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Knee instability

R Gaillard, S Lustig, A Peltier, V Villa, E Servien, P Neyret
BACKGROUND: Despite excellent long-term outcomes, posterior stabilisation by a third condyle continues to receive unwarranted criticism regarding patellar complications and instability. HYPOTHESIS: Complication rates with a tri-condylar posterior-stabilised implant are similar to those with other posterior-stabilised prostheses and have diminished over time due to improvements in prosthesis design. MATERIAL AND METHODS: Post-operative complications and revision rates were assessed retrospectively in a prospective cohort of 4189 consecutive patients who had primary total knee arthroplasty (TKA) using a tri-condylar posterior-stabilised implant (Wright-Tornier) and were then followed-up for at least 24 months...
October 19, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
A Achtnich, S Rosslenbroich, K Beitzel, A B Imhoff, W Petersen
OBJECTIVE: Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. INDICATIONS: Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. SURGICAL TECHNIQUE: Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion...
October 21, 2016: Operative Orthopädie und Traumatologie
Emily Meike, S M Howell, M L Hull
PURPOSE: After reconstructing a torn ACL with a soft tissue allograft, the long-term healing process of graft maturation following the short-term healing process of graft incorporation into the bone tunnels might lead to recurring instability and concomitant decreases in the activity level, function, and patient satisfaction. Relying on roentgen stereophotogrammetric analysis (RSA), the primary purpose was to determine whether anterior laxity increased and whether patient-reported outcomes declined between 1 and 7 years for a particular graft construct, surgical technique, and rehabilitation programme...
October 20, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Kenji Murata, Naohiko Kanemura, Takanori Kokubun, Tsutomu Fujino, Yuri Morishita, Katsuya Onitsuka, Shuhei Fujiwara, Aya Nakashima, Daisuke Shimizu, Kiyomi Takayanagi
OBJECTIVE: Joint instability induced by anterior cruciate ligament (ACL) transection is commonly considered as a predisposing factor for osteoarthritis of the knee; however, the influence of re-stabilization on the protection of articular cartilage is unclear. The aim of this study was to evaluate the effect of joint re-stabilization on articular cartilage using an instability and re-stabilization ACL transection model. DESIGN: To induce different models of joint instability, our laboratory created a controlled abnormal joint movement (CAJM) group and an anterior cruciate ligament transection group (ACL-T)...
October 15, 2016: Osteoarthritis and Cartilage
Ravi Gupta, Gladson David Masih, Gaurav Chander, Vikas Bachhal
BACKGROUND: Despite improvements in instability after anterior cruciate ligament (ACL) reconstruction, associated intraarticular injuries remain a major cause of concern and important prognostic factor for long term results as it may lead to osteoarthritis. Delay in ACL reconstruction has been in variably linked to increase in these injuries but there is lack of consensus regarding optimal timing of reconstruction. The goal of this study was to investigate delay in surgery and other factors, associated with intraarticular injuries in ACL deficient knees...
September 2016: Indian Journal of Orthopaedics
J-G Cao, L Wang, H-W Zhao, J Liu
OBJECTIVE: The objective of the study is to evaluate the clinic effectiveness of semitendinosus and gracilis transfer for the treatment of medial collateral ligament (MCL) injury of total knee arthroplasty (TKA). PATIENTS AND METHODS: From March 2009 to May 2014, a series of 11 patients with MCL injuries of primary TKA were treated by semitendinosus and gracilis transfer. Another 18 patients (21 knees) were recruited as control group. The two groups of patients were comparable for gender, age, body mass index, varus knee deformity, KSS score, joint activity degree and type of prosthesis comparison without significant difference (p > 0...
September 2016: European Review for Medical and Pharmacological Sciences
Humberto G Rosas
Although rare, posterolateral corner (PLC) injuries can result in sustained instability and failed cruciate ligament reconstruction if they are not diagnosed. The anatomy of the PLC was once thought to be perplexing and esoteric-in part because of the varying nomenclature applied to this region in the literature, which added unnecessary complexity. More recently, three major structures have been described as the primary stabilizers of the PLC on the basis of biomechanical study findings: the lateral collateral ligament, popliteus tendon, and popliteofibular ligament...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Jacob Matz, James L Howard, David J Morden, Steven J MacDonald, Matthew G Teeter, Brent A Lanting
BACKGROUND: Patellofemoral joint biomechanics contribute to anterior knee pain, instability, and dysfunction following total knee arthroplasty (TKA). Information about specific factors leading to anterior knee pain and dysfunction is currently limited. Changes in patellofemoral joint offset (PFO) refers to a mismatch between the preoperative and postoperative anteroposterior geometry of the patellofemoral joint. It remains unclear whether these changes lead to adverse outcomes in TKA...
September 14, 2016: Journal of Arthroplasty
Yaxia Zhang, Michael Joyce, Jean Schils, Thomas W Bauer
Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas, predominantly involving lung, mediastinal lymph nodes and other organs. Synovium involvement is infrequent, and as far as we know, involvement of a periprosthetic membrane has not been reported in the English literature. Intra-articular diffuse tenosynovial giant cell tumor ("conventional diffuse pigmented villonodular synovitis") is an uncommon, locally aggressive neoplasm with few previous case reports in which it arose in periprosthetic tissues after knee arthroplasty...
October 7, 2016: Skeletal Radiology
Kamal Deep, Frederic Picard, Joseph Baines
PURPOSE: The aim of this study was to assess the kinematics of arthritic knees prior to TKA. The hypothesis was that the arthritic knee follows distinct patterns with regard to deformity in coronal plane as it flexes from extended position. METHOD: Data from 585 consecutive arthritic knees that had undergone TKA using two non-image-based navigation systems were included in the study. Coronal plane alignment given by the femoro-tibial mechanical angle (FTMA) was recorded in extension, 30°, 60°, 90° and maximum flexion prior to making any bony cuts or ligamentous releases...
