Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears.

We assessed the results of 198 meniscal tears that had a major segment in the central avascular region repaired with an arthroscopically assisted inside-out technique. There were 177 patients whose mean age was 28 years. Eighty-two percent were injured during sports, and 71% also required anterior cruciate ligament reconstruction.

Plane talk about shoulder radiographs.

The evaluation of patients who have pain, loss of motion, instability, or weakness in the shoulder is often enhanced by x-ray assessment. A common approach to radiographic examination of the shoulder is to take two anteroposterior (AP) views, one with the humerus in external rotation and one with the humerus in internal rotation.

Joint loading with valgus bracing in patients with varus gonarthrosis.

The purpose of this study was to determine whether a brace designed to unload varus degenerative knees actually alters medial compartment loads by decreasing the adduction moment. Eleven patients who had arthrosis confined to the medial compartment were fitted with a valgus brace and tested before and after brace wear with pain and function scoring instruments and by automated gait analysis. The biomechanical data from these patients were compared with those from 11 healthy control subjects.

Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis.

We report a critical rating of results for 11 patients with bicruciate ligament reconstructions and immediate protected knee motion after knee dislocations (seven acute and four chronic). Six patients had concurrent repair or reconstruction of medial ligamentous structures, and six had reconstruction of the lateral and posterolateral ligaments. All patients returned for followup at a mean of 4.

Diagnosis of complete and partial posterior cruciate ligament ruptures. Stress radiography compared with KT-1000 arthrometer and posterior drawer testing.

Stress radiography was performed on 21 patients with unilateral posterior cruciate ligament tears: 10 complete and 11 partial. An 89-N posterior load was applied to the proximal tibia and a lateral radiograph was taken of each knee in 70 degrees of flexion. The relative amount of sagittal translation (involved minus noninvolved) was determined at both the medial and lateral tibial plateaus from the radiographic films.

Anterior cruciate ligament reconstruction with autogenous patellar tendon graft in patients with articular cartilage damage.

To test if anterior cruciate ligament reconstruction with autogenous patellar tendon can alleviate symptoms and functional limitations and increase activity levels in patients with advanced articular cartilage damage, we looked at 53 patients with arthroscopically documented cartilage damage. In this group, a mean of 7.5 years had elapsed between the original injury and the reconstruction, and 90 prior operative procedures had been done.

A comparison of results of arthroscopic-assisted anterior cruciate ligament reconstruction between workers' compensation and noncompensation patients.

This investigation compared the results of arthroscopic-assisted anterior cruciate ligament patellar tendon autogenous reconstruction in patients who received Workers' Compensation (WC) benefits with results of similar surgery in patients who did not receive such benefits, to determine if differences existed based on this variable alone. Thirty-eight patients (19 WC benefits, 19 NoWC) were matched for age, injury chronicity, number of prior operations, and months of follow-up. All had the same operation and rehabilitation.

A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstruction.

Although there is a higher relative incidence of anterior cruciate ligament injuries in female than in comparable male athletes according to the literature, the majority of populations studied after reconstruction are male-dominated. We wished to determine whether a selection bias for reconstruction based on sex is warranted according to complications and outcome. Ninety-four patients (47 of each sex) were matched for chronicity of injury, age, preoperative sports activity levels, articular cartilage condition, and months of followup.

A comparison of results in acute and chronic anterior cruciate ligament ruptures of arthroscopically assisted autogenous patellar tendon reconstruction.

We conducted a prospective study of 94 consecutive patients who received a patellar tendon autograft for anterior cruciate ligament rupture. Eighty-seven patients (93%) returned for followup a mean of 28 months postoperatively; 57 had chronic and 30 had acute or subacute ruptures. There were no significant differences between the subgroups for age, sex, articular cartilage lesions, or months of followup.

Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis.

We reviewed the results of arthroscopic-assisted anterior cruciate ligament (ACL) allograft reconstruction in 40 patients who had advanced articular cartilage deterioration documented by arthroscopy during the reconstruction. A mean of 7 years had elapsed between the original injury and the reconstruction, and 102 prior operative procedures had been done in 34 of the 40 patients. A total of 64 articular cartilage lesions were noted; 34 knees had lesions in the medial or lateral tibiofemoral compartment.

