The Knee
This study examined calcified cartilage and bone structure in the development of age-related cartilage changes in the knee. Image analysis was used to examine the calcified cartilage and bone structure. There was a significant decrease in bone volume fraction with increasing age in the knee except for the patella. The study found the cancellous network of the patella to be markedly different from...
The story of treatment of patello-femoral instability is one of failure rather than success. Insall has pointed out that 30% have had more than one procedure.80% good results30% second operation6-40% redislocation43% persistent maltracking35% P/F crepitus22% +ve apprehensionThe reasons for this are clear. There is confusion and lack of uniformity about the classification of these conditions. There...
Six cases of anterior cruciate laxity in a varus knee with medial articular degeneration were treated by arthroscopic debridement, high tibial osteotomy and extra-articular Losee type lateral illio-tibial band tenodesis. A 2-year review demonstrated good symptomatic results, a significant improvement in the level of pain experienced, and an increased activity score. There was no subjective instability...
The patella is a sesamoid bone within the extensor apparatus. Rarely is the patella itself the cause of malalignment. However, it is the reference point for malalignment syndromes, and as such has six degrees of freedom, with displacement and rotation possible at each of the three cartesian axes. Imaging is therefore important in assessing displacement. However, the extensor mechanism is only...
In the acute meniscal injury in the young person, the vertical tear produces a bucket handle displacement or large tag and this is most commonly posteriorly and radial tears may occur, particularly on the lateral side.In the middle aged patient, or in those with a long history of high physical activity or sports, the degenerative type tears are important and now constitute a large group with knee...
The mechanism consists of the quadriceps muscle, the patella, the patellar tendon, the patellar retinacula and the tibial tuberosity. Typically as one gets older the injuries ascend with tibial tuberosity injuries being common in the younger patient and injuries to the quadriceps itself being more common in the older patient. Injuries can be traumatic, either direct or indirect or iatrogenic. Iatrogenic...
The knee joint is amenable to unicompartmental resurfacing because it is composed of three separate articulations, namely, medial, lateral and patello-femoral, each with exclusive articular surfaces. In addition, pathological lesions are often circumscribed affecting only localised areas. The patello-femoral joint is, on its own, a common site for pathological lesions such as chondro-malacia in...
The extensor mechanism comprises the quadriceps muscle and tendon, the patella and supporting structures and the patellar tendon. MRI enables excellent delineation of bony and soft tissue abnormalities related to these structures. With respect to quadriceps injuries, the exact site of muscular or tendinous damage can be identified. In partial thickness tears the extent of the injury may be assessed...
Cysts of the semilunar cartilages of the knee joint, particularly the lateral one, are not uncommon (Raine and Gonet, 1972). The first meniscal cyst was reported by Nicaise (1883), whilst the first clinical description was by Ebner (1904). Whether the lesion was that of the meniscal or parameniscal tissue is still a matter of dispute. Bennett and Shaw (1936) argued that a distinction between parameniscal...
SummaryDeteriorating knee function following rupture of the anterior cruciate ligament is frequently observed particularly in patients who continue with a high level of sport activity. The high incidence of meniscal lesions in the chronic anterior cruciate ligament insufficient knee is well established and this paper considers the relationship of meniscal pathology to degree of anterior cruciate...
Lateral patellar dislocation in children may be seen:(1) At birth(2) Later in childhoodCongenital dislocation of the patellaCongenital dislocation of the patella refers to an irreducible lateral dislocation present since birth and associated with a lateral position of the entire quadriceps mechanism. It is rare and difficult to diagnose in a baby. It is the cause of a fixed flexion contracture of...
Anterior knee pain is a common disorder in which there are many underlying causes. As in all orthopaedic disorders it is essential to come to a firm diagnosis before a specific plan of treatment can be decided upon. All too often, a specific diagnosis is not made and some arbitrary form of surgery such as lateral release is performed in the hope rather than expectation that relief of symptoms will...
The definition of a cyst is a pathological fluid filled sac bounded by a wall .The classification of meniscal cysts remains confused despite numerous theories. We feel that this is because the term meniscal cyst is used as a global term for cysts of different aetiologies. With the increasing use of MRI, more meniscal cysts are being diagnosed.MRI is undoubtedly the best technique for showing...
Reasons for chronic pain in the anterior part of the knee following trauma or surgeryNerve contusions, entrapments, neuromas: We saw and still see quite a number of nerve pain due to cut nerve brances and entrapments of the saphenous nerve system and also a variety of neruomas of the saphenous with its wide variations on the large medial knee area.Nerve problem with incisions, multiple incisions:Sometimes...
NotesPatellofemoral pain is often attributed to chondromalacia. Arthroscopic and cadaver studies, however, have demonstrated clearly that chondromalacia is present commonly as an incidental finding with no evidence of association pain. Also, Bently, Metcalf and McGinty and others have noted that there are many patients with anterior knee pain who have completely normal patellar articular cartilage...
The fibro-cartilaginous meniscus of the knee joint consists of multiple fibres of collagen (mainly Type 1) surrounded by matrix consisting of proteoglycans which are similar to those in hyaline cartilage. Lying within the matrix are the fibro-chondrocytes. The fibro-chondrocytes produce the matrix. The collagen bundles are arranged mainly in a circumferential orientation with a relatively small...
The entire imaging spectrum can be of use in evaluating patello-femoral joint dysfunction in certain clinical circumstances1. Plain filmsDespite being 100 years old, good quality pain radiographs are still front-line investigation.Interpretation of the skyline view needs to be guarded as there are many different radiographic techniques employed. A lateral in 20° flexion is good for assessing patella...
I. The history is important!A. Was onset of pain spontaneous or with minor injury suggesting underlying malalignment?B. Was there blunt trauma to the patella itself, to the retinaculum, or to the patellar tendon?C. Has there been any surgery around the knee?D. Is there any history of hip, back or knee problems?E. Has there been effusion? (Suggesting articular rather than retinacular problem)F. With...
The function of the quadriceps decelerator-extensor mechanism is one of the most important systems for the normal function of the knee for a normal gait-pattern.Normal flexion and extension motion is a joint-venture. It is almost not possible to have a full flexion mobility and at the same time an extension deficit on the same knee (exception with bone deformity after fracture).Extension deficit...
Research literature overwhelmingly supports the use of exercise in management patellofemoral joint problems.Over the last few years we have seen a move away from the more traditional protocol of only using static quadriceps and straight leg raising, to a more complex approach based on developing an individual programme from four main components which are:1. Vastus medialis obliquus strengthening ...