ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Articular cartilage does not heal when injured. There are many procedures that can be used to treat symptomatic articular cartilage defects. This article describes each surgical technique, the rehabilitation necessary after the procedure, and the recent clinical results.

ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Deformity of the knee can result from ligament imbalance, abnormal bone architecture, or a combination of these. The valgus knee offers a unique presentation of these problems, and arthroplasty surgery requires meticulous preoperative planning to restore proper alignment, component positioning, and joint stability. Particular points requiring address include lateral femoral condyle hypoplasia and tibial plateau deficiency secondary to developmental abnormality or wear, the sequential release of the lateral structures, balanced for flexion and extension, and the possibility of medial collateral ligament laxity. Understanding these factors will prevent postoperative complications and enhance the knee arthroplasty stability and durability.

ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The patellofemoral joint presents a complex challenge to the surgeon. There are many surgical options for treatment, but none is universally successful in all cases. Tibial tubercle osteotomy has a long history in the distal approach to treating patellar problems. The current approach to the patellofemoral joint continues to evolve. Previous standard measurements and treatments are being re-examined, and with this, the role of moving the tubercle in the treatment of patellar pain and/or instability. Present techniques attempt to optimize joint stability and contact area without increasing articular cartilage stress.

ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Correct placement of the tibial and femoral tunnels is critical to the success of any anterior cruciate ligament reconstruction. Three characteristics of correctly placed tunnels are reviewed, including prevention of graft impingement against the intercondylar roof during extension, prevention of graft impingement against the posterior cruciate ligament during flexion, and replication of the tension pattern of the intact anterior cruciate ligament. The transtibial technique, in which the tibial tunnel is positioned and drilled first and then the femoral tunnel is positioned and drilled through the tibial tunnel, is the focus of this paper. The importance of correctly placing the tibial tunnel in the sagittal and coronal planes is emphasized for two reasons: (1) the placement of the tibial tunnel in the sagittal plane determines whether there is roof impingement, and (2) the placement of the tibial tunnel in the coronal plane controls the placement of the femoral tunnel, which determines whether there is posterior cruciate ligament impingement and high graft tension. The development and step-by-step use of a tibial and femoral guide system designed for use with the transtibial technique is presented. The indications, contraindications, and clinical results using this guide system and the shortcomings of the point-and-shoot and posterior cruciate ligament referencing guides are discussed.

ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The following article outlines the historical perspective, indications, and operative technique for reconstruction of the posterolateral corner knee. We prefer a fibular-based reconstruction utilizing a semitendinosus autograft to reconstruct the stabilizing structures of the posterolateral corner. Although the anatomy of the posterolateral corner is complex, we believe that reconstituting the lateral collateral ligament and the popliteus-popliteofibular complex effectively restores the varus and rotational stability afforded by the posterolateral corner. Advantages to this technique include the limited dissection and decreased surgical time compared to other procedures. In addition, the procedure does not significantly disrupt the anatomy of the posterolateral corner, and hence can be used to augment a primary repair of the posterolateral structures.

ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Although less frequently injured than the anterior cruciate ligament, the posterior cruciate ligament (PCL) is commonly ruptured during motor vehicle accidents and athletic competition. The PCL prevents posterior translation of the tibia in flexion, and a deficiency of this ligament has been associated with symptoms of pain, instability, and early degenerative changes in the knee. As the morbidity resulting from PCL tears has become better recognized, the number of indications for ligament reconstruction has also increased. When operative intervention is elected, we recommend the tibial inlay method for PCL reconstruction. This reconstructive technique effectively decreases anterior to posterior laxity in the knee by reproducing anatomically the essential anterolateral bundle of the PCL. Other PCL reconstructions, such as the transtibial tunnel technique, are associated with early graft failure, presumably due to graft degradation at the “killer turn.” Because the aggressive treatment of PCL injuries is a relatively new occurrence, there is a limited volume of data regarding long-term outcomes. This article describes and illustrates the evaluation of PCL injuries and the tibial inlay procedure, reviews the relevant studies, and discusses the future of PCL reconstruction.

ISSN:1536-0636    

出版商:OVID    

年代:2003

数据来源: OVID