Medial subluxation of the patella without previous lateral retinacular release.

This case presented a 17-year-old patient with persistent complaints localized to the right patellofemoral joint. Clinical examination demonstrated increased medial translation of the patella on manual stress. In contrast to previous published reports on medial patellar subluxation, this patient had not undergone prior lateral retinacular release. Arthroscopic examination documented medial tracking of the patella as well as excess medial translation. Imbrication of the patient's lateral patellar retinaculum centralized patella tracking and diminished medial translation on stress testing as observed arthroscopically and clinically. This case illustrates that medial patellar subluxation is a subtle problem that may be overlooked in the patient presenting with patellofemoral complaints and should be included in the differential diagnosis.

Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee.

Clinical evaluation of posterolateral complex injuries of the knee can be difficult. To determine if magnetic resonance imaging can assist in decision-making in the treatment of posterolateral complex injuries, six consecutive patients with acute posterolateral knee trauma were imaged preoperatively with standard magnetic resonance imaging sequences. Magnetic resonance imaging findings were then correlated with results of examination under anesthesia or open lateral reconstruction. There were five complete lateral complex injuries (grade III) and one partial tear. Magnetic resonance imaging was able to accurately depict the extent of injury preoperatively in each case. All patients had concomitant anterior cruciate ligament tears. There was one partial posterior cruciate ligament tear. Visualization of the arcuate complex, biceps femoris tendon, lateral capsule, iliotibial band, popliteal tendon, and lateral collateral ligament was possible. A characteristic bone contusion on the anteromedial femoral condyle was present in all patients with complete posterolateral disruptions. Lateral complex injuries of the knee can be very accurately demonstrated on magnetic resonance imaging, and this imaging technique can be used to clarify the exact nature of the injury to allow better surgical planning.

Histologic and microradiographic analysis of a revised porous-coated anatomic (PCA) patellar component. A case report.

A retrieved uncemented, porous-coated human patellar component was evaluated histologically and microradiographically. The metal portion of the component and porous coating were made of cobalt--chromium-based alloy. Because of adhesive capsulitis and inadequate knee flexion, the patient had revision surgery 11 months after the original total knee arthroplasty. Clinically, the device was not grossly loose. Contact microradiography of the porous material showed no calcified tissue ingrowth. Undecalcified histologic sections demonstrated only fibrous tissue ingrowth, with obvious bone-resorptive activity as well as numerous multinucleated giant cells adjacent to the porous metal.

Revisions with cemented long-stem prostheses.

The purpose of this paper was to describe the surgical techniques for removing and replacing failed femoral prosthetic components. We have also tried to develop a rationale for the use of long-stem femoral components to maximize femoral fixation and to protect the femur from future stresses. It is our recommendation that the revision femoral implant should be anchored into at least 100 mm of healthy bone distal to any previous metal, cement, perforation, or fracture. The surgical techniques described are demanding and require careful practice and preparation on the part of the surgical team. Distal intermedullary plugging and precise biphased cementing techniques are advocated to achieve microinterlock in the distal femur and to provide bulk filling of the proximal femur.

Tendon injuries about the ankle.

The proper treatment of tendinous ankle injuries will yield a strong, stable joint. Generally, athletes can expect to return to their preinjury athletic level. Tendon strain or inflammation, either from a single incident or simple overuse, requires prolonged conservative therapy. Tendon rupture should be approached aggressively to insure a powerful, stable ankle.

Medical and surgical treatment of the septic hip with one-stage revision arthroplasty.

Sepsis of the hip, particularly associated with total hip arthroplasty, can be treated successfully by an aggressive antimicrobial and surgical approach to accomplish a one-stage revision. Although this is a very acceptable alternative to Girdlestone arthroplasty, 13% (6 hips) of the septic total hip revisions failed. The possibility of hematogenous seeding of the total hip should be recognized by all health care professionals. Aggressive treatment of infections or potential infections is mandatory.

Tendon injuries about the ankle.

The proper treatment of tendinous ankle injuries will yield a strong, stable joint. Generally, athletes can expect to return to their preinjury athletic level. Tendon strain or inflammation, either from a single incident or simple overuse, requires prolonged conservative therapy. Tendon rupture should be approached aggressively to insure a powerful, stable ankle.

Surgical repair of the ruptured Achilles tendon. Analysis of 40 patients treated by the same surgeon.

Forty patients with acute ruptures of the Achilles tendon were treated surgically by the same physician (T.B.Q.) during a period of 1947 to 1971. The average followup was 19 years. Ninety percent of the patients were men (average age 37.5 years) who were engaged in recreational sport activities. The majority denied a physical conditioning program. The acute ruptures were treated by a surgical procedure which consisted of a 15-cm incision on the medial aspect of the tendon with either the plantaris muscle being woven through the Achilles tendon in a clockwise fashion or a pull-out wire, supplemented with silk mattress sutures, being used to repair the ruptured tendon. The wound was closed and the patient's leg was immobilized. The wire was removed at 6 weeks. The rehabilitation plan consisted of ambulation with a heel lift and elastic stocking (the height of the lift was gradually reduced) and toe exercises. The patients began walking downstairs backwards at 3 months and continued exercises until full range of motion was attained. Subjectively, the results were excellent as graded by the patients. Objectively, there were some minor deficits but they did not impede the overall function. On a scale of 1 (poor) to 4 (excellent), the clinical results were rated excellent (42%), good (36%), fair (15%), and poor (6%). This review has supported our contention that a positive Thompson test is a reliable indicator for a rupture of the Achilles tendon and that surgical treatment of complete ruptures is a successful mode by the procedure described followed by our rehabilitation program.