Salvation for failure of lateral retinacular release / 中国医师进修杂志

Objective To investigate a simple effective way to salvage failure of lateral retinacular release. Methods From March 2007 to May 2009,there were 23 knees of 23 cases for failure after lateral retinacular. All the patients had patellofemoral joint malatignment in some extend,whose patellofemoral joint CT scanned in dynamic. Before curing,the index of patellar tilting angle (PTA) was 19.6° ±5.7° , congruence angle(CA) was 23.6° ± 12.5° , patellar femoral index(PFI)was 2.7 ± 0.8, and hospital special score (HSS) knee score was (74.0 ± 9.2) points,then put on elastic knee sleeves for arranging the malalignment of patellofemoral joints, coincidentally, rehabilitation of vastus medians administered. Results All the patients were followed up for 6 - 26 (11.0 ± 2.3 ) months, 22 cases of 24 knees gained the excellent or good results,1 case had to experience surgery again. After curing, PTA was 11.2° ±3.7°,CA was 6.4° ±7.8°, and PFI was 1.1 ±0.3,escalated HSS knee score was (87.0 ±6.5) points, in these excellent or good patellofemoral joints. Significant difference showed apparently in the cohort through curing (P <0.05). Conclusion Administering elastic knee sleeves along with correct rehabilitation is a simple effective no-incisive cure for salvaging failure of lateral retinacular release.

The Effect of Tourniquet on Patellofemoral tracking during Total Knee Arthroplasty

PURPOSE: To evaluate the effect of the tourniquet on intraoperative patellar tracking and to determine how this may influence the decision to perform lateral release during primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From Jan. 1998 to Feb. 1999, 126 TKAs in which patellar tracking was assesed with tourniquet inflated were chosen as a control group. From May 1999 to June 2000, a total of 221 consecutive TKAs in which patellar tracking was assessed before and after tourniquet release were selected as a study group and were placed into 1 of 3 groups: Group I (49 out of 221) were knees that tracked properly both before and after tourniquet release. Group II (150 out of 221) were knees that maltracked with the tourniquet inflated and subsequently corrected with the tourniquet deflated. Group III (22 out of 221) were knees that maltracked both before and after tourniquet release, therefore required a lateral release. The lateral release rate, patella tilt and displacement were compared among groups. RESULTS: In control group, the lateral release rate was 65.9%(83/126). The patella tilit and displacemen were 2.65+/-0.78 degree and 3.51+/-1.68 mm respectively. In study group, the lateral release rate was 10.0%(22/221). The patella tilit and displacement were 0.76+/-0.85degree and 2.96+/-1.96 mm in study group. CONCLUSION: Tourniquet application alters intraoperative patellar tracking during TKA. When contemplating lateral retinacular release, tourniquet release and reevaluation of patellar tracking should be considered.

The Comparision of the Midvastus and Paramedian Approaches for Total Knee Arthroplasty

PURPOSE: To present the results of mdivastus and paramedian approach for total knee replacement arthroplasty (TKA). MATERIALS AND METHODS: Thirty two patients having bilateral total knee replacement arthroplasty were randomized prospectively-one knee having a vastus muscle-splitting approach(MVS) and the other knee having a median parapatellar approach(MPP)- to compare the difference in lateral release, operation time, postoperative ROM and drain amount, HSS score, return to SLR and extension lag at 2 weeks in TKA. RESULTS: The MVS approach offered an early advantages compared with MPP approach, especially in terms of lateral release[22(68.7%)on MPP and 5 15.6%) on MVS (p=0.014)], ROM at postoperative 2 week (p=0.043) and early return to SLR (p=0.023). There were no significant differences in operation time, postoperative ROM and drain amount, HSS score and extension lag. CONCLUSION: The MVS approach has the potential to improves the rapid restoration of quadriceps mus-cle control and to lead to reduction in the need for lateral release in TKA.

An Analysis of the Results of the Treatment of the Resistant Clubfoot / 대한정형외과학회잡지

The Clufoot is still controversial in the etiology, the pathology, and the method of the treatment. Turco issued one stage posteromedial soft tissue release in 1971, which is still widely used. But the Turco's procedure is not satisfactory results in forefoot adduction and ankle motion. McKay and Simon were performed one stage complete subtalar soft tissue release and reported better results compared with those who had posteromedial release. So we performed Turco's posteromedial release with lateral release by Cincinnati incision in 12 patients (20 feet) and analysis the results from Oct. 1987 to Jul. 1989 at the department of orthopaedic surgery of CNUH. The results were as followings ; 1. The mean age of the patient at first examination was 1 year 9 months (range from at birth to 5 year 10 months) and the mean age at operation was 2 year 1 month (range from 4 months to 5 year 10 months). 2. The clinical results were excellent in 2 feet, good in 14 feet, fair in 3 feet and unsatisfactory in 1 foot. 3. The radiological results were satisfactory in 18 feet and unsatisfactory in 2 feet. 4. Forefoot adduction was corrected in 14 feet (70%) as normal range, 3 feet as acceptable, and 3 feet as unacceptable 10' over the normal range. 5. Two feet of hind foot overcorrection result was operation as McKay's method. 6. The Clincinnati incision was favorable to visulization and release of the posteromedial, anteromedial and posterolateral structure of the foot.