1/34. Irreducible posterolateral dislocation of the knee.Traumatic knee dislocations are relatively rare, often associated with neurovascular injury, and almost always amenable to closed reduction. However, over the years, several authors have recognized that the rare knee dislocation not reducible by closed manipulation usually involves posterolateral dislocation of the tibia and button-holing of the medial femoral condyle through the medial retinaculum. These cases present with a dimple sign, a characteristic invagination of tissues at the medial joint line. Open reduction entails extraction of the soft-tissue collar that becomes incarcerated in the trochlea and intercondylar notch. We present an interesting case of irreducible posterolateral knee dislocation and review many of the salient points associated with this entity. Additionally, we include intraoperative video footage available on the Journal Web site to promote a better appreciation of the dramatic visual presentation and physical examination of this unusual injury.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/34. 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 = 0.13446398929005keywords = physical (Clic here for more details about this article) |
3/34. Incomplete bicruciate knee injuries: Results of treatment with isolated anterior cruciate ligament reconstruction.PURPOSE: To determine how the presence of a partial injury to the posterior cruciate ligament (PCL) in conjunction with an anterior cruciate ligament (ACL) tear affects the outcome of ACL reconstruction. TYPE OF STUDY: Case series. methods: Between 1990 and 1998, 18 patients with surgically documented complete ACL ruptures and partial PCL tears, referred to as "incomplete bicruciate knee injuries," were treated with arthroscopic ACL reconstruction and PCL observation. Fifteen patients (83%) were available for follow-up evaluation at a mean of 60 months postoperatively. Follow-up evaluation consisted of physical examination, standard radiographs, isokinetic muscle testing, KT instrumented laxity testing, stress radiographs for posterior and total anterior-posterior translation, and Lysholm, Tegner, and IKDC outcome scores. RESULTS: At follow-up, 11 patients had a negative Lachman and 4 had a 1 Lachman (3 to 5 mm translation). Instrumented arthrometer tests performed at follow-up showed less than 3 mm of increased anterior translation versus the opposite knee on manual maximum testing at 30 degree in 11 patients, and 3 to 5 mm translation in the remaining 4 patients, with an average of 1.3 mm increased translation. Symptomatic posterior instability was present in only 1 patient who had sustained a repeat injury resulting in a complete PCL tear postoperatively. Final IKDC outcome scores were normal or near normal in 13 patients (87%) and abnormal in 2 (13%). The average Lysholm score was 93 at follow-up, and only 1 patient had a score lower than 80. CONCLUSIONS: overall, the results of treatment of incomplete bicruciate knee injuries in this study compare favorably with the results of isolated ACL reconstruction reported in other series. We conclude that the clinical significance of an arthroscopically defined partial PCL tear in an ACL-deficient knee is minor, and that isolated ACL reconstruction in this setting appears to be effective treatment.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/34. Atypical growth plate closure: a possible chronic Salter and Harris Type V injury.Salter-Harris Type V epiphyseal injury is relatively uncommon. The authors present a case involving the proximal tibia diagnosed both by radiologic and histologic findings. The findings suggest that Salter-Harris Type V injury can be a possible outcome when the disappearance of the physeal plate is reported in a patient who has great physical activity in childhood, even if the patient has suffered from no major injury.- - - - - - - - - - ranking = 0.13446398929005keywords = physical (Clic here for more details about this article) |
5/34. Subchondral microfracture of the knee without osteonecrosis after arthroscopic medial meniscectomy.We report a case of an osteonecrosis-like lesion of the knee that developed shortly after an arthroscopic medial meniscectomy. Clinical presentation, physical findings, and imaging of the knee including magnetic resonance imaging were similar to those of the cases that have been reported as osteonecrosis after meniscectomy. However, histologic analysis of the lesion revealed that there was no osteonecrosis but rather a subchondral microfracture with active callus formation.- - - - - - - - - - ranking = 0.13446398929005keywords = physical (Clic here for more details about this article) |
