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A randomised double-blind prospective trial in patients undergoing knee arthroscopy was performed to determine whether the addition of morphine to bupivacaine for intra-articular injection gave any additional analgesic effect over the use of bupivacaine alone. In group A (n=22) 3 ml water and 10 ml 0.5% bupivacaine were injected intra-articularly. In group B (n=22) 3 mg morphine in 3 ml water and...
Mode of failure analyses of explanted prosthetic ligaments and clinical MRI studies of autologous reconstructions have identified that the position of the exit of the tibial tunnel is critical for the survival of an intra-articular reconstruction of the anterior cruciate ligament. When drilling the tibial tunnel, the position of the exit must be positioned behind the roof and apex of the intercondylar...
The purpose of this study was to evaluate the results at minimum 2 years follow-up of our original hamstrings technique, with intra and extra articular ACL plasty, followed by an aggressive rehabilitation program. Forty young sports practising patients were prospectively selected. IKDC score, Lysholm scale score as well as KT 2000 and isokinetic tests with a Lido machine (Lido CA) were used for patient...
We report an unusual case of separation of bipartite patella in a patient with nail-patella syndrome. Arthroscopic lateral release and medial plication was carried out for anterior knee pain and patellar subluxation. During post-operative rehabilitation the bipartite patella separated. This was bone grafted and internally fixed by tension band wiring with good end results.
The relationship between the remnant of the injured cruciate ligaments and the end-point was investigated by analyzing quantitatively the magnitude and stiffness of anterior-posterior instability using a knee arthrometer (KT-2000). Thirty-eight normal subjects, 44 chronic ACL injuries and 20 chronic PCL injuries were involved. In the ACL injury, the magnitude of the displacement increased regardless...
The Denham knee replacement is a semi-constrained, uni-centric, fully congruous joint replacement that uses intramedullary techniques to accurately reproduce anatomical alignment. A continuing study was made of the originator's series until 1991, with a subsequent independent clinical and radiological review of the surviving implants in 1996. In clinic at an average of 12 years from implantation,...
Activity and functional knee scores were used to evaluate the 44 patients who had an Elmslie-Trillat type tibial tubercle transfer for chronic disabling anterior knee pain. The mean age of the patients was 26.9 years (S.D.=9.4) and the mean follow-up was 4.8 years (S.D.=3.2); 70.5% had a satisfactory outcome but 29.5% continued to have significant symptoms affecting activities of daily living. Increasing...
Medial dislocation of the patella is a rare clinical problem. A mild variety of subluxation of the patella can be identified on arthoscopy but frank medial dislocation, idiopathic or traumatic, is very uncommon. The patella is known to medially dislocate repeatedly as a complication of medial tibial tubercle transfer surgery. We present four such cases in three patients and describe their treatment...
The muscle strength of knees with an injured anterior cruciate ligament (ACL) is generally assessed by the peak of the isokinetic muscle contraction. However, assessment of the characteristics of muscle contraction, such as the contraction velocity and contraction endurance, has been largely ignored due to a lack of data. In this study, we have performed frequency analysis of the surface electromyograms...
One-hundred Oxford unicompartmental knee arthroplasties were reviewed. The follow-up period ranged from 1 to 11 years (mean=5.6 years). Eleven patients had died and six cases were lost to follow-up. Seven knees have required revision, four cases revised due to loosening, two cases due to progressive arthritis and one case was due to fracture of the medial tibial plateau. At mean follow-up of 5.5 years...
This report reviews 12 cases of knee joint arthrodesis. In all cases the intramedullary Kuntscher nail technique was used. The main indications were: pseudoarthrosis in five cases, failure of total knee replacement in four, advanced deformity in two and a malignant lesion in one case. A previous arthrodesis with an other technique was tried in five cases. Union of the joint was achieved in a mean...
There are a number of pathological conditions involving abnormal geometry, including extremely small sizes, where standard off-the-shelf total knees do not suffice. Usually, these conditions require total joints which provide varus-valgus stability. This report concentrates on condylar knees with intercondylar stability, namely the constrained condylar type. The design and manufacture of these custom...
There is a need for an accurate representation of arthroscopic knee findings on a diagram. The first time in the literature this Knee Diagram is generated, using three-dimensional projection of the four dissected cadaveric knees articular surfaces. Computer-aided design and drafting software is utilized to find the average dimensions of the four cadaveric knee surfaces. Mercator earth projection principle...
We prospectively studied the ability of the post-operative salvage and reinfusion of unwashed blood to reduce the allogeneic blood transfusion requirements of 339 patients undergoing various types of knee replacement procedures (unilateral, bilateral, revision and unicompartmental). For each type of procedure studied, the use of post-operative blood salvage and reinfusion significantly reduced the...
An unusual case of osteochondroma arising in the soft tissues adjacent to the knee is presented. The controversy arises from the confusion of this mass with giant synovial chondromatosis or the more dangerous chondrosarcomas. Preoperatively, CT scans can demonstrate that these lesions are isolated to the soft tissues, and there is no connection to bone; this can be confirmed at surgery. Detailed histological...
MRI was performed for 171 medial menisci of 147 patients, ranging in age from 40 to 86 years (mean 66.6 years), who showed clinical signs in the medial compartment. We classified the MRI findings of the medial menisci using the modified grading system of Crues et al. (Radiology 1987;164:445–448) [1], and their grade 3B into three types based on the shape of the meniscus at the menisco-capsular junction...
Objective: To develop and validate the Edinburgh Knee Function Scale (EKFS), to measure outcome in knee patients not requiring surgical management. Methods: Out-patients (551) with a non-surgical knee problem were recruited. Data collection was by postal questionnaire. The validation process followed the methods of Streiner and Norman. Results: The response rate was 78.2%. Cronbach's alpha was 0.87...
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