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Anatomy of femur and knee

Anagha P Parkar, Miraude E A P M Adriaensen, Søren Vindfeld, Eirik Solheim
BACKGROUND: The anterior cruciate ligament (ACL) is regularly reconstructed if knee joint function is impaired. Anatomic graft tunnel placement, often assessed with varying measurement methods, in the femur and tibia is considered important for an optimal clinical outcome. A consensus on the exact location of the femoral and tibial footprint centers is lacking. PURPOSE: To systematically review the literature regarding anatomic centers of the femoral and tibial ACL footprints and assess the mean, median, and percentiles of normal centers...
November 29, 2016: American Journal of Sports Medicine
T K Kim, Mark Phillips, Mohit Bhandari, John Watson, Rajesh Malhotra
BACKGROUND: Most TKA prostheses are designed based on the anatomy of white patients. Individual studies have identified key anthropometric differences between the knees of the white population and other major ethnic groups, yet there is limited understanding of what these findings may indicate if analyzed collectively. QUESTION/PURPOSE: What are the differences in morphologic features of the distal femur and proximal tibia among and within various ethnicities? METHODS: A systematic review of the PubMed database and a hand-search of article bibliographies identified 235 potentially eligible English-language studies...
October 4, 2016: Clinical Orthopaedics and related Research
Christophe Sauret, Hélène Pillet, Wafa Skalli, Morgan Sangeux
Accurate calibration of the medio-lateral axis of the femur is crucial for clinical decision making based on gait analysis. This study proposes a protocol utilizing biplanar radiographs to provide a reference medio-lateral axis based on the anatomy of the femur. The biplanar radiographs allowed 3D modelling of the bones of the lower limbs and the markers used for motion capture, in the standing posture. A comprehensive analysis was performed and results from biplanar radiographs were reliable for 3D marker localization (±0...
September 12, 2016: Gait & Posture
Shuntaro Yoshida, Koichiro Ichimura, Tatsuo Sakai
INTRODUCTION: The quadriceps femoris (QF), a major extensor of the knee joint, plays an important role in human movement. However, descriptions of the three vastus muscles of the QF in anatomy textbooks remain confusing. MATERIALS AND METHODS: We analyzed 33 QFs by a novel approach, using isolated muscle specimens to clarify the structures of the vastus lateralis (VL), vastus medialis (VM), and vastus intermedius (VI) origins. RESULTS: The origins of the VL and VM were quite constant in shape and location, but the VI was much more structurally diverse...
September 6, 2016: Clinical Anatomy
S F DeFroda, J A Gil, C T Born
PURPOSE: Fractures of the lower extremity, particularly of the femur and acetabulum, may be difficult to immobilize with splinting alone. These injuries may be best stabilized with the application of various types of skeletal traction. Often, traction is applied percutaneously in an emergent setting, making the knowledge of both superficial and deep anatomy crucial to successful placement. METHODS: Review was performed via PubMed search as well as referencing the Orthopaedic literature...
July 23, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Mélanie L Beaulieu, Grace E Carey, Stephen H Schlecht, Edward M Wojtys, James A Ashton-Miller
BACKGROUND: Most ruptures of the native anterior cruciate ligament (ACL) and ACL graft occur at, or near, the femoral enthesis, with the posterolateral fibers of the native ligament being especially vulnerable during pivot landings. Characterizing the anatomy of the ACL femoral enthesis may help us explain injury patterns which, in turn, could help guide injury prevention efforts. It may also lead to improved anatomic reconstruction techniques given that the goal of such techniques is to replicate the knee's normal anatomy...
December 2016: Journal of Experimental Orthopaedics
Soo Yeon Kim, Phuong Uyen Le, Boleslav Kosharskyy, Alan D Kaye, Naum Shaparin, Sherry A Downie
Genicular nerve radiofrequency ablation (RFA) has recently gained popularity as an intervention for chronic knee pain in patients who have failed other conservative or surgical treatments. Long-term efficacy and adverse events are still largely unknown. Under fluoroscopic guidance, thermal RFA targets the lateral superior, medial superior, and medial inferior genicular nerves, which run in close proximity to the genicular arteries that play a crucial role in supplying the distal femur, knee joint, meniscus, and patella...
