condyles and a shearing effect which gradually damages articular cartilage.The high incidence of large chondral defects of the medial femoral condyle associated with chronic complete ACL tears is widely known and requires treatment,...
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This review paper starts with some basic definitions of anatomical positioning nomenclature and isometry, examines the reasons for aiming for isometry and discusses the tensile properties of ligaments and grafts in the light of length changes imposed by knee motion. An examination of the biomechanics of different tibial and femoral graft attachments, and the effects of errors from isometric siting,...
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Reconstruction of the anterior cruciate ligament has been performed using a variety of materials. The use of patella tendon autograft has become increasingly popular, especially in the younger patient. There are, however, recognized complications using this technique: lack of full extension has been described in 7-24% of patients; anterior knee pain in 6-30% of patients; patella fracture; and patella...
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The relevance of retaining the anterior cruciate ligament during total knee replacement was evaluated for a mobile bearing low contact stress knee prostheses. Two different kinds of prostheses were used, one retaining both cruciate ligaments and one retaining only the posterior cruciate ligament. Twenty prostheses of each kind were implanted in a total of forty cadavers. Referring to the anterior-posterior...
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The lesion of patellar tendonitis is thought to be due to a chronic overload of the tendon which results in repetitive microscopic damage and inflammation within the upper central aspect of the patellar tendon resulting in histological focal degeneration. The surgical treatment of detachment or excision of the central portion of the tendon and drilling of the inferior pole of the patellar has little...
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We performed 192 Accord total knee replacements, with both components cemented in, between 1983 and 1989. There were 79 rheumatoid arthritic (RA) knees of which 29 (36.7%) required ligament release, and 113 osteoarthritic (OA) knees of which 52 (46.0%) required ligament release at the time of surgery. The results of the four groups, OA and RA with and without ligament release, with a minimum follow...
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Between 1981 and 1986, 149 total knee arthroplasties were performed on 112 patients by the senior author using the total condylar prosthesis. Of the original group, 61 are known to have died and 98% of those that remain alive (50 patients, 70 knees) were independently evaluated at a mean interval of 10.4 (range 8.0-13.1) years after surgery. Assessment was performed by the junior authors, using...
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High tibial osteotomy was performed in 50 patients with medial compartment osteoarthritis or osteonecrosis of the knee. The femorotibial angle, mechanical axis of the lower extremities, flexor and extensor power of the knee, and changes in the centre of gravity were measured before and after surgery in order to elucidate the mechanism underlying the effect of high tibial osteotomy. Postoperatively...
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Between 1986 and 1993, as part of a prospective on-going trial, 205 patients had prosthetic ACL reconstruction for chronic symptomatic knee instability. The mean interval from injury to surgery was 39.2 (range 6-216) months.Overall, there were 22 (10.7%) confirmed ruptures and 183 satisfactory implants. The mean follow-up was 30.4 months in the ruptured group and 30.2 months in the satisfactory...
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We wish to report our experience with patellaplasty in total knee replacement. Patellaplasty involves excision of the deep articular surface of the patella. The raw surface of the patella is then left to articulate with the total knee arthroplasty. This procedure was carried out in 26 osteoarthritic knees undergoing total knee replacement.All of these patients were followed with a minimum follow...
