ABSTRACT
Sixty-three knees in 62 patients with insufficiency of the anterior cruciate ligament (ACL) were treated by arthroscopic partial or total meniscectomy without ligament reconstruction. The implications of this sequence of treatment with this combination of pathologies was documented. At 4.5 years after meniscectomy, 84% of the knees were subjectively improved and 10% were subjectively worse. Sixty-eight percent of the patients had persistent knee pain and 52% had episodes of giving way. Roentgenographic evidence of osteoarthrosis was present in 65% of 34 knees at 4.4 years after operation. Additional surgery was required in 24% of the knees. Meniscectomy without a stabilization procedure should be performed only infrequently in knees with deficient ACL.
Subject(s)
Anterior Cruciate Ligament Injuries , Joint Instability/surgery , Knee Injuries/surgery , Menisci, Tibial/surgery , Acute Disease , Adolescent , Adult , Anterior Cruciate Ligament/surgery , Arthroscopy , Chronic Disease , Female , Follow-Up Studies , Humans , Knee Injuries/diagnostic imaging , Knee Joint/diagnostic imaging , Male , Radiography , Reoperation/statistics & numerical data , Retrospective Studies , Survival Analysis , Tibial Meniscus Injuries , Treatment OutcomeABSTRACT
Twenty-five patients, who did not have osteoporosis and who were between the ages of seventeen and sixty years, were treated for one or more stable compression fractures of a vertebra with compaction of less than 50 per cent and without an associated neurological deficit. The patients were followed for a minimum of nine years. Associated vertebral fractures (12 per cent) were identified during the first three months after the injury, but no deformity progressed after three months. Radiographic changes of degenerative disc disease were evident in eight patients, but the changes did not correlate with symptoms or with level of activity. With one exception, all patients functioned as well as uninjured subjects of comparable age. Patients who have a compression fracture of a vertebra should have serial radiographs made for at least three months to ensure that all fractured vertebrae are identified and to document any progression of deformity.
Subject(s)
Fractures, Bone/rehabilitation , Lumbar Vertebrae/injuries , Thoracic Vertebrae/injuries , Adolescent , Adult , Back Pain/etiology , Female , Fractures, Bone/complications , Fractures, Bone/therapy , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Anterior knee pain is a common symptom, especially in adolescence, and often no specific cause is sought or identified. Physicians who treat patients with knee pain should understand the normal anatomic features and the biomechanics of the patellofemoral joint. We review this information and discuss important aspects of the physical examination and roentgenographic evaluation in patients with anterior knee pain. Once the clinical cause of anterior knee pain has been established, directed nonoperative treatment including physical therapy should be initiated. Surgical intervention is generally reserved for patients in whom nonoperative management is unsuccessful and identifiable abnormalities exist.
