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At least 451 records · Page 25Linked to original sources
PubMed1994

Posteromedial pivot shift of the knee: a new test for rupture of the posterior cruciate ligament. A demonstration in six patients and a study of anatomical specimens.

A new test--the posteromedial pivot-shift test--was used to demonstrate a rupture of the posterior cruciate ligament of the knee in six patients. An anatomical study of seventeen specimens showed that in order for the posteromedial pivot shift to occur, the posterior collateral ligament, the medial collateral ligament, and the posterior oblique ligament must be cut; if one of these three ligaments is intact, the subluxation will not occur.

Adolescent↗
PubMed1993

[Ligaments of the knee].

The authors study the various ligaments of the knee and, for each one, the anatomy, mechanisms of injury, clinical diagnosis, indications for imaging (plain x-rays, arthroscopy, MRI). The anterior cruciate ligament and posterior cruciate ligament are best visualised by MRI. The tibial collateral ligament and fibular collateral ligament are also well visualised by MRI. The value of the posteromedial and posterolateral angle points, stabilising functional structures, is emphasised together with the important diagnostic distinction between isolated ligamentous lesions and associated lesions. MRI constitutes the best imaging technique for assessment of the lesions. It completes the clinical examination and should be performed early.

Anterior Cruciate Ligament↗
PubMed1995

Magnetic resonance imaging of knee ligaments.

Magnetic resonance imaging is a noninvasive and nonionizing imaging modality that has made a significant contribution to our understanding of musculoskeletal injury. With technological advances, sequences have become more accurate and valuable in providing information for the clinician. This information often can guide diagnosis and treatment. The decision to use MRI technology over other modalities is based on cost, availability, information required, and observer interpretation. The risk exists, however, for abuse of this expensive technology at a time when health-care dollars are becoming more scarce. It should never be used as a substitute for sound clinical judgment in the form of careful history taking and thorough physical examination. Also, it should be used when a patient management or intervention will be altered based on the information obtained. The future management of knee ligament injury undoubtedly will be shaped by MRI and its related technologies.

Anterior Cruciate Ligament↗
PubMed1997

MR imaging of the knee ligaments and the postoperative knee.

MR imaging is an accurate, noninvasive, and cost-effective method for the evaluation of acute knee ligament injuries and in the examination of the postoperative knee. Understanding the normal anatomy and the pertinent clinical aspects of knee injuries is a prerequisite for accurate interpretation of MR imaging studies. The increasing popularity of ACL reconstruction following disruption of this ligament requires knowledge of the various surgical techniques and their MR imaging appearance as well as the appearance of possible complications.

Anterior Cruciate Ligament↗
PubMed1997

[The medial collateral ligament of the knee].

Injuries of the medial collateral ligament (MCL) of the knee are easily diagnosed on clinical grounds. These lesions are generally treated conservatively. Radiological examinations are generally unhelpful. However, injuries of the MCL may be associated with those of many other ligaments of the knee in the case of complex strain of the knee so that the clinical diagnosis may be challenging; in some cases, surgical repair of associated lesions is indicated. In these cases of multiple ligamentous injuries, a radiological study of ligamentous abnormalities may be of interest. The anatomical background and the different radiological findings including those of X-rays, US, arthrography and MRI, obtained in patients with injuries of the MCL, are described; radiological differentiation of ruptures of the MCL with or without knee instability is emphasized.

Arthrography↗
PubMed1996

A comparison of isokinetics and muscle strength ratios following intra-articular and extra-articular reconstructions of the anterior cruciate ligament.

A prospective, randomized clinical trial was conducted to compare an intra-articular with an extra-articular reconstruction of the anterior cruciate ligament. Isokinetic muscle testing was carried out 6 months to 2 years following operation using the Biodex isokinetic dynamometer. The extra-articular procedure resulted in a lower deficit for the peak quadriceps and hamstring torques and the range of motion.

Adult↗
PubMed2006

Accuracy of magnetic resonance imaging of the knee and unjustified surgery.

Magnetic resonance imaging of the knee is greater than 90% accurate in detecting intraarticular disease when performed and interpreted by musculoskeletal magnetic resonance imaging specialists in specialized medical centers. However, independent imaging institutions often offer less expensive services to health insurers. We wondered if the magnetic resonance imaging performed in our community is of equivalent quality and accuracy. We studied a homogenous group of healthy, young, and fit military recruits to represent a cross section of our country's population. We analyzed all knee magnetic resonance images of soldiers who subsequently had primary arthroscopic knee surgery within a 3-month period from 1997-1998. The results were compared with surgical findings of four structures: medial meniscus, lateral meniscus, anterior cruciate ligament, and articular cartilage. Of the 1185 arthroscopies and 633 magnetic resonance images of the knee performed in 14 institutions, 139 paired magnetic resonance imaging arthroscopic reports met our inclusion criteria. The results showed a false positive rate of 65% for the medial meniscus, 43% for the lateral meniscus, 47.2% for the anterior cruciate ligament, and 41.7% for articular cartilage disease when compared with surgical findings. Accuracy rates were 52%, 82%, 80%, and 77%, respectively. Thirty-seven percent of the operations supported by a significant disorder on magnetic resonance imaging were unjustified. Our findings highlight the consequences that may occur when basing medical care on cost rather than quality of care.

