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At least 307 records · Page 17Linked to original sources
PubMed2002

Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees.

Both total knee alignment methods, the anatomic and classic, seek to achieve stability in flexion and extension. However, posterior femoral condyle referencing (anatomic alignment) combined with perpendicular tibial resection (classic alignment) results in a 3 degree relative internal rotation of the femoral component with lateral joint opening. The current cadaver study investigated the influence of total knee alignment methods and femoral component malrotation (3 degrees and 6 degrees internal and external malrotation) on femorotibial laxity. Varus and valgus excursion tests were done at 0 degrees, 30 degrees, 60 degrees, and 90 degrees knee flexion under vertical loading conditions of 150 N. None of the alignments produced increased laxity in extension. The largest laxity was found on the varus test at 60 degrees flexion with the femoral component at 6 degrees internal rotation. A 3 degree internal rotation of the femoral component showed increased varus laxity only for the combined alignment method. This finding shows that the femoral component position of the combined alignment method is a 3 degree relative internal malrotation and that an additional internal malrotation may compromise varus stability. Posterior femoral condyle referencing did not provide proper femoral component rotation. A ligament tensor may be helpful in determining femoral component rotation after soft tissue release in extension is performed.

Arthroplasty, Replacement, Knee↗
PubMed2002

Bone anatomy and rotational alignment in total knee arthroplasty.

The purpose of the current study was to investigate the bone anatomy in determining the rotational alignment in total knee arthroplasty using computed tomography. Axial images of 109 knees in 83 patients with varus osteoarthritis who had total knee arthroplasty were analyzed. On the images of the distal femur and the proximal tibia, a baseline for the anteroposterior axis of each component was drawn based on the epicondylar axis for the femur and the medial (1/3) of the tibial tuberosity for the tibia. The angle between these two lines was analyzed as the rotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Fifty-four knees (49.5%) had an angle of 5 degrees or greater and 13 knees (11.9%) had an angle of 10 degrees or greater. There was a tendency to align the tibial component in external rotation relative to the femoral component. The results indicated that the landmarks of each bone were the intrinsic cause of the rotational mismatch in knees with varus osteoarthritis. Surgeons doing total knee arthroplasties should be aware of this and check the rotational mismatch between the components. When it is present, the tibial component should be realigned to match the femoral component rotation to minimize problems caused by the mismatch.

Aged↗
PubMed2003

Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee.

To assess the reliability of the landmarks for the rotationally neutral alignment of the tibial component in total knee arthroplasty for Japanese patients, the rotational position of the medial (1/3) of the tibial tuberosity relative to the femoral epicondylar line (Angle TT) and that relative to the center of the ankle (Angle TT-AA) were measured in 24 knees with medial femorotibial osteoarthritis and in 28 normal knees by computed tomography. Angle TT-AA shows the degree of medial torsion of the tibia. The range of Angle TT and that of Angle TT-AA each was greater than 40 degrees. The position of the tibial tuberosity and degree of medial torsion of the tibia varied by individual. In patients with severe medial torsion, the internal rotation of the foot is extreme if the medial (1/3) of the tibial tuberosity is used for the rotationally neutral alignment of the partially constrained tibial component. In the treatment specifically of patients from East Asian countries, medial torsion of the tibia should be taken into account in total knee arthroplasty to ensure proper patellar tracking and proper rotation of the foot in knees with medial femorotibial osteoarthritis.

Adult↗
PubMedDate not supplied

Correction of non-Blount's angular knee deformity by permanent hemiepiphyseodesis.

This retrospective study evaluated the results of permanent hemiepiphyseodesis for the correction of non-Blount's coronal plane angular knee deformity. The medical records and radiographs of 75 patients with 125 angular knee deformities were analyzed for overall rate of success and factors predicting successful correction of deformity. There were 38 patients with idiopathic genu valgum and 37 with various other skeletal disorders. Sixty-nine out of 75 patients had reached skeletal maturity at latest follow-up. One hundred six knees out of 125 were successfully treated by the procedure. Of the 19 remaining knees, 15 were operated on too close to skeletal maturity to expect correction and 4 were technically unsuccessful in achieving closure of the targeted physis. There were no complications other than overcorrection, which occurred in 15 knees (11 patients). This study indicates that permanent hemiepiphyseodesis is a very useful procedure if performed in a timely and technically successful manner.

Adolescent↗
PubMedDate not supplied

Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy.

