To compare
Purpose: At a time when total knee arthroplasty (TKA) with an ultra-congruent tibial plateau or a mobile plateau are advocated by many, the question is whether TKA with a fixed plateau preserving the
Aims. The aim of this study was to assess the effect of
Poor availability of allografts in South Africa has led to an increased use of synthetic augmentation to stabilize knee joints in the treatment of knee dislocations. This study aims to evaluate multiligament knee injuries treated with a
We have examined the relationship between the size of the flexion gap and the anterior translation of the tibia in flexion during implantation of a
Background:. For the past four decades controversy surrounds the decision to retain or sacrifice the
The significance of the
Aims. Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without
We investigated the role of a functional brace worn for four months in the treatment of patients with an acute isolated tear of the
We report the results of a prospective randomised trial which assessed the role of the
1. Seventeen cases of knee injury are described in which the predominant lesion was rupture of the
The issue of preservation or sacrifice of the
High-flexion knee replacements have been developed to accommodate a large range of motion (ROM >
120°) after total knee arthroplasty (TKA). Femoral rollback or posterior translation of the femoral condyles during knee flexion is essential to maximise ROM and to avoid bone-implant impingement during deep knee flexion. The
Introduction: Much debate exists regarding sparing or sacrificing the
The role of
We report a retrospective analysis of the results of combined arthroscopically-assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in 19 patients with chronic (three or more months) symptomatic instability and pain in the knee. All the operations were performed between 1996 and 2003 and all the patients were assessed pre- and post-operatively by physical examination and by applying three different ligament rating scores. All also had weight-bearing radiographs, MR scans and an examination under anaesthesia and arthroscopy pre-operatively. The posterior cruciate ligament reconstruction was performed using an arthroscopically-assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis. The mean follow up was 66.8 months (24 to 110). Pre-operatively, all the patients had a grade III posterior sag according to Clancy and demonstrated more than 20° of external rotation compared with the opposite normal knee on the Dial test. Post-operatively, seven patients (37%) had no residual posterior sag, 11 (58%) had a grade I posterior sag and one (5%) had a grade II posterior sag. In five patients (26%) there was persistent minimal posterolateral laxity. The Lysholm score improved from a mean of 41.2 (28 to 53) to 76.5 (57 to 100) (p = 0.0001) and the Tegner score from a mean of 2.6 (1 to 4) to 6.4 (4 to 9) (p = 0.0001). We conclude that while a combined reconstruction of chronic
The
To investigate the effectiveness of avulsion fracture of tibial insertion of
We analysed the long-term results with a mean follow-up of 10.2 years, of 66 total knee replacements in 42 patients with rheumatoid arthritis. In all cases the
We compared function in two groups of high demand patients who had undergone total knee arthroplasty (TKA), one group using a posterior cruciate sacrificing (PCS) prosthesis and the other a posterior cruciate retaining (PCR) prosthesis of similar design. Patients were eligible for the study if surgery had been performed more than two years ago and they were under 65 years of age and had no coexisting morbidity that markedly decreased their physical activities. One surgeon operated on 28 patients in group A (20 TKAs), routinely retaining the
We have assessed the clinical and radiological outcome of traumatic knee injuries resulting in open reconstruction of the
We assessed arthroscopically 22 young athletes with an isolated acute
Computational modeling has been used to simulate the natural and prosthetic kinematic and kinetic function in an attempt to compare designs and/or predict a desired motion path from a design. The levels of soft tissue can range from basic ligaments (MCL, LCL, and ACL & PCL) to more complex models. The goal of this study was to evaluate the sensitivity of the
Purpose. We conducted a prospective study to investigate the role of the LARS ligament system to reconstruct the
Purpose: To introduce modified tibial inlay technique for autogenous bone-patellar tendon-bone (BPTB)
Introduction. t is accepted dogma in total knee arthroplasty (TKA) that resecting the
Objective. The aim of this study was to assess the results of combined arthroscopically assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in patients with chronic (3 months or more) symptomatic instability and pain. Patients & methods. A retrospective analysis of all the patients who had a combined reconstruction of the
