ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Tendon allograft is one of the useful ways to reconstruct the anterior cruciate ligament (ACL) without sacrificing normal tissues. Because it has advantages and disadvantages/concerns, this article makes suggestions regarding graft collection/selection, indication for the procedure, graft preparation, the currently performed technique to mimic the anatomic two bundles of ACL, and postoperative rehabilitation.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Antibiotic-loaded cement spacers are commonly used for delivery of local antimicrobial agents and maintenance of collateral ligament length during the treatment of the infected knee replacement. The use of these spacers has continued to evolve with loading of higher dosages of antibiotics and creation of mobile spacers, which allow knee range of motion. Although mobile spacers have facilitated ease of reimplantation, improvement of final functional outcomes has not been confirmed. Potential disadvantages of cement spacers include bone erosion and extensor mechanism compromise. The specific indications for use of medullary, static, and mobile spacers and the fabrication of antibiotic-loaded cement spacers is discussed.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Valgus high-tibial osteotomy is an established treatment for medial osteoarthritis in the varus knee. The classic technique involves removal of a laterally based bone wedge from the tibia, fibula osteotomy, and osteosynthesis of the tibia by a lateral exposure. This procedure has a certain risk potential regarding peroneal nerve injuries, instability of the osteotomy, and secondary loss of correction. Open-wedge osteotomy from medial avoids muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy, and leg shortening. Only one osteotomy must be performed, and the correction can be adapted intraoperatively. A new plate fixator (Tomofix; Mathys Medizinaltechnik AG, Bettlach, Switzerland) adapted specifically to this procedure and inserted percutaneously allows for stable fixation of the osteotomy.1The use of bone grafts or bone substitutes can be avoided in most cases. The authors have treated 166 patients with this technique in a prospective study from March 2000 to May 2002. All patients started partial weightbearing immediately and full weightbearing was possible 6 to 10 weeks after surgery. The mean opening of the osteotomies was 10 mm. Complications included two deep and one superficial infection, one pseudarthrosis, and two secondary recurrences of varus deformation. Two patients required secondary implantation of a knee prosthesis. All but one osteotomy healed uneventfully, and 36 implants were removed until now.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Compromised patellar bone stock poses significant technical challenges in knee revision surgery. The alternatives that have been proposed include reinsertion of a biconvex patellar component, patellar bone grafting, patellectomy, and leaving the unresurfaced patellar bone remnant in place. Various results have been reported with these methods, but not one of them has yet been widely accepted. A novel sagittal osteotomy that was used in four patients is described. This osteotomy leaves the extensor mechanism intact and allows the medial and lateral halves of the residual patella to hinge open in the shape of a “gull wing.” This conforms to the femoral trochlear groove and when combined with particulate bone grafts, it consolidates as a mass resembling a patella. The procedure has been limited to severe cases and obviates the need for patellectomy.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Increasing emphasis on the comprehensive reconstruction of the knee and on restoration of knee function after injury has heightened the interest in meniscus preservation. The approach to meniscal tears in the active individual emphasizes tissue repair over resection because meniscal tissue preservation has several potential advantages that improve the biomechanics and natural history of knee function over time. The technical approach to meniscal repair has significantly evolved in the last 10 years and continues to expand. Numerous techniques and multiple devices have been introduced and present the clinician with a vast array of surgical options. More recently, case reports documenting morbidities associated with the use of newer generation meniscal repair fixators have raised concerns regarding these devices and prompted recommendation that repair using suture may be preferred. An update on meniscus repair techniques is presented outlining and reviewing the current available procedures and implants including postoperative care, preliminary results, and complications. Technical pearls and pitfalls including optimal indications are reviewed for several of the repair methods as well as potential future directions in the approach to meniscal disease.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Total knee arthroplasty (TKA) in patients with established knee osteoarthritis and major varus, mostly due to constitutional proximal deformity, remains a challenging procedure. Orthogonal cuts result in asymmetric bone resection and subsequent bone related laxity in the convex side. This situation requires a major release of the medial collateral ligament to achieve good ligament balancing, but is sometime excessive with subsequent residual medial laxity. A technique was developed that combines high tibial osteotomy and TKA in the same sitting to address such major deformities. It allows achievement of good realignment without excessive release. Opening osteotomy is performed first and the TKA is then placed, with stem augmentation, to ensure stability of the construct. Preliminary results of this original demanding method are encouraging, and it is suggested that this option be considered in severe varus osteoarthritic knees.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Although the medial collateral ligament is the most frequently injured knee ligament, controversy still exists concerning its treatment. Despite the support of nonoperative management by some animal and clinical studies, the functional outcome varies in patients treated nonoperatively. The purpose of this study is to discuss the initial evaluation, the preoperative assessment, and the surgical techniques for treating medial collateral ligament injuries and to report the results of a reconstructive technique using a semitendinosus autograft to augment the ligament repair. Eight patients with persistent symptoms after nonoperative management of isolated medial collateral ligament injuries were treated with anatomic repair and augmentation with autograft semitendinosus. The average follow-up time from surgery was 35.8 months. All patients demonstrated less valgus laxity at follow-up with five Grade I and three Grade 0. The average Single Assessment Numeric Evaluation rating was 87 (range: 70–100), average Lysholm score was 87 (range: 81–95), and average Tegner activity scale rating was 7 (range: 4–9). The International Knee Documentation Committee results were two normal, five nearly normal, and one abnormal. Nonoperative management of all isolated medial collateral ligament injuries does not uniformly yield good results. A minority of patients with medial collateral ligament tears will require operative intervention to optimize knee function and decrease symptoms. In a small series of patients, surgical techniques that restore the native anatomy through ligament repair, and protect the repair with autograft augmentation, have led to good functional results.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malaligned knees. We present the indication, the operative technique, and the results of 58 patients treated by simultaneous high tibial osteotomy and cruciate ligament reconstruction. The indication for simultaneous high tibial valgus osteotomy and anterior cruciate ligament (ACL) reconstruction is chronic anterior knee instability in varus knees of patients who were younger than 40 years of age. In these patients, frequently medial meniscus deficiency secondary to prior injuries and/or chronic knee instability has led to unicompartmental (medial) tibiofemoral degenerative changes. First the osteotomy (closed wedge or open wedge technique) is carried out followed by the arthroscopic ACL reconstruction (patellar tendon, hamstrings, allografts). From April 1996 until December 2000, 58 patients underwent simultaneous osteotomy and cruciate ligament reconstruction. Average correction angle of the osteotomy was 7° (range: 4°–10°). Subjectively, all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications occurred in four patients. Unstable varus malaligned knees can be sufficiently treated by osteotomy and ACL replacement, suggesting that it is cost-effective therapy with good short-term results. Performing both operations in one procedure facilitates early rehabilitation and return of the patients back into the activities of daily living and sports.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID