Biomedical subjects
Publications and source records attributed to Burak Beksac.
The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a very rare condition in children. An isolated avulsion fracture of PCL in a child and its repair by open reduction and internal fixation with a screw is reported.
Limitation of motion after knee arthroplasty can be the result of a multiplicity of factors. Among these are malpositioning of the components, especially in the sagittal plane; oversizing at the patellofemoral or tibiofemoral joint spaces; retaining posterior osteophytes; and persisting with a tight posterior cruciate ligament. Postoperatively, problems with physical therapy likewise can cause limitation of both extension and flexion. Specific patient factors also may affect the range of motion after surgery. Although most patients achieve a postoperative flexion that is highly correlated to that which was present preoperatively, factors such as pain, obesity, and deformities of adjacent joints may limit such motion.
Between September 2001 and September 2002, forty consecutive minimally invasive total knee replacements were done. A modified midvastus approach was used and the patella was subluxed, but not everted. We compared the results of this group with an age-matched and sex-matched cohort of total knee replacements done between June 2000 and September 2001 with a standard technique. A posterior-stabilized knee (Genesis II) was used in both groups. Patients achieved motion considerably faster in the minimally invasive total knee replacement group. Mean flexion for minimally invasive total knee replacement at 6 and 12 weeks was 114 degrees (range, 90-132 degrees ) and 122 degrees (range, 103-135 degrees ) respectively, compared with 95 degrees (range, 65-125 degrees ) and 110 degrees (range, 80-125 degrees ) for the control group. Improved range of motion was also seen at one year postoperatively. The average range of motion at one year postoperatively in the minimally invasive total knee replacement was 125 degrees (range, 110-135 degrees ) compared with 116 degrees (range, 95-130 degrees ) in the Control Group. Postoperative Knee Society scores were also higher in the minimally invasive total knee replacement group. There was no difference in xray alignment. There were no infections, extensor mechanism or neurovascular complications. The mini midvastus approach without patella eversion combined with a small incision was associated with a more rapid functional recovery and improved range of motion in total knee replacement without compromising implant positioning.
Total knee replacement traditionally has been done through an anterior incision approximately 18 cm long, using a capsular incision that separates the interval between the rectus femoris and vastus medialis musculature. Although giving excellent exposure, this incision also disrupts the suprapatellar pouch and may lead to adhesions and difficulty with rapidly regaining flexion. It is hypothesized that, by using a more minimally invasive incision, there will be a more rapid return of flexion and the patient will require fewer narcotic medications postoperatively. This retrospective review compared 32 total knee replacements done through a minimally invasive mini-midvastus approach with 26 total knee replacements done through the standard medial parapatellar approach. Preoperative Knee Society scores and postoperative functional outcomes were compared. Postoperative flexion was measured daily during hospitalization and at a 6-week and 3-month followup. Pain was assessed by a visual analog scale and the amount of pain medication used during hospitalization. Implant position was measured. The MIS group had an average skin incision length of 12.8 cm. Passive flexion on a daily basis was significantly higher in the MIS group compared with the standard group. At 6 weeks postoperatively, the change in Knee Score was statistically higher in the MIS group and the average visual analog pain score and the total amount of pain medication was lower. The radiographic alignment and position of all the components was normal in all patients in both groups. The limited disruption of the extensor mechanism results in more rapid restoration of the quadriceps muscle control.