1/246. Three cases of patella fracture in 1,320 anterior cruciate ligament reconstructions with bone-patellar tendon-bone autograft.Between September 1992 and December 1996 we reviewed three transverse displaced fractures of the patella occuring in 1,320 ACL reconstructions using bone-patellar tendon-bone autograft. All the patients suffered local injury to the donor knee between 8 and 12 weeks postoperatively. Immediate rigid fixation using single or double anterior tension band allowed early mobilization and full weight bearing. Between 6 and 9 months after fracture, the screws and the wire were removed and the grafts tested. Results of the pivot shift and Lachman test under anesthesia were negative and arthroscopic visualisation showed the graft to be intact. Postoperative assessment included the Lysholm and Tegner scales, the International Knee documentation Committee Evaluation form (IKDC), KT-1000 arthrometer, and isokinetic dynamometer strength testing. No significant differences in the final outcome were noted between reconstructions complicated by patellar fracture and normal ACL reconstructions.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/246. Extensive post-traumatic ossification of the patellar tendon. A report of two cases.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.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
3/246. Transient peroneal nerve palsies from injuries placed in traction splints.Two patients thought to have distal femur fractures presented to the emergency department (ED) of a level 1 trauma center with traction splints applied to their lower extremities. Both patients had varying degrees of peroneal nerve palsies. Neither patient sustained a fracture, but both had a lateral collateral ligament injury and one an associated anterior cruciate ligament tear. One patient had a sensory and motor block, while the other had loss of sensation on the dorsum of his foot. After removal of the traction splint both regained peroneal nerve function within 6 hours. Although assessment of ligamentous knee injuries are not a priority in the trauma setting, clinicians should be aware of this possible complication in a patient with a lateral soft tissue injury to the knee who is placed in a traction splint that is not indicated for immobilization of this type of injury.- - - - - - - - - - ranking = 3.0069071754806keywords = injury, nerve (Clic here for more details about this article) |
4/246. Distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella. A case report and an experimental study.A 12-year-old boy presented with a proximally retracted patella 5 months after an injury to the left knee. The clinical and radiographic features and the findings at operation led to the conclusion that the original lesion had been a distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella, produced by the medial and lateral longitudinal patellar retinacula. Loading experiments on amputation and cadaver specimens showed that these retinacula, apart from being tendons for the vastus medialis and the vastus lateralis, respectively, constitute a direct fibrous connection of considerable strength between the patella and the tibia and thus are capable of producing avulsion fractures.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
5/246. The locked patella. An unusual complication of haemophilia.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.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
6/246. Isolated posterior cruciate ligament insufficiency induces morphological changes of anterior cruciate ligament collagen fibrils.We studied the ultrastructural changes of the human anterior cruciate ligament (ACL) with transmission electron micrograph cross-sections following isolated posterior cruciate ligament (PCL) injury. biopsy specimens were obtained from the proximal third and anteromedial aspect of the ACL. Fourteen patients with PCL-deficient knees at a mean of 22.1 months from injury to surgery and 5 normal knees amputated secondary to malignant tumors or traumatic injuries were used as controls. A significant difference was found in the number of collagen fibrils per 1 microm2 between the PCL-deficient knee group and the control group. There was a significant difference found in the collagen fibril diameter between the PCL-deficient knee group and the control group. The collagen packing density (the percentage of sampled area occupied by collagen fibrils) was also significantly different between the PCL-deficient knee and the control group. The current study shows that an isolated PCL insufficiency can induce morphological changes in ACL collagen fibrils, suggesting that a PCL insufficiency can have adverse effects on other ligamentous structures in the knee joint.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
7/246. rehabilitation program for both knees when the contralateral autogenous patellar tendon graft is used for primary anterior cruciate ligament reconstruction: a case study.STUDY DESIGN: Case study of a basketball player who underwent an alternative surgical procedure for anterior (cruciate ligament (ACL) reconstruction and outline of the rehabilitation process designed for this procedure. OBJECTIVES: To describe the surgical procedure, detail the rehabilitation program, and report on this patient's clinical outcome. BACKGROUND: Anterior cruciate ligament injury, its treatment, and rehabilitation continue to be an area of interest to both clinicians and researchers. Surgical procedures have been refined and rehabilitation programs are constantly being evaluated and updated to allow the safest and most predictable return to activity. Currently, the autogenous bone-patellar tendon-bone graft is the graft of choice for ACL reconstruction. Typically the graft is taken from the ipsilateral knee. An alternative procedure is to take the graft from the contralateral, noninvolved knee, allowing 2 separate rehabilitation programs to take place. methods AND MEASURES: The patient was followed from the time of injury to 2 years postoperatively. Data collected included range of motion, isokinetic strength scores, ligament stability scores, subjective evaluation, and functional measures. RESULTS: At 3 weeks postoperative the patient had nearly full range of motion in both knees, normal gait, and was beginning sport-specific drills. He was shooting the basketball and jumping by 5 weeks and returned to competitive sports 6 weeks after surgery. He was able to play in all 32 games of the season, starting in 23 of them. CONCLUSIONS: Using the contralateral patellar tendon graft may be appropriate for primary ACL reconstruction of patients, particularly those desiring an early expedient return to athletic competition.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
8/246. Knee pain and the infrapatellar branch of the saphenous nerve.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.- - - - - - - - - - ranking = 0.0069071754805623keywords = nerve (Clic here for more details about this article) |
9/246. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome.The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations.- - - - - - - - - - ranking = 0.001151195913427keywords = nerve (Clic here for more details about this article) |
10/246. Common peroneal nerve palsy following knee arthroscopy.We report the case of a 43-year-old woman who underwent knee arthroscopy. Postoperatively, she developed a lesion of the common peroneal nerve, which was confirmed by neurophysiological studies. Exploration showed the nerve to be in continuity and externally undamaged. At review 17 months later, there was incomplete recovery. We believe this lesion was caused by a traction injury related to patient positioning, which has not been reported previously.- - - - - - - - - - ranking = 1.0069071754806keywords = injury, nerve (Clic here for more details about this article) |
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