Aim: To compare the function in two groups of high demand patients with a total knee arthroplasty (TKA) – one group using a posterior cruciate sacrificing (PCS) prosthesis and the other a posterior cruciate retaining (PCR) prosthesis of similar design. Method: Patients were eligible for the study if they were greater than two years from surgery, less than 65 years of age and without other co-existing morbidity to significantly decrease their physical activities. Group A underwent surgery by one surgeon who routinely retained the
Introduction: The amount of loading on the cruciate ligaments depends on the tension of the external muscular structures. In vivo studies using EMG have observed a proprioreceptive eccentric co-contraction of the hamstrings during isokinetic knee extension motion. This antagonistic co-contraction increases the quadriceps force necessary to produce the same extension moment on the knee, whereas the loading on the anterior cruciate ligament was measured to be reduced, with the loading on the
Objective: The aim of this study was to assess the results of combined arthroscopically assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in patients with chronic (3 months or more) symptomatic instability and pain. Patients &
Methods: A retrospective analysis of all the patients who had a combined reconstruction of the
Objectives. Because
Purpose: The purpose of this work was to evaluate function of 256 total knee arthroplasties (TKA) (Wallaby) with preservation of the
Purpose: We report the results at more than five years of a consecutive series of total knee arthroplasties (TKAs) implanted without cement and with preservation of the
Purpose: The
Purpose of the study: Total knee arthroplasty (TKA) is considered to be an effective treatment for degenerative knee joint disease when the functional impairment and the pain fail to respond to medical treatment. The success of TKA is determined by the degree of pain relief, functional recovery, and implant survival. For many years, those advocating or not preservation of the
Medial pivot total knee arthroplasty is designed to permit posterior rolling and sliding of the lateral femoral condyle around a stable medial femoral condyle. The purpose of the current study was to analyze the weight-bearing kinematics of medial pivot TKA’s with three different treatments of the
Introduction. Compared with the cruciate-retaining (CR) insert for total knee arthroplasty (TKA), the cruciate-substituting (CS) insert has a raised anterior lip, providing greater anterior constraint, and thus, can be used in cases of
Introduction and Aims: The effects of injury to the
INTRODUCTION:. In varus knee,
Introduction. In
Purpose: Treatment of recent lesions of the
Purpose of the study: The purpose of this study was to use weight-bearing radiographies to study the mobility of the polyethylene insert in relation to the femoral and tibial components of a total knee arthroplasty (TKA) with preservation of the
The influence of
Injuries to the
Purpose: Patellar complications are among the most frequent after total knee arthroplasty. Encasing the patellar piece is one way of resisting the shear forces leading to loosening. Material and Methods: We studied at more than five years the results obtained with a total knee prosthesis implanted with preservation of the
Purpose: Patellar complications are among the most frequent after total knee arthroplasty. Encasing the patellar piece is one way of resisting the shear forces leading to loosening. Material and methods: We studied at more than five years the results obtained with a total knee prosthesis implanted with preservation of the
Purpose of the study: Opinions vary concerning results after knee arthroplasty with preservation of the
Purpose. To report clinical results and demonstrate any posterior femoral translation (PFT) in medial rotation total knee arthroplasty (TKA) of
Most studies comparing medial pivot to the posterior stabilised (PS) systems sacrifice the PCL. It is unknown whether retaining the PCL in the Medial Congruent (MC) system may provide further benefit compared to the more commonly used PS system. A retrospective review of a single-surgeon's registry data comparing 44 PS and 25 MC with PCL retained (MC-PCLR) TKAs was performed. Both groups had similar baseline demographics in terms of age, gender, body mass index, and American Society for Anaesthesiology score. There was no significant difference in their preoperative range of motion (ROM) (104º±20º The MC provides stability in the medial compartment while allowing a degree of freedom in the lateral compartment. Preserving the PCL when using MC may paradoxically cause an undesired additional restrain that slows the recovery process of the patients after TKA. In conclusion, compared to MC-PCLR, a PS TKA may expect significantly faster improvement at 3 months post operation, although they will achieve similar outcomes at 1-year post operation.
