Cases reported "Joint Diseases"

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1/32. reflex extension loss after anterior cruciate ligament reconstruction due to femoral "high noon" graft placement.

    We describe a rare case of a painful reflex extension loss due to femoral malplacement of an anterior cruciate ligament (ACL) graft in a female high-level athlete. The graft was placed on the femoral site in the "high noon" position combined with a slight medial tibial tunnel placement. The resulting anterior-posterior cruciate ligament impingement near extension caused a persistent functional extension deficit of 20 degrees. Under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a proprioceptive reflex leading to a functional extension loss while the patient is awake. After sacrifice of the graft and subsequent replacement of the ACL, full range of motion was achieved within 2 months. After a 3-year postinjury history of 3 arthroscopies and 2 ACL reconstructions, the athlete reached her preinjury activity level again. This rare cause of a reflex extension loss due to femoral high noon graft placement has not been described previously and should be included as a differential diagnosis when evaluating patients with an extension deficit after ACL reconstruction.
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ranking = 1
keywords = tibia
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2/32. Coxa saltans externa treated with Z-plasty of the iliotibial tract in a military population.

    Coxa saltans, or snapping hip, can be attributable to a number of causes. Coxa saltans externa typically occurs when the thickened portion of the iliotibial band snaps over the greater trochanter as the hip is flexed. This condition generally resolves with a course of nonoperative treatment. We have treated three patients with Z-plasty of the iliotibial band, which has the highest published success rate in the English language literature. Only one of three patients was able to return to full activities postoperatively. In our small series, this method of surgical treatment in an active duty military population yielded less than optimal results.
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ranking = 6
keywords = tibia
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3/32. A new consideration in athletic injuries. The classical ballet dancer.

    The professional ballet dancer presents all of the problems of any vigorous athlete. The problems include osteochondral fractures, fatigue fractures, sprains, chronic ligamentous instability of the knee, meniscal tears, impingement syndrome, degenerative arthritis of multiple joints and low back pain. attention to minor problems with sound conservative therapy can avoid many major developments and lost hours. Observations included the extraordinary external rotation of at the hip without demonstrable alteration in the hip version angle and hypertrophy of the femur, tibia and particularly the second metatarsal (in female dancers). Careful evaluation of the range of motion of the extremities, serial roentgenographic examination, and systematic review of previous injuries, training programs and rehearsal techniques have been evaluated in a series of cases to provide the basis for advice to directors and teachers of the ballet.
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ranking = 1
keywords = tibia
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4/32. Heterotopic ossification in children with burns: two case reports.

    Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.
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ranking = 1
keywords = tibia
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5/32. Fracture of the polyethylene tibial post in a posterior cruciate-substituting total knee arthroplasty mimicking patellar clunk syndrome: a report of 5 cases.

    Fracture of the tibial post in posterior cruciate-substituting total knee arthroplasty has been described in several reports. Additionally, wear of the cam and post mechanism, including polyethylene debris generation and osteolysis of the peri-implant bone stock as been described. Users of a cam and post type posterior stabilized total knee arthroplasty are also familiar with the rare occurrence of the "patellar clunk syndrome," in which suprapatellar fibrous nodular scar tissue becomes entrapped in the intercondylar box of the femoral component as the knee extends from the flexed position and produces a palpable and sometimes audible "clunk." This condition is easily managed with arthroscopic excision of the scar tissue. A small series of 5 patients who presented with symptoms of a patellar clunk syndrome but who in fact had a fracture of the tibial post causing subluxation of the femur on the tibia is presented. The diagnostic characteristics that will help differentiate between the 2 problems is highlighted.
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ranking = 7
keywords = tibia
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6/32. lipoma arborescens of the knee.

    lipoma arborescens are rare lesions, typically located in the knee. They have a predilection for the suprapatellar pouch in the knee joint, but can also occur in any area of the knee joint. magnetic resonance imaging of lipoma arborescens often reveals subchondral bone cyst and/or bone erosions, and there may appear to be a correlation between lipoma arborescens and osteoarthritis. We describe a case of histologically proven lipoma arborescens in the suprapatellar pouch and infrapatellar area of the knee with no damage to the posterior compartment and bone erosion in the proximal tibia without osteoarthritis.
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ranking = 1
keywords = tibia
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7/32. Reconstruction of the chronically failed deltoid ligament: a new technique.