October 6, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
John J Elias, Michael J Kelly, Kathryn E Smith, Kenneth A Gall, Jack Farr
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is performed to prevent recurrent instability, but errors in femoral fixation can elevate graft tension. HYPOTHESIS: Errors related to femoral fixation will overconstrain the patella and increase medial patellofemoral pressures. STUDY DESIGN: Controlled laboratory study. METHODS: Five knees with patellar instability were represented with computational models...
September 2016: Orthopaedic Journal of Sports Medicine
Jorge Chahla, Chase S Dean, Justin J Mitchell, Gilbert Moatshe, Raphael Serra Cruz, Robert F LaPrade
Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency...
August 2016: Arthroscopy Techniques
Michael P O'Malley, Ayoosh Pareek, Patrick J Reardon, Michael J Stuart, Aaron J Krych
Coronal limb malalignment is a significant contributor to asymmetric joint wear, gait abnormalities, and the development and progression of degenerative joint disease. Osteotomies about the knee were developed to realign the mechanical axis of the limb to unload the affected compartment. Valgus malalignment is less common than varus malalignment, but can contribute to a variety of clinical conditions, including lateral compartment cartilage defects and arthritis, lateral patellofemoral instability, and medial collateral ligament laxity...
August 2016: Arthroscopy Techniques
Ahmad M Wagih, Ahmed M F Elguindy
Recent advances in surgeons' understanding of the anatomic, biomechanical, and radiologic features of the anterolateral ligament (ALL) of the knee have led to an increased interest in reconstruction of this structure as part of the management of knee instability. Even without any technical flaws and proper positioning of the bone tunnels, there is a small subset of patients, approximately 7% of all patients, who experience some residual anterolateral rotational instability after anterior cruciate ligament reconstruction...
August 2016: Arthroscopy Techniques
A Rosen, J Ko, C Brown
Chronic ankle instability is a common pathological consequence of ankle sprains. However, screening tools which assess self-reported dysfunction offer little insight into clinical factors which may be useful to improve deficits. The purpose of this study was to identify factors that contribute most to self-reported dysfunction. 93 individuals completed the Cumberland Ankle Instability Tool (CAIT), active range of motion, dynamic postural stability assessments, and an arthrometer inversion stress test to assess lateral ankle laxity and stiffness...
October 5, 2016: International Journal of Sports Medicine
Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Koji Murakami, Hidehiko Higaki, Hiroyuki Nakahara, Takeshi Shimoto, Hideki Mizu-Uchi, Yukio Akasaki, Yukihide Iwamoto
The purpose of this study was to investigate in vivo kinematics in healthy and osteoarthritic (OA) knees during stepping using image-matching techniques. Six healthy volunteers and fourteen patients with medial OA knee before undergoing total knee arthroplasty performed stepping under periodic anteroposterior X-ray images. We analyzed the three-dimensional kinematic parameters of knee joints using X-ray images and CT-derived digitally reconstructed radiographs. The average extension/flexion angle ranged 6°/53° and 16°/44° in healthy and OA knees with significant difference in extension (p = ...
October 5, 2016: Journal of Applied Biomechanics
Christian Konrads, Stephan Reppenhagen, Daniel Belder, Sascha Goebel, Maximilian Rudert, Thomas Barthel
PURPOSE: To analyse subjective and objective long-term outcomes of patients with anterior cruciate ligament (ACL)-deficient knees and limited demands regarding sportive activities. This subgroup of patients might be well-treated without ligament reconstruction. METHODS: We included 303 patients with unilateral tears of the ACL and conservative treatment into a prospective study. Mean age at injury was 33.8 (min. 18, max. 66) years. Follow-up was 27.1 (min. 21.3, max...
October 3, 2016: International Orthopaedics
Tetsuo Hagino, Satoshi Ochiai, Shinya Senga, Takashi Yamashita, Masanori Wako, Takashi Ando, Hirotaka Haro
PURPOSE: To study discoid meniscus in children who underwent arthroscopic surgery at our center. SUBJECTS AND METHODS: Thirty-four patients (39 knees) younger than 15 years with discoid lateral meniscus (mean age, 12.9 years; 13 males, 21 females) who underwent arthroscopic surgeries since 2007 were studied. The surgical procedure consisted of, in principle, saucerization with additional suture repair in the case of meniscal instability at the peripheral rim of the residual meniscus...
October 1, 2016: Archives of Orthopaedic and Trauma Surgery
Young Gon Na, Moon Jong Chang, Sang Hwa Eom, Seok Jin Kim, Seong Cheol Park, Tae Kyun Kim
BACKGROUND: We aimed to determine whether coronal alignment measured on the single-limb stance (SLS) radiographs differs from those on the double-limb stance (DLS) images. We also investigated whether the size of such differences was affected by the knee pathology, lower limb alignment, and geometry of the tibia or femur. METHODS: We measured coronal alignment with mechanical tibiofemoral angle (MTFA) on the DLS and SLS radiographs in patients with posterolateral rotatory instability (PLRI, 30 knees), osteoarthritis (OA) with varus deformity who were scheduled for high tibial osteotomy (HTO) (60 knees), and in normal control (60 knees)...
September 28, 2016: Knee
Juan Diego Ayala-Mejias, Benjamin Garcia-Gonzalez, Luis Alcocer-Perez-España, Jorge Hugo Villafañe, Pedro Berjano
To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up...
September 29, 2016: Journal of Knee Surgery
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