Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length.

To calculate the tibial wedge size in preoperative planning of high tibial osteotomy, the weight-bearing line (center femoral head to center tibiotalar joint) is first restored to a selected position on the lateral tibial plateau. Ten full-standing roentgenograms were examined and used to derive mathematical formulas for correcting limb alignment. A 3-4-mm shift in the weight-bearing line on the tibia occurred with each degree of tibiofemoral angulation.

Reproducibility of the knee signature system.

To assess trial-to-trial, installation-to-installation, and day-to-day effects of the Knee Signature System, we studied anterior/posterior translation measurements in six normal subjects. The protocol consisted of testing both knees on 6 days with three installations per day and three trials per installation. We recorded anterior, posterior, and total anterior/posterior translation at +/- 20 and +/- 40 pounds of force at 30 degrees of flexion.

Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture.

This study assessed the sensitivity of four different types of one-legged hop tests. The goal was to determine alterations in lower limb function in ACL deficient knees. Regression analyses were conducted between limb symmetry as measured by the hop tests and muscle strength, symptoms, and self-assessed function.

Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion.

Sixty-six patients who had meniscal repair at the same time as an ACL reconstruction were followed-up with arthroscopy at an average of 12 months postoperatively. All patients underwent immediate postoperative range of motion from 20 degrees to 90 degrees and began partial weightbearing between the 1st and 3rd postoperative weeks. The rate of meniscal healing was classified as complete, partial, or failed.

The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament.

A study was performed on the effect of the addition of an extra-articular procedure involving tenodesis of the iliotibial band to a reconstruction with a bone-patellar ligament-bone allograft for the treatment of chronic rupture of the anterior cruciate ligament. One hundred and four patients were divided into two groups for comparison: Group 1 (sixty-four patients) was treated with only an intra-articular replacement with an allograft and Group 2 (forty patients), with both an intra-articular replacement with an allograft and the extra-articular procedure. Preoperatively, there were no statistically significant differences between the two groups in terms of twenty variables, including body weight, level of activity, anterior-posterior displacements, number of previous operations, and duration of follow-up.

The early diagnosis and treatment of developmental patella infera syndrome.

Developmental patella infera and associated arthrofibrosis after knee surgery require prompt recognition and treatment. The condition develops because of contracture of peripatellar tissues, fatpad tissues, and quadriceps weakness, and may rapidly progress to permanent patella infera and disabling patellofemoral arthrosis. Case studies for five patients with acute developmental patella infera are described.

The assessment of work-related activities and limitations in knee disorders.

The success of knee treatment programs and surgery must be assessed, in part, by both the ability to return patients to work and the documentation of any work-related limitations. Existing occupational rating scales do not rate, in a valid manner, the effect of altered knee function on work activities. We performed a prospective randomized clinical trial in which two different occupational rating systems were tested on 50 patients.

The diagnosis of knee motion limits, subluxations, and ligament injury.

The clinical diagnosis of knee ligament injuries requires the clinician to: 1) estimate the abnormal motion limits that occur in one or more of the six degrees of freedom that comprise three-dimensional motion; 2) determine the abnormal position (subluxation) of the medial and lateral tibiofemoral compartments; and 3) precisely define the anatomical structures injured and degree of that injury. To determine the clinician's ability to perform these tasks, we evaluated 11 knee surgeons' clinical examination for knee instability. The positions and motions included were measured in right-left cadaveric knees by a three-dimensional instrumented spacial linkage.

An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners.

The description of the pivot shift test and its modifications is for the most part based on clinical observations. We wished to precisely determine the knee motions and medial-lateral tibiofemoral compartment subluxations that examiners induce in the knee joint to produce the pivot shift phenomenon. Eleven skilled knee surgeons performed the pivot shift test on an instrumented cadaveric lower limb.

Effect of flexion angle on the pressure-volume of the human knee.

The objective of this study was to determine pressure-volume relationships in the human knee. Eight normal knees in eight patients undergoing elective arthroscopic surgery were studied to develop pressure-volume curves at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 80 degrees of flexion, and measure capsular volume at 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees, and 80 degrees of flexion. The results showed that capsular volume decreases with flexion, whereas capsular stiffness increases.

Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament.

