Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. The results at seven years.
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Deficiency of the anterior cruciate ligament (ACL) is a common disorder which can lead to changes in lifestyle. We followed 59 patients who had had arthroscopic reconstruction of the ACL using a central-third patellar-tendon autograft for seven years to assess the long-term effectiveness of recent advances in reconstruction of the ACL. The standard criteria for evaluation of the International Knee Documentation Committee, the Lysholm knee score and measurements using the KT 1000 arthrometer all showed satisfactory results. Deterioration in the clinical performance after seven years was associated with osteoarthritic changes and correlated with chronic ligament injuries and meniscectomy. There were three traumatic and three spontaneous ruptures. We believe that the procedure can be successful, but remain concerned about failure of the graft and osteoarthritis. The results raise questions about the best time to operate and suggest that early surgery may reduce the risk of osteoarthritis. (+info)
The length of the patellar tendon after unicompartmental and total knee replacement.
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Patella infera may occur after reconstruction of the anterior cruciate ligament (ACL), high tibial osteotomy and total knee replacement (TKR). Restriction of movement of the knee and pain may result. Our aim was to compare the incidence and to assess the effects of patella infera after TKR and unicompartmental knee replacement (UKR). We reviewed radiographs of the knees of 84 patients who had had either TKR or UKR as part of a randomised, controlled trial The length of the patellar tendon was measured on serial radiographs taken before, at eight months and at five years after operation. There was no significant change in the length of the patellar tendon after UKR, but a significant reduction was observed after TKR. Five years after the operation, the shortening of the tendon had increased to a mean of 3.5 mm. Of the knees with TKR reviewed at five years, 34% developed patella infera, defined as 10% or more of shortening, compared with 5% of those with UKR. Shortening was greatest in those knees which had required a lateral release; in this subgroup the mean shortening was 7.2 mm. Shortening correlated with restriction of movement and pain in the knee. Our study has shown that patella infera develops in most patients after TKR with lateral release, and in approximately 25% of patients after TKR without this additional procedure. Patella infera rarely occurs after UKR. It is associated with restriction of movement and pain in the knee. It may be an effect of the more extensive exposure required to perform TKR and may, in part, explain the better clinical results of UKR. (+info)
The connective-tissue envelope in revascularisation of patellar tendon grafts.
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Free patellar tendon grafts used for the intra-articular replacement of ruptured anterior cruciate ligaments (ACL) lack perfusion at the time of implantation. The central core of the graft undergoes a process of ischaemic necrosis which may result in failure. Early reperfusion of the graft may diminish the extent of this process. We assessed the role of peritendinous connective tissue in the revascularisation of the patellar tendon graft from the day of implantation up to 24 days in a murine model using intravital microscopy. The peritendinous connective-tissue envelope of the graft was either completely removed, partially removed or not stripped before implantation into dorsal skinfold chambers of recipient mice. Initial revascularisation of the grafts with preserved peritendinous connective tissues began after two days. The process was delayed by five to six times in completely stripped patellar tendons (p < 0.05). Only grafts with preserved connective tissues showed high viability whereas those which were completely stripped appeared to be subvital. The presence of peritendinous connective tissues accelerates the revascularisation of free patellar tendon grafts. (+info)
Patellofemoral pain syndrome: a review and guidelines for treatment.
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Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment. Contributing factors include overuse and overload of the patellofemoral joint, biomechanical problems and muscular dysfunction. The initial treatment plan should include quadriceps strengthening and temporary activity modification. Additional exercises may be incorporated as dictated by the findings of the physical examination. Footwear should be closely evaluated for quality and fit, and the use of arch supports should be considered. (+info)
Bone-patellar tendon-bone reconstruction of the anterior cruciate ligament. A long-term comparison of early and late repair.
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Ninety-one patients were assessed 5-9 years after an anterior cruciate ligament reconstruction (bone patella-tendon bone autograft). Forty-eight patients had been treated within 6 weeks of the injury (Group I) and 43 patients more than 3 months after the injury (Group II). 73 patients had either a normal or nearly normal final outcome. The mean Lysholm score was 82 and the mean Marshall score was 42. Eighty nine patients had normal or nearly normal stability in the operated knee when compared to the contralateral joint. In none of these results was there any significant difference between the groups. Results of functional and of isokinetic strength tests, as well as the presence of anterior knee pain, were also similar in both groups. However, patients with early reconstruction had fewer degenerative changes in the tibio-femoral joint and were more satisfied with the result. They also returned to their pre-injury level of sports activity more often than those patients in the late reconstruction group. (+info)
Technical evolution of arthoscopic knee surgery.
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The widespread growth of arthroscopic techniques and their use has dramatically changed the practice of orthopaedic surgery. A high degree of clinical accuracy and minimally invasive procedure with a low surgical morbidity have encouraged the use of arthroscopy to assist in diagnosis, to determine prognosis and to provide treatment. In particular, the knee is the proper joint in which arthroscopy has its diagnostic and intraarticular surgical application. The rapid advancement of arthroscopic techniques has demonstrated a variety of surgical techniques in procedures such as meniscectomy, meniscal repair and cruciate ligament reconstruction during the last decade. This article reviews the past history of arthroscopy and technical evolution of arthroscopy in knee surgery in our department. (+info)
A case for partial patellectomy.
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The treatment of fractures of the the patella is a subject of controversy. Partial patellectomy with retention of a major fragment and suture of the quadriceps to it, seems reasonable. 18 cases of patella fracture underwent such a procedure. The average age of the patients was 47 years. Maximum recovery took an average of 5 months. There were 6 excellent results, 9 good, 3 fair. Results were assessed on the basis of pain, muscle wasting, quadriceps power, and range of knee motion. Total patellectomy and patella fixation as alternative modes of treatment are discussed. Partial patellectomy, whenever possible, is a good choice. (+info)
Comparison of patellar resurfacing versus nonresurfacing in total knee arthroplasty.
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OBJECTIVES: To determine whether resurfacing the patellar component during total knee replacement (TKR) influences the clinical outcome. DESIGN: A retrospective study of data gathered prospectively during the recovery course of patients who underwent TKR with or without patellar resurfacing. SETTING: Victoria General Hospital, Halifax, NS. PATIENTS: One hundred and eighty-five patients operated on between 1992 and 1995. The inclusion criteria were (a) osteoarthritis, (b) replacement carried out by 2 independent surgeons, (c) no comorbid illness such as rheumatoid arthritis, cancer or infection, (d) pre- and postoperative attendance at the assessment clinics. INTERVENTION: TKR with (45) or without (140) patellar replacement. MAIN OUTCOME MEASURES: Range of motion (ROM), pain assessment, Hospital Severity Score (HSS) and complications. RESULTS: There was no statistical difference between the 2 groups with respect to ROM, pain, HSS and complications postoperatively. CONCLUSIONS: Resurfacing the patella during TKR does not seem to influence the clinical outcome with respect to ROM, pain and overall complications. The decision should be based on individual criteria, depending on the preoperative and intraoperative findings. Randomized clinical trials assessing ROM, pain, complications and cost-effectiveness with long-term follow-up are necessary to further investigate this controversial issue. (+info)