Introduction. One of the more common complaints from patients in their post-operative total knee arthroplasty (TKA) is the perceived feeling of the operative leg feeling longer than the non-operative leg. Studies have shown that the leg length discrepancies may occur in up to 80% of patients following unilateral TKA patients. The purpose of this study was to determine the incidence of leg length discrepancy (LLD) after primary TKA as well as determine the correlation between deformity and incidence of LLD. Methods. We retrospectively reviewed 1108 patients who underwent a primary unilateral TKA at a single institution. 97 patients were excluded for lack of imaging, prior total hip replacement or body mass index greater than 40 kg/m2. Hip to ankle biplanar radiographs were obtained pre-operative and 6 weeks postoperatively for all patients. Two independent observers measures
We present the results of 17 children of Tanner stage 1 or 2 who underwent reconstruction of the anterior cruciate ligament between 1999 and 2006 using a transphyseal procedure, employing an ipsilateral four-strand hamstring graft. The mean age of the children was 12.1 years (9.5 to 14). The mean follow-up was 44 months (25 to 100). Survival of the graft, the functional outcome and complications were recorded. There was one re-rupture following another injury. Of the remaining patients, all had good or excellent results and a normal International Knee Documentation Committee score. The mean post-operative Lysholm score was 97.5 (. sd. 2.6) and the mean Tegner activity scale was 7.9 (. sd. 1.4). One patient had a mild valgus deformity which caused no functional disturbance. No other abnormality or discrepancy of
The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model.Aims
Methods
This study was performed to evaluate the results of transphyseal anterior cruciate ligament (ACL) reconstruction in children with open physes. Between 2001 and 2009, 31 knees in 29 patients with a mean age of 14.1 years (10-16) underwent transphyseal, arthroscopic ACL reconstruction using an autogenous four-strand hamstrings graft. The technique was identical to that used in the adult population in our unit, except that care was taken to ensure fixation did not cross the physes. The patients were followed up to the point of physeal closure at skeletal maturity. The mean length of follow up was 25 months. The primary outcome measure was graft survival. Functional outcome was measured using Lysolm scores, International Knee Documentation Committee (IKDC) scores and the Tegner activity scale. Post-operative clinical examination and radiological findings were also recorded. There were two cases of re-rupture following a further sports injury, one 12 months post-operative and one at six years. Both patients later had successful revision ACL reconstructive surgery. The re-rupture rate in this case series was 6%. Two patients underwent repair of a concomitant lateral meniscal tear at the time of surgery. The mean post-operative Lysolm score was 88 and the mean IKDC score was 88.1. The mean Tegner activity scale was 7.95. There was no evidence of growth disturbance radiologically or
Different methods of anterior cruciate ligament (ACL) reconstruction
have been described for skeletally immature patients before closure
of the growth plates. However, the outcome and complications following
this treatment remain unclear. The aim of this systematic review
was to analyse the outcome and complications of different techniques
which may be used for reconstruction of the ACL in these patients. We performed a systematic review of the literature according
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. This involved a comprehensive search of PubMed, Medline,
CINAHL, Cochrane, Embase and Google Scholar databases using the
following combinations of keywords, “knee”, “anterior cruciate ligament”,
“reconstruction”, “injury”, “children”, “adolescent”, “skeletally
immature”, “open physis” and “surgery”.Aims
Materials and Methods
To present our experience of using a combination of intra-articular
osteotomy and external fixation to treat different deformities of
the knee. A total of six patients with a mean age of 26.5 years (15 to
50) with an abnormal hemi-joint line convergence angle (HJLCA) and
mechanical axis deviation (MAD) were included. Elevation of a tibial
hemiplateau or femoral condylar advancement was performed and limb
lengthening with correction of residual deformity using a circular
or monolateral Ilizarov frame.Aims
Patients and Methods
To assess the effect of high tibial and distal femoral osteotomies
(HTO and DFO) on the pressure characteristics of the ankle joint. Varus and valgus malalignment of the knee was simulated in human
cadaver full-length legs. Testing included four measurements: baseline
malalignment, 5° and 10° re-aligning osteotomy, and control baseline
malalignment. For HTO, testing was rerun with the subtalar joint
fixed. In order to represent half body weight, a 300 N force was applied
onto the femoral head. Intra-articular sensors captured ankle pressure.Aims
Materials and Methods
The potential harm to the growth plate following reconstruction of the anterior cruciate ligament in skeletally-immature patients is well documented, but we are not aware of literature on the subject of the fate of the graft itself. We have reviewed five adolescent males who underwent reconstruction of the ligament with four-strand hamstring grafts using MR images taken at a mean of 34.6 months (18 to 58) from the time of operation. The changes in dimension of the graft were measured and compared with those taken at the original operation. No growth arrest was seen on radiological or clinical measurement of leg-length discrepancy, nor was there any soft-tissue contracture. All the patients regained their pre-injury level of activity, including elite-level sport in three. The patients grew by a mean of 17.3 cm (14 to 24). The diameter of the grafts did not change despite large increases in length (mean 42%; 33% to 57%). Most of the gain in length was on the femoral side. Large changes in the length of the grafts were seen. There is a considerable increase in the size of the graft, so some neogenesis must occur; the graft must grow.
We retrospectively reviewed the operative treatment carried out between 1988 and 1994 of eight patients with habitual patellar dislocation. In four the condition was bilateral. All patients had recurrent dislocation with severe functional disability. The surgical technique involved distal advancement of the patella by complete mobilisation of the patellar tendon, lateral release and advancement of vastus medialis obliquus. The long-term results were assessed radiologically, clinically and functionally using the Lysholm knee score, by an independent observer. The mean age at operation was 10.3 years (7 to 14) with a mean follow-up of 13.5 years (11 to 16). One patient required revision. At the latest follow-up, all patellae were stable and knees functional with a mean Lysholm knee score of 98 points (95 to 100). In those aged younger than ten years at operation there was a statistically significant improvement in the sulcus angle at the latest follow-up (Student’s This technique offers a satisfactory treatment for the immature patient presenting with habitual patellar dislocation associated with patella alta. If performed early, we believe that remodelling of the shallow trochlea may occur, adding intrinsic patellofemoral stability.
