1/43. patellar ligament reconstruction using allograft patellar ligament: a case report.This report describes a method of patellar ligament reconstruction. Our patient sustained a rupture of the patellar ligament and had reconstruction with allograft patellar ligament after failed primary repair. At the 2-year follow-up, his range of motion was 0 degrees to 110 degrees and he was able to return to unrestricted standing work.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/43. rehabilitation program for both knees when the contralateral autogenous patellar tendon graft is used for primary anterior cruciate ligament reconstruction: a case study.STUDY DESIGN: Case study of a basketball player who underwent an alternative surgical procedure for anterior (cruciate ligament (ACL) reconstruction and outline of the rehabilitation process designed for this procedure. OBJECTIVES: To describe the surgical procedure, detail the rehabilitation program, and report on this patient's clinical outcome. BACKGROUND: Anterior cruciate ligament injury, its treatment, and rehabilitation continue to be an area of interest to both clinicians and researchers. Surgical procedures have been refined and rehabilitation programs are constantly being evaluated and updated to allow the safest and most predictable return to activity. Currently, the autogenous bone-patellar tendon-bone graft is the graft of choice for ACL reconstruction. Typically the graft is taken from the ipsilateral knee. An alternative procedure is to take the graft from the contralateral, noninvolved knee, allowing 2 separate rehabilitation programs to take place. methods AND MEASURES: The patient was followed from the time of injury to 2 years postoperatively. Data collected included range of motion, isokinetic strength scores, ligament stability scores, subjective evaluation, and functional measures. RESULTS: At 3 weeks postoperative the patient had nearly full range of motion in both knees, normal gait, and was beginning sport-specific drills. He was shooting the basketball and jumping by 5 weeks and returned to competitive sports 6 weeks after surgery. He was able to play in all 32 games of the season, starting in 23 of them. CONCLUSIONS: Using the contralateral patellar tendon graft may be appropriate for primary ACL reconstruction of patients, particularly those desiring an early expedient return to athletic competition.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/43. Nonunion of a Hoffa fracture in a child.The authors report a case of a Hoffa fracture of the lateral femoral condyle that subsequently went on to nonunion in an eight-year-old child. The child presented with symptoms of knee pain and snapping five years after a motor vehicle accident. The nonunion fragment involved most of the lateral femoral condylar articular surface but spared the physis. After treatment by open reduction and limited internal fixation, the nonunion has healed, and the child has virtually full range of motion of the knee and no evidence of growth disturbance.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/43. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/43. reflex extension loss after anterior cruciate ligament reconstruction due to femoral "high noon" graft placement.We describe a rare case of a painful reflex extension loss due to femoral malplacement of an anterior cruciate ligament (ACL) graft in a female high-level athlete. The graft was placed on the femoral site in the "high noon" position combined with a slight medial tibial tunnel placement. The resulting anterior-posterior cruciate ligament impingement near extension caused a persistent functional extension deficit of 20 degrees. Under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a proprioceptive reflex leading to a functional extension loss while the patient is awake. After sacrifice of the graft and subsequent replacement of the ACL, full range of motion was achieved within 2 months. After a 3-year postinjury history of 3 arthroscopies and 2 ACL reconstructions, the athlete reached her preinjury activity level again. This rare cause of a reflex extension loss due to femoral high noon graft placement has not been described previously and should be included as a differential diagnosis when evaluating patients with an extension deficit after ACL reconstruction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/43. Split biceps femoris tendon reconstruction for proximal tibiofibular joint instability.Recurrent instability of the proximal tibiofibular joint is an infrequently diagnosed abnormality. We present a new technique for reconstructing the joint using a split biceps femoris tendon passed through a bone tunnel in both the proximal tibial metaphysis and fibular head. The case report is also presented. The procedure offers an anatomic reconstruction and firm stabilization. It allows normal motion of the proximal tibiofibular joint and preserves the normal mechanics of the ankle. This procedure is an excellent alternative to resection of the fibular head, transarticular arthrodesis, or pseudoarthrosis focus at the fibular head.