1/17. Hypertrophic dens resulting in cervical myelopathy: histologic features of the hypertrophic dens.STUDY DESIGN: A case report of a 43-year-old woman who had hypertrophic dens in the developmentally narrow atlas ring that resulted in cervical myelopathy. OBJECTIVES: To present histologic findings of the hypertrophic dens, which was excised en block the transoral approach, and to discuss the pathogenesis of the hypertrophic change of the dens. SUMMARY OF BACKGROUND DATA: Few cases have been reported of cervical myelopathy associated with hypertrophic dens, and there have been no previous reports describing the histologic features of hypertrophic dens. methods: Clinical data were reviewed from the patient's chart, and histologic features of the hypertrophic dens were examined in the sagittally cut section. RESULTS: After posterior decompression surgery, cervical myelopathy in the patient subsided. Myelopathy reappeared 4 years after surgery. Imaging studies showed osteoarthritis of the atlantodental joint, hypertrophic dens, and degeneration of the cruciate ligament. In the second surgery, transoral removal of the dens with posterior occipitocervical fusion was performed. Histologic studies showed thickening of the cortical bone of the anterior and cranial parts of the dens. The apical portion, which was the insertion portion of the ala ligaments, showed degenerative changes of tide marks. CONCLUSION: Atlantoaxial instability and enthesopathy were probably the causes of the hypertrophic changes of the dens in this case.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/17. Subcutaneous herniation of tendon interposition after trapeziectomy in three cases: explanation and implications.We report a complication following trapeziectomy and tendon interposition. Subcutaneous herniation of the tendon interposition occurred in 3 of 412 cases in which trapeziectomy, ligament reconstruction, and tendon interposition were performed. This herniation occurred posterolaterally in the early postoperative period and resulted in dorsal swelling and superficial pain. magnetic resonance imaging was helpful in confirming the diagnosis and excision of the herniated interposition material resulted in satisfactory pain relief and functional outcome as long as metacarpal stability was present.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
3/17. Posterior tibial subluxation and short-term arthritis resulting from failed posterior cruciate ligament reconstruction.Posterior tibial subluxations because of combined or isolated posterior cruciate ligament (PCL) injuries require detailed evaluation. PCL reconstructions are difficult procedures because of the low rate of such injuries and the complex anatomy of the ligament. We report on 2 cases of failed PCL reconstruction because of malpositioned femoral tunnels. These 2 cases support the existing biomechanical evidence that the correct placement of the tunnels, especially in the femur, is a major factor in defining the outcome. It seems that the drilling of the tunnels, especially in the femur, during PCL reconstruction must be performed with accuracy and always be evaluated in cases of graft failure. In addition, failed PCL reconstructions are usually accompanied by a short-term excessive arthritis that results in poor functional outcome.- - - - - - - - - - ranking = 3keywords = ligament (Clic here for more details about this article) |
4/17. Intracarpal synovitis related to Dacron interposition after trapeziectomy: a report of three cases.To prevent the mechanical consequences of trapeziectomy, interposition devices are promoted, such a Dacron spacer. We report three cases of osteolysis and synovitis related to the use of such a device. This phenomenon occurred 4 months after insertion and required revision surgery after 9 months of follow-up because of pain and extensive osteolysis of the carpal bones. Revision consisted of an extended synovectomy, removal of the broken Dacron followed by a ligamentoplasty using the Flexor Carpi Radialis. Two years after revision surgery the result was satisfactory, with no recurrence of pain or osteolysis. The Dacron device did not demonstrate improvement in clinical results after short-term follow-up when compared to conventional ligamentoplasty. We recommend cautious use of the Dacron device at trapeziectomy and attention must be paid to follow up of the patient.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/17. Bilateral arthroscopic tendon interposition arthroplasty of the thumb carpometacarpal joint in a patient with ehlers-danlos syndrome: a case report.A common finding in progressive osteoarthritis of the carpometacarpal joint of the thumb is ligamentous laxity. In patients with ehlers-danlos syndrome, which is a disorder characterized by generalized ligamentous laxity, splinting and arthrodesis have been recommended because of the random results achieved by other reconstructive procedures. We report a patient with thumb carpometacarpal joint osteoarthritis secondary to ehlers-danlos syndrome who was treated with bilateral arthroscopic tendon interposition arthroplasty.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/17. Arthroscopically assisted reduction and percutaneous fixation of dorsal perilunate dislocations and fracture-dislocations.Perilunate injuries are severe disruptions of the wrist joint that produce variable patterns of injury to the carpal anatomy. Most surgeons advocate an open reduction followed by ligament repair or internal fixation. We tried to reduce and fix the carpal bones under arthroscopic control to minimize surgical trauma and to preserve blood supply. While viewing the articular surface with the arthroscope, the disrupted proximal carpal row was anatomically reduced using Kirschner wires as joysticks, and fixed percutaneously without any repair of the capsuloligamentous tears. Three patients with dorsal perilunate dislocations or fracture-dislocations were treated by this technique. All the patients achieved accurate reduction and stable fixation, and showed successful healing of the carpal fractures with proper alignment after 10 to 12 weeks of immobilization. At 16 to 22 months follow-up, all patients showed normal radiographic findings with no evidence of instability or arthritis. The arthroscopic treatment of acute dorsal perilunate injuries is technically feasible in achieving anatomic reduction and stable fixation. Our preliminary clinical results were encouraging, but the long-term results need to be observed.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
