ABSTRACT
[Purpose] Although many studies have shown that patients have difficulty in climbing or descending stairs after undergoing total knee replacement, no study so far has compared the difficulty of stair ascent and descent based on objective indicators. This study compared stair ascending and descending processes based on three indicators and clarified which was more difficult. [Participants and Methods] We defined 1) movement method, 2) the necessity for handrail use, and 3) speed as objective indicators. Seventy-eight patients who underwent total knee replacement participated in this study. Three months after the surgery, we examined 1) whether the patients could ascend or descend in a step-over-step or step-by-step manner, 2) whether the patients required handrail support, and measured 3) the time required to ascend and descend for four steps. [Results] The step-by-step movement and handrail requirement rates associated with stair descent were higher than the corresponding rates associated with stair ascent. In addition, the time required for stair descent was greater than that required for ascent. [Conclusion] We found that stair descent was more challenging than stair ascent in terms of all three objective indices: movement method, handrail use, and speed. The results indicate that rehabilitation after total knee replacement should focus more on stair descent than on stair ascent.
ABSTRACT
To determine whether the mechanical properties of joint soft tissues such as cartilage can be calculated from quantitative magnetic resonance imaging (MRI) data, we investigated whether the mechanical properties of articular cartilage and meniscus scheduled to be resected during arthroplasty are correlated with the T2 relaxation time on quantitative MRI at the same location. Six patients who had undergone knee arthroplasty and seven who had undergone hip arthroplasty were examined. For the knee joint, the articular cartilage and lateral meniscus of the distal lateral condyle of the femur and proximal lateral tibia were examined, while for the hip joint, the articular cartilage above the femoral head was studied. We investigated the relationship between T2 relaxation time by quantitative MRI and stiffness using a hand-made compression tester at 235 locations. The patient-individualized template technique was used to align the two measurement sites. The results showed a negative correlation (from -0.30 to -0.35) in the less severely damaged articular cartilage and meniscus. This indicates that tissue mechanical properties can be calculated from T2 relaxation time, suggesting that quantitative MRI is useful in determining when to start loading after interventional surgery on cartilage tissue and in managing the health of elderly patients.
ABSTRACT
BACKGROUND: For peroneal tendon dislocation, various surgical procedures have been described. Das De et al. reported good clinical results using retinaculum repair. However, their reports are limited to case series. We have simplified the Das De procedure since 1996. The purpose of this study is to investigate the clinical outcomes of our modified Das De procedure (MD) and compare these clinical outcomes to those of the Du Vries procedure (DV) that was performed in our hospital until 1996. PATIENTS: From 1996 to 2007, 19 patients were treated by MD and from 1988 to 1996, 15 patients were treated by DV. RESULTS: A mean preoperative Ankle-Hindfoot Scale was 78.4 points (range: 65-84) in the MD group and 77.2 points (range: 67-87) in the DV group. A mean postoperative Ankle-Hindfoot Scale was 93.4 points in the MD group and 89.4 points in the DV group. Two patients (13.3%) in the DV group suffered postoperative peroneal tendon redislocation. In the MD group, there was no postoperative peroneal tendon redislocation or complication related to skin incision. In athletes, 80.0% in the MD group and 54.5% in the DV group were able to return to their previous sports. The mean duration to return to sports was 2.9 months in the MD group and 3.9 months in the DV group (p < 0.05). CONCLUSIONS: MD provided similar or slightly better clinical outcomes with less complication as compared to DV. For athletes, the rate of return to sports was higher and the duration to return to sports was significantly shorter in the MD group.
Subject(s)
Ankle Injuries/surgery , Joint Dislocations/surgery , Orthopedic Procedures/methods , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Recovery of Function , Tendon Injuries/surgery , Treatment Outcome , Young AdultABSTRACT
Osteochondritis dissecans (OCD) of the lateral femoral condyle sometimes occurs with a discoid lateral meniscus. Recently, it was reported that OCD of the lateral femoral condyle occurred after total removal of the lateral meniscus. We report the case of a 12-year-old boy with bilateral OCD of the lateral femoral condyle following bilateral total removal for discoid lateral meniscus. Valgus deviation of the knee after total removal and increased sporting activity might have concentrated excessive stress on the lateral condyles in the standing position. As a result, bilateral OCD might have occurred. Drilling of the areas of OCD on the bilateral lateral femoral condyles was done and the patient wore inner wedge arch supports postoperatively. After 2 years, neither knee pain nor arthrosis has occurred so far, but long-term follow-up of this patient is considered to be necessary.