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/43. Giving way event during a combined stepping and crossover cutting task in an individual with anterior cruciate ligament deficiency.STUDY DESIGN: Case study. OBJECTIVE: To compare knee kinematics and moments of nongiving way trials to a giving way trial during a combined stepping and crossover cutting activity. BACKGROUND: The knee kinematics and moments associated with giving way episodes suggest motor control strategies that lead to instability and recovery of stability during movement. methods AND MEASURES: A 27-year-old woman with anterior cruciate ligament deficiency reported giving way while performing a combined stepping and crossover cutting activity. A motion analysis system recorded motion of the pelvis, femur, tibia, and foot using 3 infrared emitting diodes placed on each segment at 60 Hz. Force plate recordings at 300 Hz were combined with limb inertial properties and position data to estimate net knee joint moments. The stance time, foot progression angle, and cutting angle were also included to evaluate performance between trials. RESULTS: Knee internal rotation during the giving way trial increased 3.2 degrees at 54% of stance relative to the nongiving way trials. Knee flexion during the giving way trial increased to 33.1 degrees at 66% of stance, and the knee moment switched from a nominal flexor moment to a knee extensor moment at 64% of stance. The knee abductor moment and external rotation moment during the giving way trial deviated in early stance. CONCLUSIONS: The observed response to the giving way event suggests that increasing knee flexion may enhance knee stability for this subject. The transverse and frontal plane moments appear important in contributing to the giving way event. Further research that assists clinicians in understanding how interventions can impact control of movements in these planes is necessary.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/43. Neuromuscular rehabilitation of a female Olympic ice hockey player following anterior cruciate ligament reconstruction.STUDY DESIGN: Case study. OBJECTIVE: To demonstrate the unique aspects of rehabilitating a female athlete participating in ice hockey following anterior cruciate ligament (ACL) reconstruction. BACKGROUND: The patient was a 28-year-old female who sustained a traumatic injury to her left knee while playing ice hockey. After 6 weeks of rehabilitation (15 visits), the athlete elected to undergo ACL reconstruction following buckling episodes that she experienced during both skating and walking. methods AND MEASURES: Following ACL reconstruction using a patellar tendon autograft, the patient was treated for 6 months in 44 visits. Initial treatments consisted of effusion management, neuromuscular control of lower extremity muscles, and regaining passive range of motion, especially extension. Although instability testing revealed a negative pivot shift and a 2-millimeter side-to-side difference on KT-1000 examination, the patient reported a sensation of buckling when she attempted skating at 4 months (27 visits) following ACL reconstruction. Off-ice strength and functional testing of the lower extremity did not demonstrate deficits. At that time, a specific neuromuscular program for returning a patient to ice hockey was implemented. RESULTS: Following 17 physical therapy visits, which combined sport-specific and sex-specific neuromuscular rehabilitation, the patient was able to return to competitive ice hockey. Six months following ACL reconstruction, the patient reported no feeling of instability during skating. The patient reported a Lysholm score of 100 and Tegner activity score of 9. An on-ice functional test revealed the athlete's score was 80% of her pre-injury score. CONCLUSIONS: Failure of static knee stabilizers can be a cause of instability. Following ACL reconstruction, a neuromuscular rehabilitation program may prevent residual knee instability once the static stabilizers have been restored. A sport-specific neuromuscular rehabilitation program for the athlete participating in ice hockey should be considered.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/43. Supracondylar distal femoral nonunions treated with a megaprosthesis in elderly patients: a report of two cases.The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. Despite multiple procedures during a long period, patients had a persistent nonunion. Both patients underwent total arthroplasty with a cemented kinematic rotating hinge and had significant clinical improvement. The Hospital for Special Surgery (HSS) knee scores increased from fifty-four points to seventy points in one patient and forty-two points to seventy-three points after surgery in the other patient. Both patients had excellent range of motion after surgery. A cemented megaprosthesis appears to be a viable treatment option for persistent nonunions of supracondylar femur fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/43. Intra-articular fracture of the knee with spondyloepiphyseal dysplasia congenita: successful result of open reduction and internal fixation.In spondyloepiphyseal dysplasia congenita (SEDC), since the cartilage is congenitally abnormal, functional recovery of an intra-articular fracture is uncertain even with surgical treatment. We report a 29-year-old Japanese woman with SEDC whose left knee injury (intercondylar femur fracture and tibial plateau fracture) was surgically reduced and fixed. Although special care was required during the operation for associated atlantoaxial instability and cardiopulmonary suppression due to severe thoracolumbar kyphoscoliosis as well as osteopenia, she had neither restriction of knee motion nor pain at follow-up 2 years and 4 months after surgery. Therefore, although the situation involving fractures in a patient with SEDC is complicated, we believe the main problem to be solved is whether the risk-related kyphoscoliosis and atlantoaxial instability can be managed or not. Fractures themselves can be treated based on the principles used for patients without SEDC.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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