7/17. Anteromedial osteoarthritis of the knee.Medial tibial plateaux excised during 46 unicompartmental arthroplasties for osteoarthritis were collected and photographed. The anterior cruciate ligament was intact in all joints. In every case the cartilage and bone erosion was centred anteriorly on the plateau and the posterior cartilage was intact. The site of the lesion and the intact state of the cruciate ligaments taken together explain why varus deformity was observed only in the extended knee, and why the deformity was correctable and had not become fixed. Failure of the anterior cruciate ligament may allow the erosion to extend posteriorly, producing fixed varus deformity and leading to degeneration of the lateral compartment. Anteromedial osteoarthritis is a distinct clinicopathological entity; its radiographic features enable it to be diagnosed from lateral radiographs; its anatomical features render it suitable for treatment by unicompartmental arthroplasty.- - - - - - - - - - ranking = 1.5keywords = ligament (Clic here for more details about this article) |
8/17. The importance of the meniscus in unstable knees. A comparative study.This study analyzes differences in knee function in ACL deficient knees with different meniscus status. Eighty patients, 12 women and 68 men, were matched in four groups according to sex, age, knee injuries, and follow-up time. Group I had two intact menisci; Group II, one meniscus successfully repaired; Group III, one meniscus removed; and Group IV, both menisci removed. The ACL was repaired acutely or reconstructed later in most cases and other significant ligament injuries were treated. All patients were reexamined clinically 6 to 8 years after injury. Knee function was recorded using the Lysholm knee function score. Activity level before injury and at followup was rated with the Tegner scale. Stability was tested and weightbearing roentgenograms were taken. There was a higher frequency of ACL reconstructions in Groups I and II, but instability was the same in all groups. No difference was found in Lysholm score (range, 86 to 92). The activity level was higher in Group IV at followup. A lower frequency of motion impairment was found in Group III, (20% versus 50%). Subjective evaluation was similar and positive in all groups. Group I had six meniscus ruptures during the follow-up period. In Group II three of the repaired menisci were removed, as were two of the contralateral menisci in Group III. Roentgenograms, available in 55 of 80 cases, showed osteoarthritis in 65%. There were no differences in the frequency of osteoarthritis among the first three groups, but Group IV had a higher incidence of osteoarthritic changes. osteoarthritis did not result in lower knee function, poorer subjective evaluation, or increased impairment of motion.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
9/17. Nonconstrained total elbow arthroplasty.Thirty capitellocondylar unhinged implant arthroplasties were performed on 27 patients during the period from October 1976 through June 1981. The average patient age was 59.4 years, with a preoperative diagnosis of rheumatoid arthritis in 28 elbows and osteoarthritis in two elbows. Follow-up periods averaged 39.9 months (range, 10-62 months). The indication for elbow arthroplasty were intractable pain, joint instability, failed synovectomy, or bilateral limitation of motion. Ranged of motion evaluations showed moderate increases in flexion, pronation and supination after operation, although there was no significant improvement in extension. Ewald functional evaluation scores improved significantly from the mean of eight points prior to operation to the postoperative mean of 85 points. The significant complications occurring were deep wound infections, necessitating removal of the prosthesis (6.6%), and subluxation (13.2%), which responded to conservative treatment by long-arm casting. One patient required reconstruction of the medial collateral ligament for subluxation. ulnar nerve paresthesia developed in 10% of the patients. One patient required neurolysis and transposition of the nerve for relief of symptoms. The posterolateral approach was adopted to reduce the incidence of ulnar nerve complications.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
10/17. Combined Coventry-Maquet tibial osteotomy: preliminary report of two cases.When both the medial and patellofemoral compartments of the knee joint are involved with osteoarthritis, combining the Coventry high tibial osteotomy with the Maquet tibial tubercle advancement in one single operation has the following advantages: only one incision is necessary; no donor site is needed; and the sagittal alignment of the tibial shaft with the tibial plateau is preserved, which allows a better contact of the cut surfaces and better biomechanical stability. Modified techniques provide for medial displacement of the patellar ligament and may reduce the risk of ischemic necrosis.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
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