    BACKGROUND: Chronic deltoid ligament insufficiency that results in valgus tilt of the talus within the ankle mortise (stage IV adult acquired flatfoot) represents a difficult and so far unsolved problem in foot and ankle surgery. If left uncorrected, the deltoid failure with malalignment predisposes to early ankle arthritis and the need for ankle arthrodesis or possibly ankle arthroplasty. methods: Five consecutive patients with deltoid ligament insufficiency resulting in a valgus tilt were treated with a deltoid reconstruction. Reconstruction of the deltoid ligament was done by passing a peroneus longus tendon graft through a bone tunnel in the talus from lateral to medial and then through a second tunnel from the tip of the medial malleolus to the lateral tibia. RESULTS: At a minimum 2-year followup, all patients had correction of the talar tilt. One patient had 9 degrees of valgus tilt remaining compared to 15 degrees preoperatively, and the procedure was considered a failure. The remaining four patients had correction of the valgus tilt to 4 degrees or less. CONCLUSION: Although not uniformly successful, deltoid ligament reconstruction using a tendon graft through appropriate bone tunnels can reconstruct the deltoid ligament and correct the valgus talar tilt. Successful results were achieved when combined with correction of flatfoot deformity, which is considered a necessary part of the procedure.
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ranking = 1
keywords = tibia
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8/32. A homozygous mutation in the lamin A/C gene associated with a novel syndrome of arthropathy, tendinous calcinosis, and progeroid features.

    CONTEXT: Mutations in the lamin A/C (LMNA) gene have been reported in a wide variety of disorders, including lipodystrophies, cardiomyopathy, muscular dystrophies, neuropathy, mandibuloacral dysplasia, restrictive dermopathy, and progeria. OBJECTIVE: The objective of this study was to carry out mutational analysis of LMNA in a patient with a novel syndrome of arthropathy, tendinous calcinosis, and progeroid features. DESIGN: The study design was a descriptive case report. SETTING: The study was performed at a referral center. PATIENT: A 44-yr-old male of European descent with an autosomal recessive arthropathy syndrome affecting predominantly the distal femora and proximal tibia in the knee with tendinous calcifications was studied. He also had progeroid features, such as pinched nose and micrognathia, cataract, alopecia, generalized lipodystrophy, and sclerodermatous skin. MAIN OUTCOME MEASURES: The main outcome measures were mutational analysis of lamin A/C (LMNA) and its processing enzyme, zinc metalloproteinase (ZMPSTE24), as candidate genes. RESULTS: We found a homozygous nucleotide substitution, 1718C>T, in exon 11 of the LMNA gene, resulting in substitution of a well-conserved residue serine at position 573 with leucine (S573L). This missense mutation only affects lamin A, not lamin C, because the alternative splicing site is located in exon 10. Immunofluorescence staining of the nuclei from his skin fibroblasts showed occasional misshapen morphology. CONCLUSIONS: The S573L homozygous LMNA mutation is associated with a novel phenotype of arthropathy, tendinous calcifications, and progeroid features distinct from the acroosteolysis previously reported in patients with mandibuloacral dysplasia caused by LMNA or ZMPSTE24 mutations. Thus, arthropathy with tendinous calcifications can be added to the growing list of disorders associated with LMNA mutations.
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ranking = 1
keywords = tibia
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9/32. Arthroscopic excision of the talar Stieda's process.

    One of the causes of posterior ankle pain is posterior impingement syndrome. When the talar lateral process is long, in which case it is called Stieda's process, it may be impinged between the tibia and calcaneus. We report the case of a 19-year-old patient who complained of posterior ankle pain and was diagnosed with posterior impingement of Stieda's process. He failed to respond to conservative treatment and thus underwent arthroscopic excision. The ankle was approached through standard posterior lateral and trans-Achilles portals. A 4.5-mm diameter 30 degrees arthroscope was used. Soft tissues around the talus were cleared with the help of a motorized shaver; after this, the posterior aspect of the subtalar joint could be visualized. The Stieda's process was seen to impinge between the tibia and the calcaneus in forced plantar flexion. The talar process was removed with a burr until the impingement disappeared. The patient returned to contact sports 8 weeks after surgery. Arthroscopic excision of the lateral process of the talus can be accomplished easily and return to sports is achieved in a relatively short time.
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ranking = 2
keywords = tibia
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10/32. Patellar impingement against the tibial component after total knee arthroplasty.

    patella baja developed in seven knees in five patients after posterior stabilized total knee arthroplasties when the patella became impinged against the tibial component. Patellar replacement was performed in four knees, and all patients were able to achieve deep flexion postoperatively. The mean followup was 50 months (range, 24-73 months) for these patients. The mean Insall-Salvati ratio changed from 0.87 (range, 0.70-1) immediately postoperatively to 0.66 (range, 0.55-0.84) at followup. Patellar erosion occurred in three knees without patellar replacements, accompanied by pain and reduced range of flexion. The four knees with patellar replacements showed marked erosion of the patellar component or the patella, but all remained asymptomatic. Achieving deep flexion in addition to patella baja was thought to be a key element. Patellar replacement, joint line preservation, shaving the anterior portion of the tibial component, preventing surgically induced patella baja, and careful radiographic followup should be considered when deep flexion is achieved in a knee with patella baja after a total knee arthroplasty.
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ranking = 6
keywords = tibia
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