The Knee
The maximum thickness of the patella was prospectively measured during 216 primary total knee arthroplasties (TKA) that included patellar resurfacing. Of the measured patellae, 93 were in 75 men and 123 were in 99 women. Average patient age was 68.9 years for men and 71.2 years for women. All patients were diagnosed with osteoarthritis. Mean maximal patellar thickness in men was 26.1 mm and in women...
Primary and revision total knee arthroplasty have become common orthopaedic procedures. The operating surgeon, at times, may be faced with a difficult surgical case due to soft tissue contractures or bone deformities. A review of multiple surgical techniques using soft tissue releases and osteotomies are presented including their potential complications. Although these techniques are aimed at the...
Posterior tibial slope can help to decrease ligament tension during flexion in total knee arthroplasty. External rotation of the tibial component has also been advocated to facilitate patellar tracking. However, combined anteroposterior inclination and rotation can produce a change in axial alignment. A mathematical model was used to determine the relationship between tibial slope and rotation...
The objective of this study was to measure three-dimensional knee motion or functional laxity with implants which either retained the posterior cruciate ligament (PCL+) in ten patients, or substituted for excised PCL with a posterior stabilized articulating surface (PCL-S) in ten patients. The intent was to identify the specific influence and significance of the presence of the PCL under active flexion...
'Second look' arthroscopy was performed in 129 patients after anterior cruciate ligament reconstruction. Meniscal or chondral lesions noted at the time of reconstruction were subsequently reviewed at the second arthroscopy and any new lesions were also noted. Stabilization of the knee resulted in a significant reduction in the incidence of meniscal injury, however, the incidence of chondral lesions...
Anterior knee pain is a common clinical problem. Patient assessment is difficult. Recently, it has been suggested that the so-called 'skyline' views of the patellofemoral joint have no role to play in screening for maltracking and some would suggest that computerized tomography (CT) offers a more accurate method of investigation. The aim of this study was to evaluate the performance of CT in the...
The Knee Signature System (KSS) was used to measure anterior-posterior laxity of the knees of 34 patients who had an old tibial plateau fracture. The mean total tibial translation with respect to the femur was 9.8 (range 3.1-19.5) mm in the injured knees and 7.5 (range 3.1-14.2) mm in the uninjured knees (P < 0.01). A side-to-side difference (injured versus uninjured knee) to 3 mm or more was...
In a prospective, double blind, randomized study, 30 ASA I patients were allocated to three groups depending on the drug injected intra-articularly, in an attempt to establish the best postoperative analgesic protocol following knee arthroscopy. Group 1 received 3 mg of preservative-free morphine in 25 ml saline; group 2, 5 mg of preservative-free morphine in 25 ml saline; and group 3, 25 ml 0.25%...
The purpose of this study was to review the results of ACL reconstruction using a patellar tendon graft placed 'over the top' plus a Macintosh lateral tenodesis, examining changes in knee laxity and functional status with increasing time. There were 74 patients operated on over an 11 year period, and divided into four groups for analysis according to postoperative time. There was a significant and...
Infections following total knee arthroplasty constitute a devastating problem and represent a difficult obstacle for surgeons in the treatment of these patients. This study was performed in order to evaluate the in vitro antibacterial activity of bone cement impregnated with five different antibiotics effective against staphylococci and to measure the elution of these antibiotics from the cement...
The congenital lateral discoid meniscus may produce intermittent and vague symptoms with difficulty and delay in clinical diagnosis. However, a very gross snap in movement of the knee affected by this anomaly is pathognomonic.Young, in 1989, first described a discoid lateral meniscus in a cadaver. The snapping knee syndrome was described by Kroiss in 1910.The incidence in this country of...
The anatomy of 1000 symtomatic meniscus lesions is described and related to the age of the patients. All symtomatic lesions found during the study period were treated by arthroscopic surgery.Meniscal lesions were commoner in the right knee (56.5%) and 81% of the patients were men. Of the medial meniscus tears, 75% were vertical and 23% horizontal. Vertical tears of the medial meniscus occurred...
TechniqueMedial meniscal repair: Once a decision to carry out meniscal repair has been made, a 6-7-cm incision is made at the posteromedial corner. Dissection is carried down to the capsule, deep to the direct head of the semimembranosus. If more than 3 or 4 sutures are to be placed, and if the medial compartment is tight, then the Henning joint distractor should be used. Thorough preparation of...
As a general principle, meniscal problems in childhood should be treated as conservatively as possible. The quoted incidence of discoid meniscus is between a low of 1.4% up to 16% in Japan. Noble and Hamblin (1975), in a cadaver study in the UK, found 5% of lateral menisci were discoid and had probably remained asymptomatic throughout life. Allowing for a 3 or 4% incidence of discoid meniscus at...
Anteromedial displacement of the tibial tuberosity is a highly effective technique for transferring the tibial tuberosity when anteriorisation is desired in addition to medial shift of the patellar tendon insertion. Prompt primary bone healing can be achieved, allowing rapid rehabilitation with substantially improved patellofemoral mechanics. No bone grafting is necessary to achieve anteriorisation...
Each technique of meniscal repair has its own unique problems that the surgeon should be aware of. Other problems may arise regardless of the specific technique used.Vascular injurySince the popliteal artery lies just posterior to the origin of the lateral meniscus, it is more at risk during lateral meniscal repair. A needle passed through the anteromedial portal and over the posterior horn of the...
The menisci are important in load transmission, and also have a significant dynamic function in the stabilisation of the knee joint. The posterior part of the medial meniscus acts synergistically with the anterior cruciate ligament.The need for replacement arises when the anterior cruciate ligament substitute lacks the protection of the posterior part of the medial meniscus which has often been removed...
Magnetic resonance imaging (MRI) is being increasingly employed in the evaluation of internal derangement of the knee with meniscal assessment forming a very important part of the examination. The ability to obtain images in multiple planes and the inherent high soft tissue contrast of MRI means that detailed non-invasive assessment of the menisci is possible.TechniqueThe examination is performed...
Tear patterns of menisci are dependent on the histologic and biomechanical make-up of the meniscus, the amount of degeneration present, and the forces brought to bear on the meniscus. Disruption of circumferentially oriented collagen bundles and radial tie fibers create radial split, oblique flap tears, and vertical longitudinal tears.. Shear forces between the tibial plateau and femoral condyle...
The high frequency of patellar tendinitis in volleyball players was first noticed by Maurizio (1963); however, the term Jumper's Knee was described first by Blazina et al. in (1973) as an affliction involving the athlete's knees and synonymously used with patellar (or quadriceps) tendinitis (Ferreti et al., 1983). Whether it is the quadriceps attachment to the patella, the inferior pole of the...