A total of 22 patients with a tibial avulsion
fracture involving the insertion of the posterior cruciate ligament
(PCL) with grade II or III posterior laxity were reduced and fixed
arthroscopically using routine anterior and double posteromedial
portals. A double-strand Ethibond suture was inserted into the joint
and wrapped around the PCL from anterior to posterior to secure
the ligament above the avulsed bony fragment. Two tibial bone tunnels
were created using the PCL reconstruction guide, aiming at the medial
and lateral borders of the tibial bed. The ends of the suture were
pulled out through the bone tunnels and tied over the tibial cortex
between the openings of the tunnels to reduce and secure the bony
fragment. Satisfactory reduction of the fracture was checked arthroscopically and
radiographically. The patients were followed-up for a mean of 24.5 months (19 to
28). Bone union occurred six weeks post-operatively. At final follow-up,
all patients had a negative posterior drawer test and a full range
of movement. KT-1000 arthrometer examination showed that the mean
post-operative side-to-side difference improved from 10.9 mm (standard
deviation ( We conclude that this technique is convenient, reliable and minimally
invasive and successfully restores the stability and function of
the knee. Cite this article:
129 knees suitable for a standard PCL retaining cemented total knee replacement were randomised into two groups, one in which PCL was retained in the normal way, the other group having the PCL fully resected. Both groups received a PCL retaining implant. The two groups were well matched with a predominance of females and a mean age of 67 years. There was no statistically significant difference in the HSS scores at an average of 57 months (range 56–60 months) in the two groups. Pain relief, deformity correction, range of motion, stability and strength were comparable in the two groups. A radiological assessment revealed femoral rollback in approximately 20% of cases with a slightly higher incidence in the PCL sacrificed group. There was no significant loosening detected in either of the categories at two years review. At five years one TKR in the PCL retained group has been revised due to an infection and one each in the two groups are awaiting revision surgery for loosening. Our findings have shown that there is no significant difference in the 5 year results of a PCL-retaining total knee replacement if the PCL is excised or preserved. This suggests two significant points:
the PCL is not functional in most patients with a total knee replacement even when retained: patients with excised PCLs show good results with PCL retaining implants, thereby questioning the need for posterior stabilised designs in all such cases.
We randomised 129 knees which were to be replaced using a standard posterior-cruciate-ligament (PCL)-retaining cemented total knee replacement into two groups. In one the PCL was retained in the normal way and in the other it was resected. They were well matched, with a predominance of women, and a mean age of 67 years. There was no statistically significant difference in the Hospital for Special Surgery scores at a mean of 57 months (56 to 60) between the two groups although 21 patients (24 knees) were lost to follow-up. Relief from pain, correction of deformity, range of movement, stability and strength were comparable in both. Radiological assessment showed femoral rollback in approximately 20% of knees with a slightly higher incidence in the PCL-resected group. There was no significant loosening detected in either group at review at two years. At five years, one knee in the PCL-retained group had been revised because of infection and one patient in each group was awaiting revision for loosening. Our findings have shown no significant difference in the five-year results for a PCL-retaining total knee replacement if the PCL is excised or preserved. This suggests two important points. First, the PCL is not functional in most patients with a total knee replacement even when retained. Secondly, patients with an excised PCL show a good result with a PCL-retaining implant, thereby questioning the need for a posterior stabilised design in such a situation.