July 2016: Pain Physician
Guenther Maderbacher, Armin Keshmiri, Hans R Springorum, Felix Greimel, Joachim Grifka, Clemens Baier
BACKGROUND: In comparison to coronal, sagittal, and rotational alignment, translational alignment parameters have been widely neglected in total knee arthroplasty (TKA) so far. As there is a certain variable range of possible component placement in mediolateral, ventrodorsal, and proximodistal direction, we hypothesized that relative positions between the femoral and tibial bones are changed after TKA, resulting in a subluxation of knees. METHODS: In 10 knees of Thiel-embalmed whole body cadavers, the relative position between the femur and the tibia during passive flexion was measured before and after TKA by means of a navigational device...
June 11, 2016: Journal of Arthroplasty
Ranjit Kr Baruah
INTRODUCTION: Ilizarov technique yields satisfactory results in difficult situations. Widely displaced fracture of the patella after failed osteosynthesis is a difficult situation. We are reporting one such case in a 27 years old male treated by modified Ilizarov technique. CASE REPORT: A 27-years old male with transverse fracture of the patella was fixed with tension band wiring. He indulged in heavy manual work including bicycling after 15 days of operation contrary to advice that led to loosening of implants and failure of reduction...
January 2016: Journal of Orthopaedic Case Reports
Andre F Steinert, Boris M Holzapfel, Lukas Sefrin, Jörg Arnholdt, Maik Hoberg, Maximilian Rudert
This article describes the concept and surgical technique of patient-specific total knee arthroplasty. Patient-specific implants and instruments are designed and fabricated based on computed tomography (CT) data of the leg. The disposable patient-specific drill guides and cutting-jigs are manufactured taking into consideration the anatomical and biomechanical axes of the knee joint and mediating the efficient pre-navigation of the osseous saw-cuts, without the need for additional navigation or balancing aids...
April 2016: Der Orthopäde
Brandon Chan, Jason Auyeung, John F Rudan, Randy E Ellis, Manuela Kunz
PURPOSE: Structured light scanning is an emerging technology that shows potential in the field of medical imaging and image-guided surgery. The purpose of this study was to investigate the feasibility of applying a hand-held structured light scanner in the operating theatre as an intraoperative image modality and registration tool. METHODS: We performed an in vitro study with three fresh frozen knee specimens and a clinical pilot study with three patients (one total knee arthroplasty and two hip replacements)...
June 2016: International Journal of Computer Assisted Radiology and Surgery
Guenther Maderbacher, Clemens Baier, Hans R Springorum, Florian Zeman, Joachim Grifka, Armin Keshmiri
BACKGROUND: During flexion, normal knee kinematics consists of a complex combination of rolling, gliding, and rotation between femur and tibia. Although in vivo studies have shown wide interindividual variability, we hypothesized that knee kinematics is either correlated to the anatomy of the individual knee joint or to the anatomic alignment of the entire lower extremity. METHODS: The passive kinematics of 10 healthy knees was assessed in whole cadavers using a commercial computed tomography-free navigation device with intracortical pins...
September 2016: Journal of Arthroplasty
Dominic T Mathis, Helmut Rasch, Michael T Hirschmann
BACKGROUND: there is only a paucity of studies dealing with bone remodeling within the tunnels after anterior cruciate ligament (ACL) reconstruction. The objective of this study was to evaluate the influence of tendon graft type and surgical fixation technique on bone tunnel remodeling in patients with symptomatic knees after ACL reconstruction. METHODS: in a retrospective study 99mTc-HDP bone tracer uptake (BTU) in SPECT/CT of 57 knees with symptoms of pain and/or instability after ACL reconstruction was investigated...