6/34. Surgical treatment options for cartilage defects within the knee.Injury to articular cartilage is increasingly diagnosed as a cause of knee pain. New surgical treatment options are now available to treat this clinical entity. diagnosis is made easier by improved magnetic resonance imaging protocols that better visualize articular cartilage. On physical examination, patients at any age can have joint surface damage and primarily experience joint line tenderness and pain with activity. Treatment options include debridement of nonviable cartilage with abrasion or microfracture of the subchondral bone, transplantation of autologous osteochondral plugs, autologous chondrocyte transplantation, transplantation of cadaveric allogenic osteochondral grafts, and, for irreparable damage, total knee arthroplasty. These newer treatment options show promising early and intermediate results.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/34. Echinococcal synovitis of the knee joint.Bone lesions are present in 1% to 2% of cases of hydatid disease. Hydatid synovitis can usually be identified due to secondary extension from the adjacent bone, or infrequently after hematogenous spread. We present an extremely rare case of hydatid synovitis without bony involvement. A 74-year-old man with diagnosed hydatid disease was admitted to our department because of left knee swelling. Neither physical examination nor laboratory studies revealed any remarkable findings. Radiographic evaluation of the knee joint was noncontributory. The patient underwent an arthroscopically assisted synovectomy, and the biopsy revealed an echinococcus contamination. No complications occurred during the postoperative period.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/34. Disruption of the extensor mechanism of the knee.Ruptures of the extensor mechanism of the knee are rare, when compared with other knee injuries, and are frequently misdiagnosed. The outcome after surgical repair may be compromised if surgery is delayed. A case of quadriceps tendon rupture that was misdiagnosed for 2 months and a review of the literature are presented. Including extensor mechanism disruption in the differential diagnosis, and careful attention to key physical findings in the examination of all acutely injured knees, will ensure that this important injury is not overlooked.- - - - - - - - - - ranking = 0.13446398929005keywords = physical (Clic here for more details about this article) |
9/34. lower extremity neuromuscular recovery following anterior cruciate ligament reconstruction; a 2-week case study.The lower extremity neuromuscular recovery of a 31-year-old male physical therapy student during the initial 2-weeks following anterior cruciate ligament reconstruction was evaluated by measuring involved side vastus medialis (VM), gluteus maximus (GMAX) and gastrocnemius (GASTROC) electromyographic (EMG) signals (1000 Hz), plantar forces (50 Hz), and knee pain as the subject performed a series of volitional, maximal effort unilateral, isometric leg presses (6 sec) in a modified continuous passive motion device. Data were standardized to pre-operative values and graphically plotted for split middle technique, celeration line assessment. From 1-8 hours post-surgery, EMG amplitudes and plantar forces decreased, pain increased, and plantar force location shifted toward the forefoot. From 9-12 hours post-surgery, EMG amplitudes and plantar forces increased and pain decreased. By 24 hours post-surgery, pain decreased to pre-operative levels. From 24-72 hours post-surgery, EMG amplitudes and plantar forces increased. From 1-2 weeks post-surgery, EMG amplitudes and plantar forces increased. From 9 hours-2 weeks post-surgery, plantar force location shifted toward the pre-operative location. Sequential increases were observed for GMAX, GASTROC, and VM EMG amplitudes. By 2 weeks post-surgery, plantar forces and VM EMG amplitudes remained reduced. Reduced plantar forces and VM EMG amplitude at 2 weeks post-surgery suggest a need for greater focus on restoring VM function before attempting closed kinetic chain exercises that require the full shock absorption capabilities of the quadriceps femoris muscle group.- - - - - - - - - - ranking = 0.13446398929005keywords = physical (Clic here for more details about this article) |
10/34. Snapping knee caused by intra-articular tumors.Locking of the knee can present with no history of antecedent injury. We identified impingement of intra-articular tumors in 2 cases. Intra-articular tumors are relatively rare. Mechanical symptoms were present in both cases. On physical examination, there was a palpable mass at the medial region of the patellofemoral joint. The interior had been replaced mainly by amorphous necrotic tissue. The definite diagnosis of a soft-tissue mass of the knee could not be made on histologic examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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