The objective of this study was to assess the effect of PCL resection on flexion-extension gaps, mediolateral soft tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilised total knee arthroplasty (TKA). This prospective study included 110 patients with symptomatic knee osteoarthritis undergoing primary robotic-arm assisted posterior-stabilised TKA. All operative procedures were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps pre- and post-PCL resection in knee extension and 90 degrees knee flexion. This study included 54 males (49.1%) and 56 females (50.9%) with a mean age of 68 ± 6.2 years at time of surgery. Mean preoperative hip-knee-ankle deformity was 6.1 ± 4.4 degrees varus.Introduction
Methods
Contemporary PCL sacrificing Total Knee Arthroplasty (TKA) implants (CS) consist of symmetric medial and lateral tibial articular surfaces with high anterior lips designed to substitute for the stability of the native PCL. However, designs vary significantly across implant systems in the level of anteroposterior constraint provided. Therefore, the goal of this study was to investigate kinematics of two CS designs with substantially different constraint levels. The hypothesis was that dynamic knee simulations could show the effect of implant constraint on kinematics of CS implants. LifeModeler KneeSIM software was used to analyze contemporary CS TKA (X) with a symmetric and highly dished tibia and contemporary CS TKA (Y) with a symmetric tibia having flat sections bounded by high anterior and posterior lips, during simulated deep knee bend and chair sit. The flat sections of CS-Y implant are designed to allow freedom prior to motion restriction by the implant lips. Components were mounted on an average knee model created from Magnetic Resonance Imaging (MRI) data of 40 normal knees. Relevant ligament/tendon insertions were obtained from the MRI based 3D models and tissue properties were based on literature values. The condyle center motions relative to the tibia were used to compare the different implant designs. In vivo knee kinematics of healthy subjects from published literature was used for reference.INTRODUCTION
METHODS
Balancing the PCL in a PCL-retaining total knee replacement (TKR) is important, but sometimes difficult to execute in an optimal manner. Due to the orientation of the PCL it is conceivable that flexion gap distraction will lead to anterior movement of the tibia relative to the femur. This tibio-femoral repositioning influences the tibio-femoral contact point, which on its turn affects the kinematics of the TKR. So far, the amount of tibiofemoral repositioning during flexion gap distraction is unknown which leads to uncertain kinematic effects after surgery. The goal of this study was to quantitatively describe the parameters of the flexion gap (gap height, anterior tibial translation and femoral rotation) and their relationship while the knee is distracted during implantation of a PCL-retaining TKR with the use of computer navigation. Furthermore, the effect of PCL elevation angle on the flexion gap parameters was determined. In 50 knees, during a ligament-guided TKR procedure, the flexion gap was distracted with a double-spring tensor with 100 and 200 N after the tibia had been cut. The flexion gap height, anterior tibial translation and femoral rotation were measured intra-operatively using a CT-free navigation system. PCL elevation was calculated based on the femoral and tibial insertion sites as indicated by the surgeon with the pointer of the navigation system. To identify a relationship between flexion gap height increase and anterior tibial translation, the ratio between anterior translation and gap height increase was determined for each patient between 100 and 200 N. The mean gap height increased 2.2 mm (SD 0.96) and mean increase in anterior tibial translation was 4.2 mm (SD 1.6). Hence, on average, for each mm increase in gap height, the tibia moved 1.9 mm (SD 0.96) in anterior direction. Knees with a steep PCL showed significantly more AP translation for each mm gap height increase (gap/AP-ratio was 1 : 2.31 (SD 0.63)) compared to knees with a flat PCL (gap/AP-ratio was 1 : 1.73 (SD 0.50)). The increase in femur (exo)rotation was on average 0.60° (SD 1.4). With a tensioned PCL the tibia will move anteriorly on average 1.9 mm for every extra mm that the flexion gap is increased. The flexion gap dynamics can be explained in part by the orientation of the PCL: the greater the elevation angle, the more anterior tibial displacement during distraction of the flexion gap. The surgeon must be aware that distraction of the flexion gap influences the tibiofemoral contact point. The tibio-femoral contact point will move posteriorly and stresses in the PCL will rise and produce limited flexion and pain. In case of a conforming insert AP-movement will be limited but high PE stresses may be introduced that can lead to wear. This information may be helpful in selecting the optimal soft tissue balancing procedure and the optimal PE insert thickness in PCL retaining TKR.