October 2015: Muscles, Ligaments and Tendons Journal
John J Elias, Neil T Soehnlen, Loredana M Guseila, Andrew J Cosgarea
BACKGROUND: The current study was performed to correlate anatomical parameters related to trochlear dysplasia, tibial tuberosity position, and patella alta with in vivo patellar tracking for subjects with recurrent patellar instability. METHODS: Eight subjects with recurrent patellar instability that failed conservative treatment were evaluated using computational reconstruction of in vivo knee motion. Computational models were created from dynamic CT scans of the knee during extension against gravity...
June 2016: Knee
Connor G Ziegler, John P Fulkerson, Cory Edgar
BACKGROUND: Studies have reported methods for radiographically delineating medial patellofemoral ligament (MPFL) femoral tunnel position on a true lateral knee radiograph. However, obtaining a true lateral fluoroscopic radiograph intraoperatively can be challenging, rendering radiographic methods for tunnel positioning potentially inaccurate. PURPOSE: To quantify the magnitude of MPFL femoral tunnel malposition that occurs on true lateral and aberrant lateral knee radiographs when using a previously reported radiographic technique for MPFL femoral tunnel localization...
January 2016: American Journal of Sports Medicine
Birhane Alem Berihu, Yared Godefa Debeb
BACKGROUND: The Sciatic nerve is the widest nerve of the body. It consists of two components, namely: the tibia and the common peroneal components derived from the ventral rami of L4 to S3 spinal nerves of the lumbosacral plexus. It exits the pelvis through the greater sciatic foramen below the Piriformis muscle and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The purpose of this study is to identify the course and variations in branching pattern of the sciatic nerve which may lead to various clinical manifestations...
2015: BMC Research Notes
Matthew R Prince, Michael J Stuart, Alexander H King, Paul L Sousa, Bruce A Levy
Reconstruction of the posterolateral corner of the knee using two-tailed techniques involved grafts originating from the femur and inserting on the proximal tibia and fibular head. This method reconstructs the fibular collateral ligament, popliteofibular ligament, and popliteus tendon using anatomically placed grafts. This article describes the history, anatomy, indications, and authors' preferred technique for a two-tailed posterolateral corner reconstruction. In addition, biomechanical and clinical outcomes of this technique will be compared...
December 2015: Journal of Knee Surgery
William Z Morris, Jeremy J Gebhart, Victor M Goldberg, Glenn D Wera
A total knee arthroplasty system offers more distal femoral implant anterior-posterior (AP) sizes than its predecessor. The purpose of this study is to investigate the impact of increased size availability on an implant system's ability to reproduce the AP dimension of the native distal femur. We measured 200 cadaveric femora with the AP-sizing guides of Zimmer (Warsaw, IN) NexGen (8 sizes) and Zimmer Persona (12 sizes) total knee arthroplasty systems. We defined "size deviation" as the difference in the AP dimension between the anatomic size of the native femur and the closest implant size...
July 2016: Journal of Knee Surgery
Dominic Gillespie, Daniel Mandziak, Colin Howie
INTRODUCTION: Patellar instability is a condition with multifactorial aetiology, potentially involving soft tissue characteristics, the bony anatomy of the patella, femur and tibia, and alignment of the lower limb. The shape of the distal femur and patellofemoral joint has been frequently studied using plain orthogonal and skyline radiographs. We investigated a possible contribution of hypoplasia of the lateral femoral condyle in the axial plane to patellar instability. METHODS: The geometry of the distal femur and alignment of the lower limb on plain radiographs and MRI scans in 25 young adult patients with patellar instability was measured, and compared to a control group of 75 age-matched patients...
November 2015: Archives of Orthopaedic and Trauma Surgery
Victor W Wong, Heinz K Bürger, Matthew L Iorio, James P Higgins
PURPOSE: To elucidate the vascular anatomy of the superolateral geniculate artery (SLGA) and its supply to the periosteum of the lateral femoral condyle (LFC) and to provide guidelines for flap design and describe an illustrative case. METHODS: Thirty-one fresh cadaveric limbs were dissected. The vascular anatomy of the SLGA and its distal branches to skin, muscle, and periosteum were identified. Fluoroscopic images were taken during continuous perfusion of a radiopaque contrast dye into the SLGA...
October 2015: Journal of Hand Surgery
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