Adult↗
PubMed1989

[Plastic surgery of the anterior cruciate ligament: experimental study of intra-articular aramid fibers in dogs].

The authors explored the possibility of replacing an anterior cruciate ligament with an aramid fiber (Kevlar) implant. This study was performed in intra-articular site in 9 dogs and the average implantation period was 5 months. Studies were carried out by macroscopic, photon microscopy, and electron microscopy examination of the samples obtained at the time the animals were sacrificed. Clinical and radiographic studies of the knees were performed in order to assess functional consequences. Overall, the results showed a partial or complete rupture of 10 neoligaments out of the 17 studied ligaments; on the other hand, osseous anchorage and reintegration in the intra-articular zone appeared satisfactory. Kevlar fiber only partially meets the performance specifications for an artificial ligament intended to serve as an anterior cruciate ligament substitute. Some positive results have encouraged the authors to carry on further this experimental study.

Animals↗
PubMed2003

[Management of complex distal radius fractures].

Complex injuries of the distal radius can be associated with articular comminution, severe soft tissue injury, large metaphyseal and/or diaphyseal bone defects, carpal ligament tears or its combinations. We recommend a standardized three step approach for the management of these severe injuries: external fixation as an emergency procedure; treatment of soft tissue damage and further diagnostics as needed; definitive adapted operative therapy after thorough analysis of the specific injury.

Bone Plates↗
PubMedDate not supplied

Computer-assisted tomography of the knee.

The potential contributions and limitations of computer-assisted tomography of the knee have been analyzed. The knee was examined in the transaxial, sagittal, semi-sagittal and coronal planes. The positioning for obtaining intra-articular detail is outlined, and the indications are discussed. Delineation of the cruciate ligaments is remarkably clear and clinically applicable. The menisci can be demonstrated, but improvement in spacial resolution and changes in the physical construction of the scanner will be required to permit an adequate clinical evaluation.

Evaluation Studies as Topic↗
PubMed2005

The ABJS 2005 Nicolas Andry Award: osteoarthritis and injury at the base of the human thumb: survival of the fittest?

The basal joint complex, consisting of four trapezial articulations providing a foundation for the thumb, defines our anatomic evolution from a Simian ancestry by providing an opposable member. Ironically, the trapeziometacarpal joint also is responsible for the most common malady leading to operative reconstruction in the upper limb for arthritic disease. The paradoxic relationship between these two facts has stimulated investigation that has defined the scientific basis for common surgical procedures and provided a foundation for the development of novel treatments for conditions at the base of the thumb. Patterns of articular surface degeneration are determined by areas of contact loading in the joint. Ligament reconstruction, metacarpophalangeal joint flexion splinting, and extension metacarpal osteotomy for early disease resulting from instability all have biomechanical justification for their clinical application. Likewise, percutaneous pinning of Bennett's fracture dislocation is predicated on reestablishing functional continuity of the beak ligament and unloading the palmar joint surfaces. For advanced disease, ligament reconstruction has become the cornerstone of arthroplasty. Perhaps most importantly, the trapeziometacarpal joint as an instability model can provide insight into the interplay of mechanical and biological factors in producing the primary lesion associated with osteoarthritis.

Awards and Prizes↗
PubMed2004

Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes.

PURPOSE: Malleolar fractures have been reported to be associated with a poor prognosis even when the anatomic reduction is complete. Soft tissue injuries such as damage to the cartilage and ligaments, soft tissue impingement, and the existence of free bodies within the intra-articular space account for this poor outcome. In treating fresh malleolar fractures, an arthroscope is used at our institution to confirm anatomic reduction on the articular surface and treat intra-articular injuries. This study evaluated the arthroscopic findings and surgical outcome for fresh malleolar fractures. TYPE OF STUDY: Prospective case study. METHODS: The subjects were 105 patients (105 joints) who had experienced malleolar fractures and had undergone surgical fixation between January 1996 and May 1999. Arthroscopy was used to confirm the fracture line, cartilaginous damage, presence of detached cartilaginous fragments in the articular space, ligament damage, and diastasis of the distal tibiofibular joint. The cartilaginous damage was treated using shaving, and the free cartilaginous fragments were excised. Diastasis of the distal tibiofibular joint was treated using distal tibiofibular joint fixation, using a screw. Fracture fixation was conducted after anatomic reduction had been confirmed using fluoroscopy and arthroscopy. RESULTS: Cartilaginous damage was noted in 21 patients, among whom 13 were treated by shaving and 8 underwent cartilaginous fragment removal. Fixation of the distal tibiofibular joint was conducted in 8 patients. From a postoperative radiographic evaluation, a good result in 100 cases and a fair outcome in 5 were confirmed. The clinical results were good in all, and no postoperative complications or pseudoarthrosis were noted. CONCLUSIONS: The use of an arthroscope during treatment of malleolar fractures enables diagnosis and treatment of the lesions within the ankle joint, producing a satisfactory surgical outcome. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series (no control group).

Adult↗