We evaluated the accuracy of six clinical tests for posterior instability in 24 knees with acute surgically-proven posterior cruciate ligament injuries and intact anterior cruciate ligaments. We also performed stress radiography under anaesthesia. The gravity sign and the posterior drawer test in near extension and its passive reduction were diagnostic in 20 of the 24 knees, and the active reduction of posterior subluxation was diagnostic in 18. The reversed pivot shift sign helped to diagnose severe posterior and posterolateral subluxations, but the external rotation recurvatum test was negative in all 24 knees. Stress radiography in near extension revealed a highly significant increase in posterior tibial subluxation in the injured knees.
Recently, tibial insert design of cruciate-substituting (CS) polyethylene insert is employed. However, in vivo kinematics of using CS polyethylene insert is still unclear. In this study, it is hypothesized that CS polyethylene insert leads to stability of femolo-tibial joint as well as posterior-stabilized (PS) polyethylene insert, even if PCL is sacrificed after TKA. The purpose of this study is an investigation of in vivo kinematics of femolo-tibial joint with use of CS polyethylene insert before and after PCL resction using computer assisted navigation system intra-operatively in TKA. Twenty-four consecutive patients who had knees of osteoarthritis with varus deformity were investigated in this study. All TKAs (Triathlon, Stryker) were performed using computer assisted navigation system. In all patients, difference between extension and flexion gap was under 3mm after bony cut of femur and tibia. During surgery, CS polyethylene tibial trial insert were inserted after trial implantation of femoral and tibial components, before and after resection of PCL, respectively. The kinematic parameters of the soft-tissue balance, and amount of coronal (valgus/varus), sagittal (anterior/posterior) and rotational relative movement between femur and tibia were obtained by interpreting kinematics, which display tables throughout the range of motion (ROM) (Figure1). During record of kinematics, the surgeon gently lifted the experimental thigh three times, flexing the hip and knee. In each ROM (30, 45, 60, 90, max degrees), the data were analyzed with paired t-test, and an ANOVA test, and mean values were compared by the multiple comparison test (Turkey HSD test) (p < 0.05).Introduction
Materials and Methods
Aims. The aim of this study was to screen the entire genome for genetic markers associated with risk for anterior cruciate ligament (ACL) and
In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.
The posterior drawer is a commonly used test to diagnose an isolated PCL injury and combined PCL and PLC injury. Our aim was to analyse the effect of tibial internal and external rotation during the posterior drawer in isolated PCL and combined PCL and PLC deficient cadaver knee. Ten fresh frozen and overnight-thawed cadaver knees with an average age of 76 years and without any signs of previous knee injury were used. A custom made wooden rig with electromagnetic tracking system was used to measure the knee kinematics. Each knee was tested with posterior and anterior drawer forces of 80N and posterior drawer with simultaneous external or internal rotational torque of 5Nm. Each knee was tested in intact condition, after PCL resection and after PLC (lateral collateral ligament and popliteus tendon) resection. Intact condition of each knees served as its own control. One-tailed paired student's t test with Bonferroni correction was used. The posterior tibial displacement in a PCL deficient knee when a simultaneous external rotation torque was applied during posterior drawer at 90° flexion was not significantly different from the posterior tibial displacement with 80N posterior drawer in intact knee (p=0.22). In a PCL deficient knee posterior tibial displacement with simultaneous internal rotation torque and posterior drawer at 90° flexion was not significantly different from tibial displacement with isolated posterior drawer. In PCL and PLC deficient knee at extension with simultaneous internal rotational torque and posterior drawer force the posterior tibial displacement was not significantly different from an isolated PCL deficient condition (p=0.54). We conclude that posterior drawer in an isolated PCL deficient knee could result in negative test if tibia is held in external rotation. During a recurvatum test for PCL and PLC deficient knee, tibial internal rotation in extension results in reduced posterior laxity.
The aim of this study was to compare the maximum
laxity conferred by the cruciate-retaining (CR) and posterior-stabilised
(PS) Triathlon single-radius total knee arthroplasty (TKA) for anterior
drawer, varus–valgus opening and rotation in eight cadaver knees
through a defined arc of flexion (0º to 110º). The null hypothesis
was that the limits of laxity of CR- and PS-TKAs are not significantly
different. The investigation was undertaken in eight loaded cadaver knees
undergoing subjective stress testing using a measurement rig. Firstly
the native knee was tested prior to preparation for CR-TKA and subsequently
for PS-TKA implantation. Surgical navigation was used to track maximal
displacements/rotations at 0º, 30º, 60º, 90º and 110° of flexion.
