ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

An articular cartilage lesion of the knee is a therapeutic problem and the capacity of cartilage to heal is very limited. Unhealed cartilage lesions are likely to progress to osteoarthritis. Therefore, it is important to diagnose and treat the lesion at an early stage. Autologous chondrocyte transplantation (ACT) is a two-staged procedure that consists of initial arthroscopic evaluation and cartilage harvesting. After isolation and 2 weeks of culturing of the chondrocytes, the implantation can be done in open surgery. Rehabilitation starts the day after surgery and continues over a long period of time; return to competitive sports is possible. The long-term results after ACT are good or excellent in more than 80% of the patients.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Autologous osteochondral transplantation represents one solution: to bring about a hyaline or hyaline-like repair of the defected area. This paper discusses the experimental background and 10 years of clinical experience with autologous osteochondral mosaicplasty. Several series of dog and horse studies and subsequent clinical practice have confirmed the survival of the transplanted hyaline cartilage. Fibrocartilage fills the donor sites located on the less–weight-bearing surfaces. Clinical scores, imaging techniques, control arthroscopies, histologic examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage. According to these investigations, 92% of femoral condylar implantations have shown good to excellent results, as have 88% of tibial resurfacements, 81% of patellar and/or trochlear mosaicplasties, and 94% of talar procedures. The Bandi score showed long-term donor site disturbances in 3% of patients. Sixty-nine of the 81 control arthroscopies represented good gliding surfaces, histologically proven survival of the transplanted hyaline cartilage, and fibrocartilage coverage of the donor sites. In the entire series, there were four deep infections and 38 painful hemarthroses after surgery. Multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty, and microfracture cases in homogenized subgroups) demonstrated that mosaicplasty yielded favorable clinical outcome in long-term follow-up compared to the other three techniques. Intermediate-term evaluation of the femoral condylar implantations (3–6 y follow-up) and talar mosaicplasty procedures (3–7 y follow-up) confirmed the durability of the early results. From these encouraging results from an increasingly large series and similar results from other centers, it seems that autologous osteochondral mosaicplasty may be a viable alternative treatment of localized full-thickness cartilage damage of the weight-bearing surfaces of the knee and other weight-bearing synovial joints.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Meniscal transplantation as a treatment of degenerative knee joint disease remains controversial. When confronted with a medial or lateral compartmental pain syndrome in a patient after total meniscectomy, the orthopedic surgeon faces manifest therapeutic challenges. Apparently, satisfactory results can be obtained consistently after proper correction of axial malalignment. However, in the well-aligned knee joint, it seems logical to reimplant the meniscus when it has been removed anteriorly and incapacitating pain has led to functional impairment. Experience gained from medium-term implantation results suggests that arthroscopically assisted lateral transplantation is the most effective procedure, whereas the open technique seems to be best suited for medial meniscal transplantation, with either dual or single skin incision allowing for medial collateral ligament release. The use of bone blocks for allograft fixation is still controversial because meniscal implantation should be anatomic to restore meniscal function. Accurate bone block fixation is difficult, but meniscal transplantation without bone blocks might induce erratic meniscal behavior.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In the athletic population, isolated anterior cruciate ligament (ACL) injuries, isolated medial collateral ligament (MCL) injuries, and combined ACL/MCL injuries are commonly seen. The recommended treatment of each of these injuries is different. Often, in the acute setting, the ACL is reconstructed and the MCL is managed nonsurgically. However, the management of patients with chronic combined ACL/MCL injuries is not as straightforward. If patients are treated with ACL reconstructions alone, some will have persistent medial laxity that may compromise their ACL reconstruction. The current surgical options that address laxity on the medial side of the knee require significant surgical exposure and mobilization of the tissues. Alternatively, the MCL healing response technique—microperforation—reestablishes an acute biologic healing environment for the chronically injured MCL.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Osteotomy is a classic operation in the treatment of unicompartmental osteoarthrosis of the knee. It has often been presented as a possible alternative to prosthetic joint replacement, but the indications depend on the stage and articular diffusion of the degenerative changes and on the patient's profile and are very different in most cases from the indications for unicompartmental or total knee replacement. A relatively new technique of high tibial osteotomy will be illustrated in this article with careful step-by-step presentation of all the details of the operation. Compared to the Coventry lateral closing wedge osteotomy, this technique turns upside down the method of correction of the varus deformity and adds a wedge medially. It is based on a special dedicated system of instruments and plates developed by Puddu et al. in the early 1990s.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The young patient with knee osteoarthritis (OA) presents a challenging treatment dilemma to the orthopedic surgeon. In the varus knee, delay of OA progression has been successfully performed with proximal tibial osteotomy; in the valgus knee, however, varus distal femoral osteotomy (VDFO) has usually had better results. VDFO is indicated in the physiologically young, active patient in whom conservative therapy for symptomatic lateral compartment arthritis in a stable knee without significant flexion deformity has failed. Meticulous preoperative planning is crucial and entails obtaining long-leg standing radiographs to determine the mechanical and anatomic axes. The medial closing wedge technique is the most common method of performing VDFO, although the lateral opening, dome osteotomy, and hemicallotasis techniques have all had their proponents. Proper pin placement is necessary to correctly make the osteotomy and to obtain the desired correction of deformity. The osteotomy is then stabilized with internal fixation, usually a 90° blade plate. Postoperative weight-bearing is generally delayed for 6–8 weeks. Complications can include nonunion, failure of fixation, infection, loss of correction, and acceleration of medial compartment arthritis. With proper selection and careful attention to detail, VDFO can be successful in delaying the need for total knee arthroplasty (TKA), and it has been associated with 71%–83% good/excellent Hospital for Special Surgery scores at 4–8-year follow-up.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Unicondylar knee arthroplasty (UKA) has seen a very significant revival in interest in the past 3–4 years in the United States. Results in the 1980s and 1990s were not very encouraging and the surgical procedure was almost abandoned. With the dawn of minimally invasive surgical (MIS) techniques, there is more interest in the procedure. The indications for the surgery have been clearly defined and the surgical technique has been significantly changed. UKA should not be performed as a total knee arthroplasty (TKA). The MIS approach is a limited one and the soft tissues must be managed so proper visualization and technique are still possible. Alignment and balancing are different because the surgery is performed on only one side of the knee. The knee must not be overcorrected and flexion and extension balancing must be established without significant ligament releases. The slope of the tibial cut and the distal femoral cut can be used to a certain extent to adjust the balance. The technique demands accuracy but it is not difficult to master. The early results of MIS UKA are very encouraging and mimic the published results of TKA and of UKA performed with open arthrotomy. The future of knee surgery will include more partial knee replacements and will certainly progress to MIS total knee replacement.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Techniques addressing the patellofemoral joint in total knee arthroplasty continue to evolve. Patellofemoral problems continue to represent common causes of patient complaints after knee replacement. Proper selection of implants and surgical technique is vital to restore patellofemoral biomechanics and prevent anterior knee pain. This article will focus on the surgical techniques useful in successful patellar resurfacing.

ISSN:1536-0636    

出版商:OVID    

年代:2002

数据来源: OVID