Reconstruction of the anterior cruciate ligament: comparison of outside-in and all-inside techniques.
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The aim of this prospective study was to compare two arthroscopic techniques for reconstructing the anterior cruciate ligament, the "outside-in" (two incisions) and the "all-inside" (one incision) techniques. The results obtained for 30 patients operated on using the "outside-in" technique (group I) were compared with those for 29 patients operated on using the "all-inside" technique (group II). Before surgery, there were no significant differences between the groups in terms of Lysholm score, Tegner activity level, patellofemoral pain score, or knee laxity. Both groups displayed significant improvements in Lysholm score after 24 months, from 69 (16) to 91 (9) in group I and from 70 (17) to 90 (15) in group II (means (SD)). There were also significant improvements in patellofemoral pain scores in both groups, from 13 (6) to 18 (5) in group I and from 14 (6) to 18 (4) in group II after 24 months. No difference was found between the groups in knee stability at the 24 month follow up. The IKDC score was identical in both groups at follow up. The operation took significantly longer for patients in group I (mean 94 (15)) than for those in group II (mean 86 (20)) (p = 0.03). The mean sick leave was 7.7 (6.2) weeks in group I and 12.3 (9.7) weeks in group II (p = 0.026), indicating that there may be a higher morbidity associated with the "all-inside" technique. It can be concluded that there were no significant differences between the two different techniques in terms of functional results, knee laxity, or postoperative complications. The results were satisfactory and the outcome was similar in both treatment groups. (+info)
Extensive post-traumatic ossification of the patellar tendon. A report of two cases.
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Two men, aged 21 and 50 years, were seen with ossification of the patellar tendon after injury to the knee in adolescence. They complained of pain and had patella alta. Large bony masses were excised from below the affected patellae. The patellar tendon was then reconstructed using a Leeds-Keio ligament. The results at six and ten years, respectively, were good, with neither patient having pain or an extension lag. (+info)
Changes in joint cartilage aggrecan after knee injury and in osteoarthritis.
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OBJECTIVE: To determine the concentrations of aggrecan fragments in synovial fluid from patients with knee joint injury, osteoarthritis (OA), or acute pyrophosphate arthritis (PPA; pseudogout), and to test their relative reactivity with the 846 epitope, a putative marker of cartilage aggrecan synthesis. METHODS: Samples of knee joint fluid from 385 patients and 9 healthy-knee volunteers were obtained in a cross-sectional study. Study groups were acute PPA/ pseudogout (n = 60), anterior cruciate ligament (ACL) rupture (n = 159), meniscus lesion (n = 129), and primary knee OA (n = 37). The 846 epitope on aggrecan was assayed by competitive solution-phase radioimmunoassay. Aggrecan fragments were assayed by enzyme-linked immunosorbent assay using a monoclonal antibody (1-F21). Cartilage oligomeric matrix protein (COMP), C-propeptide of type II collagen (CPII), bone sialoprotein, matrix metalloproteinases 1 and 3, and tissue inhibitor of metalloproteinases 1 were previously quantified by immunoassays. RESULTS: Reactivity of the 846 epitope was increased in all study groups compared with the reference group, and was highest in patients with primary OA. The median levels (in microg fetal aggrecan equivalents/ml) of the epitope were 0.28 (range 0.24-0.47) in the reference group, 0.48 (range 0.26-1.32) in PPA/pseudogout, 0.61 (range 0.12-2.87) in ACL rupture, 0.53 (range 0.22-3.02) in meniscus lesion, and 0.68 (range 0.31-4.31) in primary OA. The 846 epitope reactivity per microg aggrecan fragments in the joint fluid was higher in late-stage OA than in early-stage OA. Epitope 846 reactivity correlated positively with several markers of matrix turnover, particularly with COMP (r(s) = 0.421) and CPII (r(s) = 0.307). CONCLUSION: The observed differences in 846 epitope reactivity in synovial fluid, and its concentration in relation to aggrecan and other markers of matrix turnover, were consistent with marked ongoing changes in aggrecan turnover after joint injury and in the development of OA. OA is thus a disease characterized by dynamic changes in tissue macromolecule turnover, which is reflected by measurable changes in aggrecan epitopes in the synovial fluid. (+info)
Common peroneal nerve palsy: a clinical and electrophysiological review.