Plyometric training in female athletes. Decreased impact forces and increased hamstring torques.

The purpose of this study was to test the effect of a jump-training program on landing mechanics and lower extremity strength in female athletes involved in jumping sports. These parameters were compared before and after training with those of male athletes. The program was designed to decrease landing forces by teaching neuromuscular control of the lower limb during landing and to increase vertical jump height.

Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement.

We studied posterior cruciate ligament reconstruction in a cadaveric model using two substitutes: a 1-mm diameter flexible cable and an 11-mm diameter Achilles tendon autograft. The thin cable allowed us to study five femoral and five tibial attachments in each knee. A nearly isometric attachment was located after cutting the posterior cruciate ligament while the tibia was reduced with a 100 N anterior force.

Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligaments of the knee joint.

We report the results of treatment of combined deficiency of the posterolateral complex and one or both cruciate ligaments. The posterolateral complex deficiencies were corrected by a proximal advancement procedure of the lateral collateral ligament and posterolateral complex tissues. The cruciate ligaments were reconstructed with either autogenous or allogenic tissue.

Technical considerations in the management of complex meniscus tears.

Meniscal repair continues to be an important procedure in patients with meniscal tears. The orthopedic literature has recommended excision of complex tears or tears that are located in the central avascular region. For the past 13 years, the authors have repaired all meniscal tears that can be reduced anatomically and that have healthy tissue that will support the multiple sutures required for a stable repair, regardless of tear pattern or location.

Effect of tibial attachment location on the healing of the anterior cruciate ligament freeze model.

We studied the healing response of a devitalized anterior cruciate ligament to a treatment of initial anterior-posterior joint translation in goats. Devitalization and devascularization were achieved by five successive freeze-thaw cycles. Anterior-posterior translation was surgically altered by an osteotomy of the tibial attachment of the devitalized ligament and its reattachment either in the anatomical position or in a position 5 mm posterior.

Reconstruction of the anterior cruciate ligament with human allograft. Comparison of early and later results.

Sixty-eight patients who had had reconstruction of an acute rupture of the anterior cruciate ligament with either a fascia lata or a bone-patellar ligament-bone allograft returned for two follow-up evaluations, at two to four years and at five to nine years (mean, seven years) postoperatively. The early (two to four-year) results in these patients have been reported previously. The mean time between the early and the later evaluation was fifty-six months (range, twenty to ninety-six months).

Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: a critical analysis of the reliability of gait analysis data.

Anatomic and mechanical factors that affect loading in the knee joint can contribute to pathologic changes seen at the knee in degenerative joint disease and should be considered in treatment planning. The objectives of this study were to quantify the relationships between the alignment of the bones of the lower extremity, foot progression angle, and knee adduction moment, and to determine the reliability of our gait measurements. Gait analysis and complete radiographic evaluation of the lower extremity were performed on 11 healthy subjects.

Knee hyperextension gait abnormalities in unstable knees. Recognition and preoperative gait retraining.

Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament complex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis.

The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee.

We performed a prospective study of 46 patients with ruptures of the anterior cruciate ligament and medial ligamentous structures. All patients had anterior cruciate ligament allograft reconstructions. Group I comprised 34 patients in whom all of the medial structures were ruptured (parallel and oblique fibers of the superficial medial collateral ligament and the posteromedial capsule) and were treated operatively.

Intertester reliability of measurements obtained with the KT-1000 on patients with reconstructed anterior cruciate ligaments.

Clinicians frequently measure anterior tibial displacement on patients following surgical reconstruction for a torn anterior cruciate ligament (ACL). Little is known about the reliability of measurements of anterior tibial displacement obtained on patients following an ACL reconstruction. The purpose of this study was to describe the degree of error associated with repeated measurements of anterior tibial displacement on patients with reconstructed ACLs.