Thirty-four patients with ambulatory spastic diplegia (ages 10-19.8 years) who were part of a prospective study of selective dorsal rhizotomy (SDR) had standardized radiographs before and after SDR. Follow-up ranged from 5 to 11.6 years after surgery. Two different surgical approaches were used: laminectomy (14 patients) and laminoplasty (20 patients). Radiographs were measured for coronal and sagittal balance. Thirty patients had a spinal deformity at long-term follow-up compared with 10 patients before surgery. Seventeen patients (50%) developed lumbar hyperlordosis greater than 60 degrees. Six patients (18%) developed grade 1 spondylolisthesis, Scoliosis occurred de novo in eight patients (24%) and progressed by greater than 5 degrees in two patients with preoperative scoliosis. No significant differences were found between laminoplasty and laminectomy patients. None of the patients have undergone any surgical intervention for spinal deformity. There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.

Adolescent↗
PubMedDate not supplied

Tibial bracing.

Explore the source record for details and available documents.

Bone Malalignment↗
PubMed2003

Incremental diagnostic value of 99mTc methylene diphosphonate bone SPECT in patients with patellofemoral pain disorders.

Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The purpose of this study was to assess the value of single photon emission computed tomography (SPECT) bone imaging compared with arthroscopy in the differential diagnosis of anterior knee pain. Twenty-seven patients with chronic anterior knee pain and 27 age matched control patients were examined prospectively. All patients underwent a detailed clinical history and a thorough physical examination of the knee. Planar and SPECT knee scintigraphy was performed using 99mTc methylene diphosphonate (99mTc-MDP). Subsequently, arthroscopic examination of all three compartments of the affected knee was performed. The association between the scintigraphic findings and arthroscopy was examined statistically. Planar and SPECT scintigrams were classified as follows: focal or diffuse uptake in the patella only (eight patients), uptake in the patella and a corresponding focus in the distal femur (12 patients), and uptake in the patella associated with linear increased activity along the distal femur (six patients). One patient had no patellofemoral SPECT abnormalities. Six of eight patients with isolated increased patellar activity were diagnosed with chondromalacia of the patella, while 2/8 patients had arthroscopic findings unrelated to patellofemoral abnormalities. Seven of 12 patients with corresponding uptake in the patella and distal femur were diagnosed with patellofemoral arthritis. Eleven other patients with corresponding patellar and femoral activity were diagnosed with increased lateral patellar compression syndrome. In these patients the patellar foci were always lateral, and they separated during flexion of the knee. Seven patients had further scintigraphic findings in addition to patellofemoral abnormalities, unsuspected clinically. Nine of 27 patients in the control group (33%) had either focal or diffuse increased patellar uptake. Compared to arthroscopy SPECT imaging had a sensitivity of 100% for patellofemoral abnormalities and a specificity of 64% (negative predictive value, 100%; and positive predictive value, 72%). The overall observed agreement between SPECT and arthroscopy was 81% (kappa=0.63). It is concluded that SPECT imaging of the knee is highly sensitive for the diagnosis of patellofemoral abnormalities. SPECT significantly improves the detection of maltracking of the patella and the ensuing increased lateral patellar compression syndrome. This information could be used to treat patellofemoral problems more effectively.

Adult↗
PubMed2006

Patellofemoral pain syndrome: evaluation of location and intensity of pain.

OBJECTIVES: To identify the sites and intensity of pain in patients with patellofemoral pain syndrome. METHOD: A prospective cohort study was conducted at an academic sports medicine practice in Boston, Massachusetts. All patients met inclusion criteria and were enrolled and evaluated during the study time frame. A single sports medicine orthopaedic surgeon examined a consecutive sample of patients with patellofemoral pain not explained by one of several well-defined anterior knee pain diagnoses. The study group consisted of 100 patients (75 females, 25 males) with median age of 14 years. Eleven discrete locations were palpated for tenderness. Hamstring tightness was evaluated by measuring the popliteal angle. Patients reported intensity of pain using a 0- to 9-point ordinal scale. Regression and nonparametric statistical methods were used. RESULTS: The most common site of pain was the patella during anterior-posterior compression (90 patients), followed by the distal pole of the patella, the medial plica, and the nonarticular medial femoral condyle. Median "worst pain" intensity was 6 out of a possible 9. The most common site of "worst pain" was also the patella in compression (63 patients). Median duration of symptoms was 10 months, with an interquartile range of 3 to 20 months. Pain intensity was inversely correlated with duration of symptoms (P < 0.01). CONCLUSIONS: In these patients with patellofemoral pain syndrome, the major source of pain was the patella subchondral bone.

Adolescent↗
PubMed2003

Treatment of tibia vara by the Ilizarov method.