Mixed-effects modelling was used to define the behaviour of the
TKAs. The laxity measured for the CR- and PS-TKAs revealed no statistically
significant differences over the studied flexion arc for the two
versions of TKA. Compared with the native knee both TKAs exhibited
slightly increased anterior drawer and decreased varus-valgus and
internal-external roational laxities. We believe further study is required
to define the clinical states for which the additional constraint
offered by a PS-TKA implant may be beneficial. Cite this article:
Aims. A functional anterior cruciate ligament (ACL) or
Aims. This study compared patient-reported outcomes of three total knee arthroplasty (TKA) designs from one manufacturer: one cruciate-retaining (CR) design, and two cruciate-sacrificing designs, anterior-stabilized (AS) and posterior-stabilized (PS). Methods. Patients scheduled for primary TKA were included in a single-centre, prospective, three-armed, blinded randomized trial (n = 216; 72 per group). After intraoperative confirmation of
Instability currently represents the most frequent cause for revision total knee replacement. Instability can be primary from the standpoint of inadequately performed collateral and/or
Aims. Unicompartmental knee arthroplasty (UKA) has become a popular method of treating knee localized osteoarthritis (OA). Additionally, the
Aims. Little is known about the risk factors that predispose to a rupture of the
Introduction. The range of motion (ROM) obtained after total knee arthroplasty (TKA) is an important measurement to evaluate the postoperative outcomes impacting other measures such as postoperative function and satisfaction. Flexion contracture is a recognized complication of TKA, which reduces ROM or stability and is a source of morbidity for patients. Objectives. The purpose of this study was to evaluate the influence of intra-operative soft tissue release on correction of flexion contracture in navigated TKA. Methods. This is prospective cohort study, 43 cases of primary navigation assisted TKA were included. The mean age was 68.3 ± 6.8 years. All patients were diagnosed with grade 4 degenerative arthritis in K-L grading system. The average preoperative mechanical axis deviation was 10.3° ± 5.3 and preoperative flexion contracture was 12.8° ± 4.8. All arthroplasties were performed using a medial parapatellar approach with patellar subluxation. First, medial release was performed, and
Knee arthroscopy is typically approached from the anterior, posteromedial and posterolateral portals. Access to the posterior compartments through these portals can cause iatrogenic cartilage damage and create difficulties in viewing the structures of the posterior compartments. The purpose of this study was to assess the feasibility of needle arthroscopy using direct posterior portals as both working and visualising portals. For workability, the needle scope was inserted advanced from anterior between the cruciate ligament bundle and the lateral wall of the medial femoral condyle until the posterior compartments were visualised. For visualisation, direct postero-lateral and -medial portals were established. The technique was performed in 9 knees by two experienced researchers. Workability and instrumentation of the posteromedial compartment and meniscus was achieved in 56%. The posterior horns could not be visualised in four specimens as the straight lens could not provide a more medial field of view. Visualisation from the direct medial posterior portal allowed a clear view of the medial meniscus, femoral condyle and
Purpose: We analysed knee prostheses preserving the
In an attempt to alleviate symptoms of the disease, patients with knee osteoarthrosis (KOA) frequently alter their gait patterns. Understanding the underlying pathomechanics and identifying KOA phenotypes is essential for improving treatments. We aimed to investigate altered kinematics in patients with KOA to identify subgroups. Sixty-six patients with symptomatic KOA scheduled for total knee arthroplasty and 12 age-matched healthy volunteers with asymptomatic knees were included. We used k-means to separate the patients based on dynamic radiostereometric assessed knee kinematics. Ligament lesions, KOA score, and clinical outcome were assessed by magnetic resonance imaging, radiographs, and patient reported outcome measures, respectively. We identified four clusters that were supported by clinical characteristics. Compared with the healthy group; The flexion group (n=20): revealed increased flexion, greater adduction, and joint narrowing and consisted primarily of patients with medial KOA. The abduction group (n=17): revealed greater abduction, joint narrowing and included primarily patients with lateral KOA. The anterior draw group (n=10): revealed greater anterior draw, external tibial rotation, lateral tibial shift, adduction, and joint narrowing. This group was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the greatest KOA score. The external rotation group (n=19): revealed greater external tibial rotation, lateral tibial shift, adduction, and joint narrowing while no anterior draw was observed. This group included primarily patients with medial collateral and
