In a clinical and radiographic survey of the elbows of 120 pitchers ages 11 and 12, 20% were found to have symptoms, 10% flexion contractures, and 23% roentgenographic changes related to traction stresses on the medial side of the elbow. Five per cent had more serious lateral compression findings related to the radial head or capitellum, but none of these had symptoms. Although this represents a definite incidence of abnormal occurrence, there were no statistically significant correlations or interrelations found relating to pitching experience, valgus elbow deformities, symptoms, flexion contractures, or x-ray findings.

Age Factors↗

PubMedDate not supplied

Rotary mechanics after pes anserinus transplant: a method for dynamic assessment.

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Athletic Injuries↗

PubMedDate not supplied

Limited arthrography in acute knee injuries.

Fifty consecutive limited arthrograms in acute knee injuries are reported with operative findings in 27 knees. The arthrograms were completely accurate regarding cruciate and medial collateral ligament integrity in 82% of all of the cases. Improvements in technique and recognition of superimposed anatomical structures led to fewer errors in interpretation as the series progressed. Limited arthrography is recommended as a useful office procedure in the early evaluation of knee ligament integrity in acute painful knee injuries.

Adolescent↗

PubMedDate not supplied

Posterior cruciate ligament injuries. Results of early surgical repair.

A retrospective study of 20 patients (19 men and one woman) with clinical diagnosis of posterior cruciate ligament injuries (seen between December 1969 and September 1977) was conducted. Eighteen patients underwent surgery an average of 2.6 days after injury. Tears of the posterior cruciate ligament were confirmed in all patients and a high incidence of associated ligamentous injuries was noted. No cases of truly isolated posterior cruciate injury were found. The posterior drawer sign was the most accurate test for posterior cruciate disruption. Torn posterior cruciate ligaments, as well as associated ligamentous injuries, were repaired to bone when possible. Irreparable disruptions or unstable repairs were reinforced with dynamic tendon transfers. We prefer to use as a tendon transfer the medial one-third of the medial head of the gastrocnemius because it provides static posterior drawer resistance and functions dynamically. The average follow-up period was 30.8 months. A comparison of preoperative and follow-up stability was made and it revealed that all patients exhibited mild residual instability. A functional rating showed that seven patients had excellent results, seven had good, three had fair, and one patient had poor results among those surgically treated. One patient treated conservatively rated good. The other one was lost to followup. The results of our study demonstrate that early surgical repair with dynamic augmentation, as indicated, can lead to acceptable functional results in the majority of knees with posterior cruciate ligament injury.

Accidents, Traffic↗

PubMedDate not supplied

Presidential address of the American Orthopaedic Society for Sports Medicine.

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Orthopedics↗

PubMedDate not supplied

Reconstruction procedures for anterior cruciate ligament insufficiency: a computer analysis of clinical results.

A pre- and postoperative study of 205 patients who had surgical reconstruction of the anterior cruciate ligament (ACL) of the knee was evaluated with the use of a prototype computer program. An average followup of 4.1 years revealed a 27% improvement in subjective complaints and a 8% improvement in objective findings. The anterior drawer test was improved 25% and subluxation of the lateral tibial plateau (ALRI) was improved 118% correlating highly (P less than 0.001) with a good result. Seventy-four percent of patients had undergone medial meniscectomy, 58% lateral meniscectomy, and 41% had both menisci removed at followup after reconstruction. Ninety-two percent of the 121 patients responding to a final subjective complaint evaluation felt that their knee was significantly improved (average 6.1 years after reconstruction). The computer demonstrated a wide variation in the results of reconstruction within the intraarticular, extraarticular, and combined groups. The addition of associated procedures to the main reconstructive procedure significantly affected the results. This study reveals improvement of subjective complaints and objective findings after reconstructing the anterior cruciate ligament and proposes the use of computer analysis for specific evaluation of different procedures.

Adolescent↗

PubMedDate not supplied

Anterior cruciate reconstruction in the chronically unstable knee using an expanded polytetrafluoroethylene (PTFE) prosthetic ligament.

The purpose of this study is to review 30 patients with failed, multiply operated knees, or knees with gross instability which were reconstructed using the expanded polytetrafluoroethylene (PTFE) prosthetic ligament as a substitute for the ACL. The results were then compared with our experience with the proplast ligament used in a previous clinical series. This prospective review evaluated the patients preoperatively and at regular intervals during the postoperative period. The average followup was 24 months postoperation. Eighty-three percent of the patients had a satisfactory result, scoring greater than 140 points on a 200 point knee grading scale. Objectively, the anterior instability pattern was improved in 87% of the knees. Subjectively, pain of at least a mild degree persisted in 70% of the patients postoperatively. This pain seemed to correlate with articular cartilage changes documented intraoperatively. Major complications occurred in two patients. In conclusion, the PTFE prosthetic ligament was an improvement over the proplast ligament in the reconstruction of the multiply operated, unstable knee. The 83% satisfactory rate with the PTFE was promising compared to a 52% satisfactory rate using the proplast ligament. However, we encourage future long term studies of the PTFE prosthetic ligament in the reconstruction of the ACL in the chronically unstable knee.

Humans↗

PubMedDate not supplied

Long-term evaluation of knee stability and function following surgical reconstruction for anterior cruciate ligament insufficiency.

