The anterior cruciate ligament--current concepts.
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Anterior Cruciate Ligament↗
Biomedical subjects
R L Allum
Publications and source records attributed to R L Allum.
BASK Instructional Lecture 1: graft selection in anterior cruciate ligament reconstruction.
It is important to realise that the anterior cruciate ligament (ACL) is a living structure which at the present time cannot be truly replaced. It has a purpose built, unique anatomical structure with a blood supply and nerve supply including proprioception and no substitute currently available can fulfill all of these functions.
Anterior Cruciate Ligament↗
Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction.
Proponents of hamstring anterior cruciate ligament (ACL) reconstruction suggest that anterior knee symptoms (AKS) may be less than following the use of bone-patella-bone autograft. Our aim was to assess the incidence of AKS in a cohort of patients who had undergone hamstring reconstructions. Forty-four of 50 consecutive patients who had undergone arthroscopically assisted four-strand gracilis/semitendinosus hamstring ACL reconstructions were reviewed at a minimum follow-up of 24 months. The frequency and severity of anterior knee pain experienced during activities of daily living, sports, prolonged sitting, stair-climbing and kneeling was recorded by means of the Shelboume and Trumper anterior knee pain questionnaire. The location of both pain and any perceived sensory change was recorded using patient-drawn diagrams. Although mild or moderate symptoms occurred in a proportion of patients, only 2% experienced significant symptoms that caused limitation with daily activity, 7% with strenuous work or sport, 12% with kneeling, 5% with stairs and none with prolonged sitting. The pain was not specifically related to the incision for tendon harvest and drilling of the tibial tunnel. Areas of sensory change over the front of the knee were identifiable in 50% of patients, and of these, 86% demonstrated sensory change in the distribution of the infragenicular branch of the saphenous nerve. Although rarely a cause of limitation of activity, AKS can be a problem after hamstring ACL reconstruction and patients should be counselled accordingly.
Adolescent↗
Taking the advanced knee arthroscopic surgery course to Singapore.
The Advanced Knee Arthroscopic Surgery course was first organised in 1995 under the joint auspices of the British Association for Surgery of the Knee and The Royal College of Surgeons of England. This is a two-day course in advanced knee arthroscopic techniques, with lectures, videos and extensive practical sessions. The approach is very much hands-on, using cadavers together with sawbones and model knees. Use is also made of the specimens in the Anatomical Museum of the College. Instruction is given in anterior cruciate ligament reconstruction, meniscal repair and posterior cruciate with posterolateral ligament reconstruction. Since 1995 the course has been held on seven occasions and has been attended by over 100 senior trainees and consultants.
Arthroscopy↗
MRI of the knee: its cost-effective use in a district general hospital.
In the first year of magnetic resonance imaging (MRI) scanning of the knee in the East Berkshire Health District, 175 patients were scanned and 79 of these subsequently had an arthroscopy performed. We found that MRI accurately demonstrated the pathology present in the knee, particularly for meniscal lesions, although it was less accurate for anterior cruciate and cartilage lesions. The relative costs of MRI scanning, arthroscopy and conservative treatment are compared. On the basis of this analysis we have worked out a protocol for the cost-effective use of MRI in imaging the knee. This protocol has reduced the number of arthroscopies performed, allowing us to expend resources on patients who would definitely benefit from arthroscopic surgery.
Arthroscopy↗
Relevance of history of injury to the diagnosis of meniscal tears.
A consecutive series of 217 arthroscopic meniscectomies has been reviewed in order to investigate the incidence of significant meniscal lesions without obvious precipitating injury. There were 10 bucket handle tears out of 117 (9%) with a mean age of 32 years with no significant injury; 18 flap tears out of 69 (26%) with a mean age of 40 years; and 7 out of 19 (37%) radial tears with a mean age of 36 years also had no significant injury. This study indicates that the absence of a history of injury in the young patient with a symptomatic knee does not exclude significant meniscal tears, such as a bucket handle, and therefore has implications for history taking and diagnosis.
Adolescent↗
Acute traumatic haemarthrosis of the knee: expectant treatment or arthroscopy?
We have prospectively studied 50 patients with an acute traumatic haemarthrosis of the knee to investigate the place of examination under anaesthesia and arthroscopy in a district general hospital. There was a wide spectrum of injury to the knee, and 30% of patients required operative procedures. These important injuries could not be diagnosed reliably on initial clinical examination. We conclude that in the active patient under 35 years of age this policy allows prompt and appropriate treatment.
Acute Disease↗
Ankle motion after external fixation of tibial fractures.
