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Background@#This study evaluated the outcomes of medial patellofemoral ligament (MPFL) reconstruction using a gracilis tendon suture technique for patients with patellar instability. Potential factors affecting clinical efficacy were also evaluated. @*Methods@#This study included 22 patients diagnosed with patellar instability, who underwent MPFL reconstruction using a gracilis tendon. Their mean age was 21.5 years (range, 15–48 years), and the mean follow-up period was 26.8 months (range, 12–66 months). Clinical evaluation included the determination of Kujala, Lysholm, and Tegner scores. Radiographic evaluation included changes in congruence angle and arthritic changes in the patellofemoral joint. Additionally, patients were examined for any complications, including recurrent dislocation. Factors affecting clinical efficacy were also evaluated. @*Results@#All clinical scores improved at final follow-up. The mean congruence angle improved from 23.6° before surgery to –6.5° at final follow-up. Two of 15 patients developed osteoarthritic changes in the patellofemoral joint. Dislocation recurred in 2 patients with type C trochlear dysplasia, which showed a statistically significant association with recurrent dislocation when compared to type A and B dysplasia (p = 0.026). Kujala scores were significantly lower among patients with abnormal patellar tilts (p = 0.038), and Lysholm scores were significantly lower among patients with femoral internal rotation deformity (p = 0.024). @*Conclusions@#Satisfactory results were obtained after MPFL reconstruction using a gracilis tendon suture technique for patients with patellar instability. However, dislocation recurred in patients with type C trochlear dysplasia, and clinical efficacy was lower among patients with femoral internal rotation and patellar tilt.
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Chondrolipoma is a rare benign mesenchymoma containing mature cartilage and adipose tissues. Chondrolipoma has been encountered mainly in the oral cavity and breast; however, this type of mesenchymoma occurs extremely rarely in the knee area. This paper reports a case of a 60-year-old woman who presented with a two-year history of a palpable mass lesion at the anterior side of the left knee. Magnetic resonance imaging showed a mass lesion adjacent to the medial side of the patellar tendon. The mass had a heterogenous nature, consisting of fat components and calcification. Surgical excision was performed. The size of the excised mass was approximately 4.5 cm×3 cm×4 cm, and it had a round shape and was encapsulated. The posterior part of the mass had a mixed pattern comprised of fat and cartilage tissues. A pathological examination showed that the chondrolipoma was composed of mature adipose and hyaline cartilage tissues.
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The incidence of postoperative ileus (POI) after colonic and abdominal surgery is high. On the other hand, the reported incidence after lower extremity reconstruction ranges from 0.3% to 4.0%. This paper reports an 81-year-old woman who expired due to POI at six days after primary total knee arthroplasty. The risk factors, diagnosis, preventive methods, and treatment of POI were also investigated through literature reviews.
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Several factors need to be considered for a successful anterior cruciate ligament (ACL) reconstruction, such as preoperative planning, operation technique, and postoperative rehabilitation. Graft choice, fixation, preparation method, maturation, incorporation to host bone, and graft tension should also be considered to achieve a good outcome after an ACL reconstruction. Factors to consider when selecting a graft are the graft strength, graft fixation, fixation site healing, and donor site morbidity, as well as the effects of initial strength, size, surface area, and origin of the graft on its potential for weakening during healing. There are two types of graft for an ACL reconstruction, autograft or allograft. Several autografts have been introduced, including the bone-patellar tendon-bone, hamstring tendon, and quadriceps tendon-bone. On the other hand, each has its advantages and disadvantages. The recent increased use of allografts for an ACL reconstruction is the lack of donor site morbidity, decreased surgical time, diminished postoperative pain, and good availability of source.Despite this, there are no reports suggesting that an allograft may have a better long-term outcome than an autograft. Allografts have inherent disadvantages, including a longer and less complete course of incorporation, remodeling, biomechanically inferiority to autograft, the potential risk of an immunogenic reaction and disease transmission. Higher long-term failure rates and poorer graft maturation scores were reported for allografts compared to autografts. An autograft in an ACL reconstruction should remain the gold standard, although the allograft is a reasonable alternative. If adequate length and diameter of autograft can be obtained for an ACL reconstruction, an autograft with adequate graft fixation and postoperative rehabilitation should be chosen instead of an allograft to achieve better results.