Abstract. Introduction. We present a case series of patients that underwent knee ligament reconstruction with graft reinforcement using FibreTape (Arthrex), a 2mm wide non-biodegradable polyethylene tape. Outcomes and safety of this novel technique are reported. Methods. Data were collected from a prospectively maintained database from 03/2011 to 11/2019. All skeletally mature patients that underwent reinforced knee ligament reconstruction surgery at Basingstoke and North Hampshire Hospital were included. The cohort was interrogated for outcomes including failure, complications, and subjective patient reported outcomes at 6,12 and 24 months postoperatively. Results. 438 patients were eligible. The mean age was 33.4 years and 68% of them were males. This included 171 ACL reconstructions, 96 ACL with anterolatreal ligament reconstructions, 59 bicruciate reconstructions, 30 ACL with posterolateral corner, 49
Instability currently represents the most frequent cause for revision total knee replacement. Instability can be primary from the standpoint of inadequately performed collateral and/or
We evaluated the long-term outcome of isolated endoscopically-assisted posterior cruciate ligament reconstruction in 26 patients using hamstring tendon autografts after failure of conservative management. At ten years after surgery the mean International Knee Documentation Committee subjective knee score was 87 (. sd. 14) of a possible 100 points. Regular participation in moderate to strenuous activities was possible for only seven patients pre-operatively; this increased to 23 patients post-operatively. The mean Lysholm score improved from 64 (. sd. 15) to 90 (. sd. 14) at ten years (p = 0.001). At ten years endoscopic reconstruction of the
We describe a previously unpublished and possibly unrecognised association between injuries to the
Aims. Tibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications. Methods. In total, 759 adult patients with 766 affected knees were retrospectively reviewed. The TPF fragments on CT were multiplanar reconstructed, and virtually reduced to match a 3D model of the proximal tibia. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a tibia template. Results. The cohort included 405 (53.4%) cases with left knee injuries, 347 (45.7%) cases with right knee injuries, and seven (0.9%) cases with bilateral injuries. On mapping, the hot zones of the fracture lines were mainly concentrated around the anterior cruciate ligament insertion,
Introduction We describe an arthroscopic technique of excising a lesion from within the posterior septum of the knee. To our knowledge this has not been described in the literature. Case History A 35-year old male taxi-driver presented with pain in the back of his right knee. Examination did not reveal any abnormality except pain on flexing the knee beyond 90-degrees. MRI showed a multiloculated ganglion in the posterior compartment of the knee. The ganglion was located within the posterior septum and successfully excised arthroscopically. 6-months postoperatively the patient is assyptomatic. Anatomy of the posterior septum The posterior septum is located between the
Purpose: Posterior arthroscopy is generally performed by alternating visual control using the optic introduced via one of the anterior portals which is slid into the slit via the contralaeral posterior compartment. These two “crossed” posterior portals provide access to the posterior part of the menisci and to the condyle but remain oblique. Any sagittal partition separating the posterior compartments limits visual and instrument access to the posterior part of the articular cavity. The purpose of this work was to describe a novel back-and-forth technique for posterior arthroscopy which allows posterior access to the central pivot. Material and methods: The conventional posteromedial access was used. The optic was introduced to visualise the