Loss of ankle movement is a complication of severe tibial fractures. This can be exacerbated if the foot is allowed to drop into equinus, particularly when an external fixator is employed. The range of ankle motion following external fixation of tibial fractures as compared to the opposite normal ankle was studied in 40 of 55 patients treated over a ten-year period. Nine were excluded due to other causes of ankle stiffness, leaving 31 cases for analysis. The mean follow up was 2 years 7 months (range 1 year to 8 years 3 months), and union had occurred by a mean of 35 weeks (range 9-100 weeks). The mean loss of ankle movement was 8 degrees of plantar-flexion and 12 degrees of dorsiflexion (overall loss 20 degrees), the difference between the two being highly significant (P greater than 0.001, t test). Loss of ankle motion closely paralleled the degree of soft tissue trauma, being 6 degrees for closed fractures and 22 degrees for open fractures (0.05 greater than P greater than 0.02). Ankle function is therefore at risk when a severe tibial fracture is treated by external fixation, and appropriate measures should be taken to preserve movement and prevent an equinus contracture.
Ankle Joint↗
Day case arthroscopy and arthroscopic surgery of the knee.
A Day Case Unit was opened at Wexham Park Hospital in October 1985 and this paper describes the first year's experience in arthroscopy and arthroscopic surgery. Ninety nine knees in 96 patients were examined. The predominant diagnoses were lesions of the medial meniscus (33%), ruptures of the anterior cruciate ligament (30%) and lesions of the lateral meniscus (20%). Fourteen knees (14%) were normal. There was one postoperative infection, 3 patients had troublesome effusions and one patient developed a synovial fistula. Two patients required overnight admission. The waiting list was reduced from 14.7 weeks to 3.0 weeks. The advantages and limitations of this technique is discussed.
Adolescent↗
The locked knee.
Fifty patients presenting themselves with a locked knee were investigated prospectively by examination under anaesthesia and arthroscopy. Definite abnormality was found in 92 per cent. Torn menisci were present in 68 per cent and isolated ruptures of the cruciate ligament in 10 per cent. Loose bodies were found in 3 patients, degenerative changes alone in 2 patients and a pathological medial synovial shelf in 1 patient. No abnormality was demonstrated in 8 per cent. Sixteen per cent of the knees remained locked following the induction of anaesthesia. This study demonstrates that a true mechanical block is not necessarily present and that the position of an unstable meniscal fragment is not consistently related to the fixed position of the knee under anaesthetic. There were no clinical features that allowed the normal knees to be distinguished preoperatively from those with internal derangement. It is proposed that these patients should be managed by prompt examination under anaesthesia, arthroscopy and definitive surgery.
Adolescent↗
Simple lateral release in treatment of tennis elbow.
The records of 340 patients with a clinical diagnosis of tennis elbow were surveyed and the results of conservative treatment assessed. Of 157 patients successfully treated by local steroid injections, 92% achieved their good result after one or two injections. Repeated injections were not helpful. Simple lateral release of the common extensor origin was carried out on 42 elbows in 37 patients. Thirty-seven elbows in 32 patients were personally reviewed. Satisfactory pain relief was achieved in 33 elbows (89%). There were no significant complications.
Adult↗
Implant-induced trabecular damage in cadaveric femoral necks.
After insertion of Newman's pins, Smith-Petersen nails and compression hip screws into human cadaveric proximal femora, the area of trabecular damage was measured. The nail and hip screw caused four times the area of damage seen with Newman's pin. The Smith Petersen nail caused significant peripheral damage which was undetectable radiographically.
Bone Nails↗
The development of an unconstrained elbow arthroplasty. A clinical review.
This paper describes the development, operative technique and results of an unconstrained total elbow arthroplasty. Forty-seven elbow replacements were carried out in 44 patients between 1974 and 1982. There was a high rate of loosening in the early condylar replacements. The results in patients with post-traumatic arthritis were poor. The later design employs an ulnar stem, with a humeral stem if the distal humeral bone stock is poor. When used in carefully selected patients with rheumatoid arthritis, pain is reduced significantly, stability and movement are preserved and function is improved.
Adult↗
Keller's operation with basal osteotomy of first metatarsal.
A retrospective survey was carried out to assess the results in the middle aged and elderly of an operation for hallux valgus which combined a basal osteotomy of the first metatarsal with a Keller's procedure. Mean follow up in 34 patients (54 feet) was 3.2 years. The correction of both the hallux valgus and the varus angle of the first metatarsal was found to be satisfactory. The advantages and disadvantages of the operation are discussed.
Adult↗
A retrospective review of the healing of fractures of the shaft of the tibia with special reference to the mechanism of injury.
A retrospective review of 500 fractures of the tibia was undertaken. In 316 adults we assessed the influence of various forms of violence on the rate of healing and the incidence of complications in fractures of the shaft of the tibia. Other factors pertinent to fracture healing in the shaft of the tibia were also investigated and their relative importance was assessed.
Accidents, Traffic↗
Skateboard injuries: a new epidemic.
Forty-six injuries caused by skateboards were seen in 3 months; these were predominantly fractures and sprains of the distal part of the limb caused by indirect violence. These injuries are likely to become common. They occur most frequently when the skateboard hits a stone or other irregularity on the surface used.
Accident Prevention↗