Sixty-nine lower extremities of 45 patients (mean age, 10 years 8 months) with tibia vara were treated with the Ilizarov circular external fixator and distraction osteogenesis. Twenty-four of the patients had bilateral involvement, six of whom had simultaneous surgery and the remaining 18 had staged operations 8 to 12 months apart. In 11 limbs with femoral valgus deformity greater than 10 degrees simultaneous corrections were done. Active movements of the joints of the extremity were encouraged the day after surgery and partial weightbearing began 2 days later. All patients were followed up 27 to 178 months (mean, 80 months) after surgery. No neurovascular complications, delayed union, or nonunions were observed. The mean 28.6 degrees varus tibiofemoral angle preoperatively (range, 15 degrees -45 degrees ) improved to 7.5 degrees valgus (range, 0 degrees -18 degrees ) postoperatively. The preoperative internal torsion angle also improved from 20.7 degrees (range, 0 degrees -48 degrees ) to 3.5 degrees external torsion (range, 0 degrees -9 degrees ) postoperatively. Residual deformity was seen in six patients, and they had successful revision surgery using the same technique. The Ilizarov method allows early weightbearing and motion and allows all components of the deformity to be corrected.

Adolescent↗
PubMed2003

Radiographic measures in subjects who are asymptomatic and subjects with patellofemoral pain syndrome.

Lateral tilt and displacement of the patella are considered characteristic features of patellofemoral pain syndrome. It has been suggested that abnormal patellar tilt and displacement are detected best with the knee near full extension, which requires computed tomography or magnetic resonance imaging. The objective of the current study was to determine whether alignment abnormalities could be detected in subjects with patellofemoral pain syndrome from axial radiographs obtained at 35 degrees knee flexion using a new, standardized radiographic technique. Thirty-three subjects with patellofemoral pain syndrome and 33 matched control subjects were recruited from a military population. Lateral and axial (unloaded and with quadriceps contraction) radiographs were taken using the Patellofemoral QUESTOR Precision Radiograph system. Measures of patellar tilt and displacement, and anatomic measures (sulcus angle, patellar facet angle, patella alta) were obtained from the radiographs. No significant differences in patellar tilt or displacement were detected between the groups (paired t tests) in either the unloaded or loaded (quadriceps contracted) condition, suggesting that these measures, obtained at this knee angle are not useful diagnostic or outcome measures in patellofemoral pain syndrome. Patellar angle, sulcus angle, and patellar height also did not differ between groups suggesting that these are not etiologic factors in patellofemoral pain syndrome.

Adult↗
PubMed2003

Electromyography of the quadriceps in patellofemoral pain with patellar subluxation.

This study compared muscle activity and timing of gait phases during functional activities in 13 subjects with patellofemoral pain associated with lateral subluxation and in 11 subjects with healthy knees. Fine wire electromyography recorded activity in the vastus lateralis and vastus medialis oblique during walking and ascending and descending stairs. Subjects were filmed to divide the activities into phases and determine timing. The vastus medialis oblique and vastus lateralis had similar patterns during all activities. Subjects with patellofemoral pain had significantly increased activity in the vastus medialis oblique and vastus lateralis compared with the healthy subjects during the most demanding phases of the gait cycle, suggesting a generalized quadriceps weakness in the patients with patellofemoral pain. Timing differences were seen in walking and stair ascending with the subjects with patellofemoral pain spending significantly more time in stance compared with the healthy subjects. This may be an attempt to reduce the load on weak quadriceps. These data reflect a generalized quadriceps muscle weakness, rather than the prevailing theory of quadriceps muscle imbalance as an etiology of patellofemoral pain. Therefore, we support the practice of strengthening the entire quadriceps muscle group, rather than attempting to specifically target the vastus medialis oblique.

Adolescent↗
PubMed2004

Increased external tibial torsion and osteochondritis dissecans of the knee.

In the past, osteochondritis dissecans of the knee was associated with increased tibial exotorsion, established with a clinical measuring method. Now the gold standard for determining tibial torsion is computed tomography. The aim of the current study was to establish whether the abovementioned association could be confirmed in the current patients, measured with computed tomography. Confounding aberrations of femoral torsion were ruled out. Twenty-three patients with osteochondritis dissecans in 27 knees were treated between 1991 and 1999. Symptoms and treatment results were comparable with those reported in the literature. Femoral and tibial torsion were measured with a computed tomography scan. The average femoral antetorsion was comparable with that in the literature. The average tibial exotorsion was significantly higher than the control value. Exotorsion was increased more in patients with bilateral osteochondritis, and extremely high in patients with persisting complaints. Increased tibial exotorsion could play a role in development of osteochondritis dissecans of the knee. Extreme exotorsion might be prognostic for persistent complaints.

