The Knee
Exposure optionsMedian parapatellarSubvastusLateralPrior skin incisionsUse: The most lateal; The most recent;The Delay techniqueProtecting the patellar tendon insertionInverted VQuad snipTubercle osteotomyDelivering the tibia forward (Ranasall maneuver)Curved 1 cm osteotome inside deep MCLTo the semi-membranosis bursaIsolate and coagulate lateral inferior geniculate vesselsDistal femoral resection...
(1) Place the tourniquet high on thigh.(2) With the knee extended draw the surgical incision with a marking pen. The incision that I use is a straight midline, centered on the patella. It extends from 4 cm proximal the proximal pole of the patella to about 2 cm distal to the tibial tubercle. (Small keyhole incisions do not give adequate exposure and may cause undue tension on the skin.)(3) Flex...
Ultra high molecular weight High Molecular Weight Polyethylene (UHMWPE) is the current material of choice as the bearing surface in total knee and hip replacements. However, as it has become evident that the debris from these components can play a significant role in implant loosening, the nature of this material has become more important. This presentation will have several goals: 1. Provide a...
Since Gunston described the first flow friction total knee replacement in 1971, a myriad of prosthetic designs and instrumentation systems have been developed to aid the operating surgeon. The successful outcome of a total knee replacement, whether it be a primary or revision procedure, still relies heavily on the restoration of alignment, soft tissue balancing and the experience of the surgeon....
Patellofemoral problems account for the majority of complications experienced in total knee arthroplasty. The unresurfaced patella can undergo secondary degeneration and require late resurfacing. This more often occurs in the rheumatoid patient and it appears that all rheumatoids should probably undergo patellar resurfacing at the time of their primary arthroplasty. Osteoarthritic patients can...
What material strategies should be considered to assist in the improvement in the long-term wear performance of total knee replacements? In answering this question, it must first be acknowledged that, at least for certain total knee replacement designs, the currently used metallic alloys coupled with ultra high molecular weight polyethylene high molecular weight polyethylene have been providing excellent...
I. Rationale for correcting varus alignmentA. Biomechanical studies in Cadaver knees have shown that with uniform loading 5200-6500 N force is required to produce failure.With eccentric medial loading lateral lift-off failure occurs at 9-15% of the above force and compression load failure on the medial side occurs at 50% of the force.B. Numerous clinical studies have shown increased failure rates...
Unicompartmental knee replacement (UKA) has often been criticized for its less optimal survivorship as compared to total knee arthroplasty (TKA). This statement is counterbalanced by the advocates of unicompartmental knee replacements with the argument of better postoperative function. The aim of this retrospective study was to compare the functional outcome of both procedures.From 1989 to 1994,...
I. Microbiology of prosthetic joint infectionA. SpectrumB. Frequencies of specific pathogensC. Emerging resistance to antibiotic therapy1. MRSA, Nosocomial gram-negatives2. MRSE, Aminoglycoside-resistant staphylococci3. VREF, Penicillin-resistant viridans strep4. Aminoglycoside-resistant streptococci5. Mycobacteria, FungiII. Eradication of the pathogenA. Not gram stain specificB. Related to quantitative...
During anterior cruciate ligament reconstruction most experienced knee surgeons site the tibial tunnel by reference to tibial landmarks alone, without any reference to the apex and roof of the intercondylar notch. Clearly in most instances, a satisfactory siting of this tunnel will be produced which will avoid implant impingement. However, even in the hands of the experienced knee surgeon using a...
Based on our experience, we hypothesized that certain lateral meniscal tears identified at the time of anterior cruciate ligament reconstruction can be left without removal or repair and that they will remain asymptomatic. We looked at 189 lateral meniscal tears that were left in situ at the time of anterior cruciate ligament reconstruction. At an average clinical follow-up of 2.6 years (range,...
Reconstruction of the anterior cruciate ligament (ACL) has received considerable attention during the past 2 decades. Although treatment advances have changed the operative management of this injury, the primary goals of treatment remain constant. These include restoration of knee stability, limiting surgical morbidity, and a successful return to full activities.The mid-third autogenous patellar...
We sought to evaluate the accuracy with which joint line tenderness is associated with meniscal lesions in knees with acute anterior cruciate ligament tears. The physical assessment of joint line tenderness was performed at a mean of 8 days after the initial injury in 173 patients who subsequently underwent anterior cruciate ligament reconstruction. Identification of meniscal lesions was documented...
IntroductionIn recent years, various surgical techniques have been advocated for the reconstruction of the anterior cruciate ligament (ACL) using the bone-patellar tendon-bone graft. These operative procedures include a miniarthrotomy technique, trans-patellar tendon defect technique, arthroscopically assisted technique, and more recently, the endoscopic technique. We believe that the miniarthrotomy...
The accuracy of three-dimensional (3D) in vivo knee measurement is presently limited by artifacts from movement of soft tissue surrounding the underlying bone. To improve 3D measurement, a mechanical fixation system is proposed which attaches sensors onto the underlying bone non-invasively. A 3D X-ray technique is used to show that the system can measure knee kinematics over 65 o flexion...
One of the reasons we were told in the past we had to delay rehabilitation is because of the phenomenon of Ligamentization. Recently Steven Howell has published an article in the American Journal of Sports Medicine showing that at two years hamstrings tendons are entirely avascular. Therefore, there has not been a process Ligamentization going on in hamstrings. I wonder what our views are on the...
Traumatic dislocation of the knee is uncommon, and the knee dislocation can usually be reduced satisfactory by closed methods. We report a case of the irreducible dislocation of the knee with interposition of the patella.
Partial anterior cruciate ligament rupture can occur in isolation or in association with other knee ligament or structure injuries. Many would still argue the existence of such a lesion but partial anterior cruciate ligament tears were first reported by Darrach 57 years ago (Sandberg and Balkfors, 1987) and were followed by others (Liledahl et al., 1965; Noyes et al., 1980; McDaniel and Dameron,...
In this article we offer our approach to potential problems of anterior cruciate ligament (ACL) reconstruction and provide suggestions on how to minimise, prevent, or avoid them. Graft harvest, particularly with the patellar tendon graft, has concerned surgeons. Range of motion, quadriceps strength (if the patellar tendon is harvested from the ipsilateral knee) anterior knee (Patellofemoral) pain,...
IntroductionIn the past two decades, significant advances have been made in the surgical techniques of anterior cruciate ligament (ACL) reconstruction. However, there is no consensus of opinion as to what is the ideal time when one should undertake an ACL reconstructive procedure.In the 1950s, the practice was to repair acute knee injuries as soon as possible. This practice carried over into the...