The Knee
Assessing a patient presenting with a problem following a previous anterior cruciate ligament reconstructive surgery is often difficult. The first thing one has to consider is the integrity of the previous reconstruction, the fear being that of a re-rupture of the reconstruction. There is no doubt a learning curve in the anterior cruciate ligament reconstructive surgery with the technical aspect...
We present the results of a series of patients who had non-operative management of the medial collateral ligament with anterior cruciate ligament reconstruction. From February 1983 through December 1989, 84 of 90 consecutive patients were available for follow-up (minimum, 1 year; mean, 3.1 years) with a combined anterior cruciate ligament-medial collateral ligament injury (anterior cruciate ligament...
Hamstrings may be used as an alternative autologous graft in anterior cruciate ligament reconstruction. Four strand hamstrings (doubled semitendinosis and gracilis) produce a large graft with the advantage of greater strength than a 10-mm central tendon and the harvest is extremely benign, with no effect on the patella and the extensor apparatus. There is only temporary compromise of the knee flexors...
To compare the laxity and stability characteristics between the natural knee and condylar replacements, tests were carried out in a knee simulating machine. The tests consisted of applying compressive forces and then applying cyclic AP force and cyclic torque. The magnitudes were similar to those of functional conditions. For the natural knee, the laxities were only reduced modestly by increases...
Two hundred and twenty five osteoarthritic patients underwent primary cemented TKR and were followed prospectively for at least 5 years. Surgeries were stratified into PCL retaining (121 knees) (Group A), and Post Stabilized (84 knees) (Group B). The Genesis prothesis was used in all cases. Mean ROM at five years was 117° in Group A and 114° in Group B. 72% of Group A and 62% of Group B patients...
Impingement lesions and rupture in autologous reconstruction of the cruciate deficient knee have been found to be closely correlated with an anterior tibial tunnel placement. Thirty-three retrieved, ruptured prosthetic scaffold type implants have been subjected to scanning electron microscopy in the Department of Textiles at Manchester University. Analysis of the fracture morphology of polyester...
The Hauser operation for congenital recurrent dislocation of the patella results in patella baja and a high complication rate. A new technique is presented for revision surgery that restores normal patella alignment and relieves anterior knee pain.
False aneurysm is a rare but recognised complication following total knee replacement. We present a new method of diagnosis and treatment using colour coded, Doppler guided compression which avoids many of the complications associated with the more invasive techniques such as arteriography and surgery.
Thirty-one failed metal-backed unicompartmental arthroplasties (MBUKAs) were reviewed with respect to their etiology of failure. In 11 cases (35.5%), the failure mode was medial-lateral mismatch (medial-lateral subluxation in the coronal plane). Six cases (19%) failed secondary to lack of ingrowth in uncemented prostheses; four of which were as a result of failed femoral component ingrowth,...
Ten fresh-frozen cadaver knees were studied to investigate the contact pressure distribution and three dimensional (3-D) tracking of the patella under consecutive three different conditions. They have included (a) an intact knee, (b) the unresurfaced patella in bicompartmental knee arthroplasty (Bi-TKA), and (c) the resurfaced patella in tricompartmental knee arthroplasty (Tri-TKA). A pressure-sensitive...
Mediolateral tibiofemoral alignment after knee replacements is considered an important clinical predictor. Weight-bearing radiographic examination has been proposed as the golden standard. Clinically the most reliable measurement is lying unstressed measurement of the mediolateral angle. The comparison made in this study showed poor correlation between clinical and radiological examinations. The...
We are reporting on 46 patients who had suturing for chronic meniscal tears, 31 cases have been reviewed arthroscopically. The tears occurred both in the red-white zone (15 patients) as well as white-white zone (16 patients) ranging from isolated short peripheral tears up to complete and chronic dislocated bucket handle tears. Criteria of evaluation was the morphological appearance of the meniscus...
The patello-femoral joint is a highly loaded component of a total knee arthroplasty, but its design has often received scant attention. Plotting the patellofemoral congruity of five commonly used, loaded patellar prostheses at different angles of flexion, provides evidence of extremely high contact stresses in all the current designs. Finite element stress analysis shows how poor design leads to...
The purpose of this study was to determine whether the accuracy of the Lachman test is altered by the thigh diameter of the patient or the clinical experience and hand size of the examiner. It was found that medical students and qualified orthopaedic trainees were equally accurate. Examiner hand size, clinical experience and patient thigh diameter each had no demonstrable effect on the accuracy of...
Indications for Magnetic Resonance Imaging (MRI) of the knee vary in different orthopaedic units. This study looked at a series of MRI scans carried out for selective reasons over a 2-year period. One-hundred scans were studied and out of the series 37 patients had an arthroscopy of the knee. Findings at arthroscopy were compared to the MRI scan results. It was felt that if MRI scanning were not...
Two cases of late reconstruction of the patellar tendon using the semitendinosus and gracilis tendons are reported. Adequate graft length enabled satisfactory fixation without augmentation. Good functional recovery was achieved in both cases.