Adolescent↗
PubMed2004

Alignment influences wear in the knee after medial unicompartmental arthroplasty.

Failure of a medial unicompartmental arthroplasty may be related to wear of the cartilage in the opposite compartment or to wear in the polyethylene tibial implant. Limb alignment influences both of these factors in the long term. Fifty-eight knees with medial unicompartmental arthroplasties in patients alive at least 10 years postoperatively were evaluated for radiographic changes at their most recent followup. The average duration of clinical and radiographic followups for these patients was 15 years (range, 10-20 years). Alignment was measured preoperatively and postoperatively as the hip-knee-ankle angle on radiographs of the entire limb. An overcorrection in valgus of the preoperative deformity (hip-knee-ankle angle > 180 degrees was associated with an increased risk of degenerative changes in the opposite compartment. Severe undercorrection in varus of the deformity (hip-knee-ankle angle < 170 degrees) was associated with increased wear in the tibial component and recurrence of the deformity which was indicative of polyethylene wear. For medial implants that were implanted in moderate varus (hip-knee-ankle angle of 171 degrees to 179 degrees) the rate of wear of the polyethylene was less than in knees with severe undercorrection and the risk of degenerative changes in the opposite compartment was low.

Analysis of Variance↗
PubMed2005

Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty.

A method for taking an axial radiograph of the distal femur was developed to see the epicondyles and posterior condyles of the femur. It was hypothesized that these radiographs would be acceptable for evaluating rotational alignment in total knee arthroplasty with comparable reproducibility and good correlation to the results obtained with computed tomography images. Radiographs were obtained of 50 knees in 32 patients having total knee arthroplasty. The radiographs were taken while the patients were with the knee in 90 degrees flexion. The angle between the clinical epicondylar axis and the posterior condylar axis (twist angle) was measured and compared with the results obtained by conventional computed tomography. The interobserver variation in the axial radiography was less than or comparable to the computed tomography method. The mean discrepancy between the two methods (+/- standard deviation) was 0.5 degrees +/- 0.4 degrees (range, 0-1.9 degrees ), and a strong correlation was observed. This plain radiography is acceptable for evaluation of femoral component rotation with comparable reproducibility and correlation to the results with computed tomography. It has several advantages regarding cost, radiation dose, and lack of scatter when used for postoperative assessment.

Adult↗
PubMed2005

Case report: Radial overgrowth and deformity after metaphyseal fracture fixation in a child.

Pediatric fractures sometimes are complicated by growth disturbances. Most reported growth disturbances are in the lower extremity and can entail growth arrest or overgrowth. We report a case of overgrowth and angular deformity after an extraphyseal distal radius fracture that resulted in clinically significant pain and functional impairment because of palmar instability of the distal ulna. A dome osteotomy was successful in treating the patient's wrist pain, distal radioulnar instability, and multiplanar deformity of the distal radius.

Adolescent↗
PubMedDate not supplied

Accuracy of correction of tibia vara: acute versus gradual correction.

The purpose was to assess the accuracy of deformity correction achieved in patients with tibia vara using acute intraoperative correction compared with gradual postoperative correction. Acute correction (AC) group consisted of 14 patients (14 tibiae) with a mean age of 11.4 years and whose tibia vara was corrected acutely and held using an EBI external fixator. Gradual correction (GC) group consisted of 18 patients (18 tibiae) with a mean age of 10.2 years and whose tibia vara was corrected gradually using 6-axis deformity analysis and Taylor Spatial Frame. Deformity measurements were compared preoperatively, postoperatively, and at latest follow-up. At latest follow-up, medial proximal tibial angle deviation from normal was similar for the 2 groups; posterior proximal tibial angle was significantly greater in the AC group (5.6 degrees) than in the GC group (1.9 degrees). Mechanical axis deviation was significantly greater in the AC group (17.1 mm) than in the GC group (3.1 mm). Postoperatively, frequency of accurate translation corrections (achieved translation within 5 mm of preoperative required translation) was significantly greater in the GC group (18/18) than in the AC group (7/14). Frequency of accurate angulation corrections (medial proximal tibial angle within 3 degrees of normal and posterior proximal tibial angle within 5 degrees of normal) was significantly greater in the GC group (17/18) than in the AC group (7/14). For both groups, all tibiae with preoperative internal rotation deformity had accurate rotation correction. Correction of preoperative limb-length inequality was achieved in 5 of the 7 patients in the AC group and 11 of the 11 patients in the GC group. Gradual deformity correction is a more accurate treatment method of tibia vara than acute correction.

Adolescent↗