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Lipoma arborescens (LA) is a rare lesion that causes joint effusion and pain. LA usually presents as a unilateral knee lesion, and bilaterallesions are extremely rare. LA among adolescent patients is also extremely rare with the disorder having a much higher incidence amongadults. This paper reports a 14-year-old boy who was treated for bilateral knee LA. X-rays revealed the characteristic features of LA in bothknees, and arthroscopic synovectomy was performed to resect the lesions. Postoperative recovery progressed smoothly, and the patientwas eventually relieved of pain and swelling. LA should be considered when adolescent patients present with bilateral pain and swelling,even though this condition is rare in this age group. Furthermore, surgical synovectomy for a complete resection is an appropriate treatmentoption.
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Purpose@#This study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing. @*Methods@#Twenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA). @*Results@#The JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively). @*Conclusions@#Releasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.
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Purpose@#This study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing. @*Methods@#Twenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA). @*Results@#The JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively). @*Conclusions@#Releasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.
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BACKGROUND: Fracture–dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture–dislocations of the PIP joint. METHODS: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture–dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months). RESULTS: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8). CONCLUSIONS: For chronic fracture–dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.
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Femenino , Humanos , Masculino , Brazo , Hilos Ortopédicos , Cicatriz , Legrado , Desbridamiento , Luxaciones Articulares , Dedos , Estudios de Seguimiento , Mano , Articulaciones , Rango del Movimiento Articular , HombroRESUMEN
BACKGROUND: The purpose of this study was to evaluate the usefulness of sonication technique for microbiological diagnosis and the sterility of the recycled autoclaved femoral components from infected total knee arthroplasty (TKA) using a sonication method. METHODS: Nineteen femoral implants explanted from patients with infected TKA were sterilized with a standard autoclave method. Standard culture of the fluid before and after sonication of the sterilized implants was performed to detect pathogenic microorganisms. Additional experiments were performed to evaluate the sterility of the recycled implant by inducing artificial biofilm formation. Methicillin-resistant Staphylococcus aureus (MRSA) was inoculated into 10 implants and sterilization in a standard autoclave was performed, and then the fluid was cultured before and after sonication. RESULTS: Two of the 19 sterilized implants were positive for growth of bacteria after sonication, whereas no growth was detected in the cultured fluid from the sterilized implants before sonication. The bacteria were Staphylococcus species in all two cases. In one of 10 implants inoculated with MRSA, the culture was positive for growth of bacteria both before and after sonication. However, Staphylococcus epidermidis was cultured from both occasions and thus this implant was thought to be contaminated. CONCLUSIONS: We found sonication for identification of pathogens could be helpful, but this finding should be interpreted carefully because of the possibility of contamination. Sterilization of an infected femoral implant with an autoclave method could be a good method for using the temporary articulating antibiotic spacer in two-stage revision arthroplasty.
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Humanos , Artroplastia , Artroplastia de Reemplazo de Rodilla , Bacterias , Biopelículas , Diagnóstico , Infertilidad , Staphylococcus aureus Resistente a Meticilina , Métodos , Sonicación , Staphylococcus , Staphylococcus epidermidis , EsterilizaciónRESUMEN
PURPOSE: This study evaluated the efficacy of a smartphone application in the measurement of rotation angles in porcine knees. MATERIALS AND METHODS: Two K-wires were fixated to the femoral condyle and anterior tibial crest of 10 porcine legs. The angle created between the K-wires with an external rotation force applied was measured on a photograph and defined as the true angle. The same force was applied to the legs placed on a splint with a smartphone attached to the plantar side. The angle presented on a smartphone application was determined as the measured angle. The differences between the true and measured angles in 30° and 90° knee flexion and differences in measured angles depending on the status of the popliteus tendon were compared. RESULTS: In the intact knees, the mean true angles in 30° and 90° flexion were 20.5°±1.4° and 19.1°±1.3°, respectively, and the mean measured angles in 30° and 90° flexion were 21.1°±0.9° and 18.6°±1.6°, respectively. When the popliteus tendon was cut, the mean true angles in 30° and 90° flexion were 31.4°±1.1° and 38.5°±2.5°, respectively, and the mean measured angles in 30° and 90° flexion were 31.8°±1.2° and 39.2°±2.8°, respectively. The differences between the true and measured angles were not significant. The measured angle increased by more than 10° after cutting of the popliteus tendon in both 30° and 90° flexion. CONCLUSIONS: Using a smartphone application could be a good method of measuring knee rotation.