A prospective study was performed of the first forty-seven consecutive patients who had repair of a ruptured anterior cruciate ligament and replacement with an allograft. Patients who had a rupture of another ligament were excluded, to provide a homogeneous group. Twenty-two patients received a fascia lata allograft and twenty-five patients received a bone-patellar ligament-bone allograft.

Medial approach in elbow arthroscopy.

The author undertook a cadaveric dissection study to confirm the hypothesis that starting with the anterior medial portal in elbow arthroscopy is safer than starting with the anterior radial portal. In six cadaveric elbows, the capsule was distended with saline. Both anterior medial and anterior radial approaches were made with the elbow flexed to 90 degrees.

Repeatability of the KT-1000 arthrometer in a normal population.

Despite its popularity, the MEDmetric KT-1000 arthrometer's reliability remains inadequately documented. We conducted this study to determine the magnitude of trial-to-trial (within installation), installation-to-installation (within day), and day-to-day (between day) variability of anterior/posterior translation measurements in normal knees. We selected six normal subjects, three males and three females, and tested each on 6 consecutive days with three separate installations per day.

Reproducibility of Genucom knee analysis system testing.

The Genucom knee analysis system was studied to determine the reproducibility of test results. In the first phase of the study we investigated the reproducibility of anterior/posterior stress tests at 30 degrees and 90 degrees of flexion and varus/valgus stress tests at 20 degrees of flexion in 10 control subjects during three seatings on 3 separate days. In the second phase we studied the effect of errors in the digitization procedure (a part of the patient installation process) on anterior/posterior translation measurements.

Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees.

The purpose of this study was to evaluate the effectiveness of five hopping, jumping, and cutting-type (shuttle run) tests in determining lower extremity functional limitations in anterior cruciate ligament- (ACL) deficient knees. Ninety-three normal subjects were tested. No statistical significance was found between right and left lower limb scores (limb symmetry index) as related to sports activity level, gender, or dominant side.

A physiological profile of the elite soccer athlete.

From the Cincinnati Sportsmedicine and Orthopaedic Center and The Deaconess Hospital, Cincinnati, OH. Research Funded by the Cincinnati Sportsmedicine Research and Education Foundation and the United States Olympic Committee. The purpose of this study was to develop a physiological profile of the elite soccer athlete.

Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency.

In a prospective seven-year study, we treated 32 patients with partial ruptures of the anterior cruciate ligament (ACL) verified by arthroscopy. Twelve knees (38%) progressed to complete ACL deficiency with positive pivot shift tests and increased anteroposterior translation on tests with the KT-1000 arthrometer. Patients with partial ACL tears frequently had limitation for strenuous sports, while those developing ACL deficiency had additional functional limitations involving recreational activities.

A rationale for assessing sports activity levels and limitations in knee disorders.

Existing published knee rating systems that assess sports participation, knee function, and subjective symptomatology following ligamentous surgical procedures were analyzed. Major errors in questionnaire design and data reduction have led to invalid conclusions. A questionnaire containing a minimum set of rating criteria was formulated to validly assess athletic participation before and after treatment or surgery.

A system for grading articular cartilage lesions at arthroscopy.

Although there are several different classification systems for the description of articular cartilage damage, each has certain limitations and deficiencies which can lead to confusion. We are proposing a new system which describes articular cartilage abnormalities in simple terms. It is based on four separate and distinct variables: the description of the articular surface, the extent (depth) of involvement, the diameter of the lesion, and the location of the lesion.

Rose and Reds Dive Headfirst Into Fitness.

After 21 major league seasons, Pete Rose finally discovered the importance of conditioning. Though his career as a player benefited only briefly from the resulting fitness gains, as manager of the Cincinnati Reds he now ensures that his players' skills aren't handicapped by poor fitness.

The medical aspects of soccer injury epidemiology.

In this article, the six major studies of soccer injury epidemiology are reviewed. Strengths and weaknesses of each epidemiologic design are critiqued and the crucial importance of the definition of injury is emphasized. The effect of age, sex, and intensity of play on injury rates is discussed.

The Cincinnati Academy of Physical Education: Using Fitness to Aid Learning.

A Cincinnati public school mixes a healthy dose of activity with a rigorous academic curriculum. The result, school officials hope, will be adults who are both physically and mentally fit.