Currently used measures of knee stability and function for ACL reconstructed knees have not gained universal acceptance. Clinical test results often are given more value than the patient's subjective evaluation of the surgical outcome. This study was designed to identify specific knee stability and function variables that were most predictive of the patient's rating of knee function following one of two types of combined (intraarticular and extraarticular) ACL reconstruction procedures. Individual measures of knee stability and function were also evaluated for differences between contralateral operated and nonoperated limbs. Postoperative and healthy contralateral knees of 51 male and female patients aged 18 to 49 years (mean, 23.7 years) were evaluated on a battery of tests at an average of 48.0 months after surgery (range, 24 to 101 months). All subjects possessed a normal contralateral knee for comparative purposes. The results of this retrospective study indicated that the variables selected were not highly correlated with, nor could they effectively predict, the patients' perceptions of postoperative knee status as measured by the Knee Function Rating Form (KFR). Statistically significant differences (P less than 0.001) between operated and nonoperated knees were found for 9 of 11 variables analyzed. The data suggest that patients' perceptions of postoperative knee status were independent of the results of static and dynamic clinical tests commonly used to assess knee stability and function. Postoperative deficits of up to 30% between the surgically reconstructed and normal contralateral knees on specific measures of knee stability and function did not greatly influence the patients' perceptions of knee function. Development of new, more specific dynamic tests may be necessary before stronger relationships between clinical test results and patients' perceptions of knee status in the ACL reconstructed knee can be realized.

Adolescent↗

PubMedDate not supplied

Retrospective direct comparison of three intraarticular anterior cruciate ligament reconstructions.

A long-term retrospective study (minimum 5 years) was done looking at three groups of anterior cruciate deficient knee patients using both subjective and objective anterior cruciate tests. Twenty-seven chronic anterior cruciate ligament deficient knees reconstructed with the middle third of the patellar tendon and 28 chronic anterior cruciate ligament deficient knees reconstructed with the semitendinosus tendon were included in this consecutive group of patients and were felt to be directly comparable. It was found that the chronic anterior cruciate ligament deficient group reconstructed with the semitendinosus tendon had 4 excellent, 10 good, 7 poor, and 7 failures with an objective score averaging 4.5 of a possible 12, while the comparable group reconstructed with the middle third of the patellar tendon had 16 excellent, 7 good, 3 poor, and only 1 failure with a score of 10 of a possible 12 (P less than 0.0032). For completeness sake, 20 anterior cruciate deficient knees from this group of consecutive patients that were reconstructed acutely with the semitendinosus tendon were also examined. This group had 8 excellent results, 9 good, 3 poor, and no failures with a score of 9.8 (P less than 0.03 compared to the other group using the semitendinosus tendon). This comparison between the two groups where the semitendinosus tendon was used in the anterior cruciate ligament reconstruction was made only to show the difference between studies dealing with knee reconstructions. There may be a significant difference between a study dealing with acutely reconstructed knees versus one focusing on chronically reconstructed knees, most likely because of both patient selection and time between injury and reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

Physical examination in the diagnosis of rotatory instability.

Various tests are used to evaluate rotatory instability. Anteromedial rotatory instability (AMRI) is detected by performing an anterior drawer test with the foot in external rotation. Excessive anterior rotation of the medial tibial plateau indicates laxity of the medial structures. Anterolateral rotatory instability (ALRI) is a manifestation of an anterior cruciate ligament (ACL) deficient knee. The functional disability produced is the pivot shift phenomenon, which is elicited by the MacIntosh, jerk, ALRI, FRD, and Losee tests. Posteromedial rotatory instability is checked by noting a posteromedial displacement of the medial tibial plateau with a valgus stress. This is a relatively unusual type of instability, although it may be part of a severe valgus type. Posterolateral rotatory instability is evaluated by the external rotation recurvatum, posterolateral drawer, and reverse pivot shift tests. The abnormalities produced by these tests will clarify the method to correct the functional deficiency.

Humans↗

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The patellar compression syndrome: surgical treatment by lateral retinacular release.

Patellar compression syndrome may be a manifestation of contraction of the lateral retinacular structures which consists largely of the lateral patellofemoral ligament producing a tethering action on the patella. This may produce parapatellar pain, particularly in activities requiring repetitive knee flexion. Minor patellofemoral incongruencies with pain, grating, and functional limitation may be found on examination but the patient does not demonstrate the problems of instability of marked congenital abnormalities often seen with other patellar problems. Forty patients underwent a simple release of the lateral retinaculum to decompress the patella in the patellofemoral groove. Follow-up was obtained in 31 patients at an average of 18.3 months after surgery. Twenty-four knees which had severe preoperative pain were converted to 6 with no pain, 4 with mild pain, 11 with moderate pain and 3 whose pain remained unchanged after surgery. Twenty knees with moderate preoperative pain were changed to 4 with no pain, 11 with mild pain and 4 whose pain remained unchanged. Thirty-seven of the 45 knees had lessening of the pain after the operation and 10 patients returned to unrestricted atheletic activities.

Adolescent↗

PubMedDate not supplied

Combined instabilities of the knee.

A knee with a combination of instabilities in very difficult to restore to a completely stable condition. The ligamentous structure of the knee is a functional unit. Laxity in any of the planes of the knee motion can produce increased stretching and stress to the structures, which help to provide stability in the other planes. Since it is almost impossible to restore the knee to the pre-injury state, residual laxity in different planes of motion is going to produce increasing stress to the other components, which may have been restored to a greater degree of stability. This emphasizes the importance of a good muscular rehabilitation program and a dynamic component to knee reconstructive procedures to protect against this eventuality. Passive laxity, if present, should not be taken as a sign of failure of the procedure. Often the patient's assessment of his functional capabilities have improved after the reconstructive procedures.

Casts, Surgical↗