Pre-operative planning in revision total knee replacement is important to simplify the surgery for the implant representative, operating room personnel and the surgeon. Revision knee arthroplasty is performed for many different reasons and of variable complexity. Many implant options can be considered including cemented and cementless primary and stemmed revision tibial and femoral components, with posterior cruciate retention or resection, and either with no constraint, varus/valgus constraint, or with rotating hinge bearings. One may also need femoral and tibial spacers, metaphyseal augments, or bulk allograft. It is important to pre-operatively determine which of these implants you may need. If you schedule a revision total knee and ask the implant representative to “bring everything you've got, just in case,” they will have to bring a truck full of instruments and implants. The first step of pre-operative planning is to determine how much implant constraint will be needed. Survivorship of revision total knees with modern varus/valgus constrained or rotating hinge implants are not that unacceptable. Ideally to enhance longevity, the least constraint needed should be used. This requires determination of the status of the ligaments. Varus and valgus stress is applied to the knee in near full extension, mid-flexion, and ninety degrees of flexion. If instability of the knee is noted, then radiographs are reviewed to determine if component malposition or malalignment is the reason for the collateral ligament laxity. If radiographs don't show a reason, then have additional constraint available in case the knee can't be balanced with proper component position and ligament balancing. In cases other than simple revisions, the
Purpose. We aimed to investigate whether the anterior superior iliac spine could provide consistent rotational landmark of the tibial component during mobile-bearing medial unicompartmental knee arthroplasty (UKA) using computed tomography (CT). Methods. During sagittal tibial resection, we utilized the ASIS as a rotational landmark. In 47 knees that underwent postoperative CT scans after medial UKA, the tibial component position was assessed by drawing a line tangential to the lateral wall of the tibial component. Rotation of the tibial component was measured using two reference lines: a line perpendicular to the posterior cortical rim of the tibia (angle α) and Akagi's line (angle β). Instant bearing position and
Objective: Many have advocated the importance of correcting posterolateral rotatory instability (PLRI) in injuries causing rupture of the
Objectives. Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA. Methods. We generated a subject-specific computational model followed by the development of ± 1 mm, ± 2 mm and ± 3 mm PCO models in the posterior direction, and -3°, 0°, 3° and 6° PTS models with each of the PCO models. Using a validated finite element (FE) model, we investigated the influence of the changes in PCO and PTS on the contact stress in the patellar button and the forces on the
Aim: To accurately identify the meniscofemoral ligaments in cadaveric human specimens, and to determine anatomical variations in the
Objectives. The aim of the current study was to analyse the effects of
Thirty cruciate ligaments were retrieved from either cadavers or limbs which had been amputated. Each specimen was sectioned and stained to demonstrate the presence of collagen, nerves and vessels. All 30 specimens contained an interconnecting band of collagen fibres between the anterior and
Our aims were to map the tibial footprint of the
Purpose of the study: Kinetic studies of total knee arthroplasty (TKA) in vivo have provided divergent data but have agreed on one point: knee kinetics is abnormal after TKA. Restitution of a normal kinetics is thus the goal to reach to improve functional outcome after TKA. The Journey. ®. TKA is specifically designed to induce automatic medial rotation of the tibia during flexion. This would align the extensor system during flexion and would reduce mediolateral shear forces applied to the patellofemoral joint. Fluoroscopic dynamic studies have been conducted in vivo to confirm the reality of the femorotibal kinematics but to date there has been no study of the patellofemoral kinematics. Magnetic resonance imaging (MRI) is the gold standard for exploring the knee. The important artefacts caused by metal implants made of chromium-cobalt alloys make it difficult or impossible to interpret the images in patients with TKA. Oxinium. ®. implants are weakly ferromagnetic, allowing the development of a specific MRI sequence which can be used to explore a TKA. Material and methods: We used this technique in vivo for a 3D exploration of the patellofemoral kinematics of six Jouney. ®. TKA in comparison with five Genesis II. ®. TKA with preservation of the
Introduction. Restoration of knee function after total knee arthroplasty (TKA) often entails a balance between normal kinematics and normal knee stability, especially in performing demanding physical activities. The ultra-congruent (UC) knee design prioritizes stability over kinematics through close conformity between the femoral component and the tibial insert in extension. This configuration is intended to provide AP stability in the absence of the