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In a series of 70 patients (75 cases of common peroneal nerve palsy) the common causes were trauma about the knee or about the hip, compression, and underlying neuropathy. A few palsies occurred spontaneously for no apparent reason. The prognosis was uniformly good in the compression group; recovery was delayed but usually satisfactory in patients who had suffered stretch injuries. In the acute stage, when clinical paralysis appears to be complete, electrophysiological studies are a useful guide to prognosis. They may also indicate an underlying neuropathy and they detect early evidence of recovery. The anatomical peculiarities of the common peroneal nerve are noted and aspects of the clinical picture, management, and prognosis of palsy are discussed. (+info)
The locked patella. An unusual complication of haemophilia.
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Mechanical derangements of the knee are an uncommon complication of chronic haemophiliac arthropathy. Two patients with locking of the patella were treated by manipulation. The mechanism of the injury was forced flexion of the knee joint beyond the limit of its restricted range. The injury is a serious one and may take six months to recover. (+info)
Mucoid cystic degeneration of the cruciate ligament.
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A 35-year-old man was seen with pain in the back of the knee. MRI showed a mass in the anterior cruciate ligament. Biopsy indicated mucoid degeneration. Arthroscopic resection of the ligament was carried out, with relief of symptoms. (+info)
WOMAC Osteoarthritis Index--additional dimensions for use in subjects with post-traumatic osteoarthritis of the knee. Western Ontario and MacMaster Universities.
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OBJECTIVE: To compare the sensitivity of WOMAC and the two added dimensions Sport and Recreation Function and Knee Related Quality of Life in subjects with radiographic knee OA to that in controls. To study the influence of age on the reported outcomes. DESIGN: Outcomes were compared between subjects having had meniscectomy 21 years ago and which at time of follow-up had definite radiographic OA (N=41, mean age 57), and age- and sex-matched controls without radiographic OA (N=50, mean age 53). For the purpose of studying the impact of age, the groups were divided in two age groups, younger and older than 50 years, respectively. Close to 50% of both groups reported current physical activity levels of at least recreational golf, dancing, hiking, etc. Symptoms and function were assessed by WOMAC Osteoarthritis Index and the added dimensions Sport and Recreational Function (Sport/Rec) and Knee Related Quality of Life (QOL). A percentage score was calculated, 0 indicating extreme knee problems and 100 indicating no knee problems. RESULTS: The control group had mean scores of 88-98 for the different dimensions. The OA group scored significantly lower in all dimensions (P< 0.0001). The most discriminative dimensions in both age groups were Sport/Rec and QOL with mean scores of 52 and 59 (ranges 0-100). CONCLUSION: The dimensions Sport and Recreation Function, and Knee Related QOL were highly sensitive and discriminant outcomes in both age groups and should be assessed in addition to WOMAC in subjects with post-traumatic osteoarthritis of the knee. (+info)
Knee pain and the infrapatellar branch of the saphenous nerve.
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Pain over the front of the knee is common after surgery or trauma but often a definite diagnosis is difficult to make. Over the past year we have seen five cases in which the pain could be ascribed to damage to a branch of the infrapatellar branch of the saphenous nerve. Two were subsequent to trauma and three to surgical procedures. In all five cases surgical exploration gave symptomatic relief. Eight cadaveric knees were prosected to explore further the anatomy of this nerve in relation to the injuries. Injury to one of these branches should be considered in cases of persistent anterior, anteromedial or anterolateral knee pain or neurological symptoms following surgery or trauma. (+info)