Total knee replacement in young, active patients. Long-term follow-up and functional outcome.

We reviewed our experience with total knee arthroplasties performed between 1977 and 1992 in patients who were fifty-five years old or less to determine the appropriate management for younger patients who have severe osteoarthrosis. One hundred and fourteen knee replacements were performed in eighty-eight patients who were an average of fifty-one years old (range, twenty-two to fifty-five years old). All of the operations were performed by one of the two senior ones of us (J.

Arthroscopic treatment of the degenerative knee in older athletes.

The role of arthroscopy in the management of degenerative knee arthritis in the older athlete remains controversial. This patient population desires symptomatic improvement to maintain active lifestyles. For advanced tricompartmental osteoarthritis, total knee arthroplasty provides the most predictable results.

Proximal tibial osteotomy. A subjective outcome study.

We performed a retrospective study of the results of proximal tibial osteotomy in thirty-four men (thirty-seven knees) who had had unicompartmental osteoarthrosis of the knee. The average age of the patients at the time of the procedure was forty-nine years (range, twenty-eight to sixty years). The functional results were evaluated according to the system of Tegner and Lysholm, in which the level of participation in work and sports activities is graded on a scale from 0 points (complete disability) to 10 points (the ability to participate in competitive sports at the elite professional level).

Soft tissue expansion prior to arthroplasty in the multiply-operated knee. A new method of preventing catastrophic skin problems.

Ten knees in nine patients underwent gradual soft tissue expansion prior to major knee surgery. All patients had multiple prior operative procedures around the knee. The resultant multiple skin incisions were felt to potentially jeopardize the postoperative status of the soft tissues.

Comprehensive gait analysis in posterior-stabilized knee arthroplasty.

Sixteen patients implanted with a posterior-stabilized prosthesis (Insall-Burstein PS II, Zimmer, Warsaw, IN) and 32 age-matched control subjects were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean 46 months following the index arthroplasty. The contralateral knee was normal in 13 patients and an asymptomatic total knee arthroplasty in 3 patients. No significant differences (P > .

Management of the chronic irreducible patellar dislocation in total knee arthroplasty.

Neglected dislocation of the patella with gonarthrosis, genu valgum, flexion, and external rotation deformity is rarely encountered. Experience with five total knee arthroplasties in three patients with chronic patellar dislocation and gonarthrosis is reported. All knees had a modified proximal patellar realignment and arthroplasty with a constrained prosthesis.

Instrumentation of the patellar osteotomy in total knee arthroplasty. The relationship of patellar thickness and lateral retinacular release.

This study investigates the influence of patellar thickness in total knee arthroplasty (TKA) with routine patellar resurfacing on the rate of lateral retinacular release. A study group comprised of 121 TKAs using surgical instrumentation allowing a measured resection of the patella was compared with a control group comprised of 100 TKAs using an "eye-ball" technique for patellar resurfacing without particular attention to patellar thickness. A composite without patellar thickness equal to or slightly less than the original patella was attempted in the study group.

The posterior stabilized total knee prosthesis. Assessment of polyethylene damage and osteolysis after a ten-year-minimum follow-up.

The long-term results of use of the posterior stabilized total knee prosthesis were evaluated with regard to clinical performance, survival of the implant, polyethylene wear, osteolysis, and loosening. One hundred and twenty patients had 165 primary total knee arthroplasties, with insertion of a posterior stabilized total knee prosthesis with a metal-backed tibial component with cement, between March 1981 and March 1983. Thirty-seven patients (fifty-three knees) subsequently died, five patients (six knees) were lost to follow-up, three patients (three knees) refused evaluation, and one patient (two knees) was excluded because of severe medical debilitation.

Patellofemoral Pain After Total Knee Arthroplasty.

The incidence of patellofemoral complications after total knee arthroplasty has been reported to range from 2% to 7%. Such complications include pain, sub-luxation, dislocation, loosening, and wear. Usually these complications are attrib-utable to prosthetic design or surgical technique.

Foot drop in a long-distance runner. An unusual presentation of neurofibromatosis.

An athletic patient presented with a nontraumatic peroneal neuropathy that failed to resolve after a period of rest. A magnetic resonance image (MRI) showed a multilobulated mass in the course of the common peroneal nerve consistent with a plexiform neurofibroma. Surgical exploration revealed a mass, which coursed from the midthigh to the fibular neck, that was intimately involved with the fibers of the nerve bundle and had cystic degeneration with vesicles along its length.

An anatomic study of the subscapular nerves: A guide for electromyographic analysis of the subscapularis muscle.

Fifty shoulders from 36 human cadavers were examined to identify the nerves innervating the subscapularis muscle and their point of entry into the muscle. Most of the specimens (82%) revealed three independent nerves to the subscapularis, 16% of the specimens demonstrated four nerves, and 2% of the shoulders demonstrated two nerves to the subscapularis. Variability was noted at the level of origin (division or cord) of each primary nerve branch to the muscle.

Shoulder pain in tennis players.

Shoulder pain is a common complaint amongst tennis players. The anatomy of the shoulder girdle is complex and defining the exact pathology that accounts for shoulder pain in tennis players can be difficult. Impingement syndrome and glenohumeral instability are the 2 most common causes of shoulder pain in tennis players.

Patellectomy.

We believe the patella should be preserved when possible and stress the significant use the patella has in normal knee function. Although alternative treatments can often be found, patellectomy may be indicated in selected patients to improve function and reduce pain.

Arthroscopic evaluation and treatment of the patellofemoral joint.

Patellofemoral pain is a multifactorial problem. No single successful solution for problems related to the patellofemoral joint has been identified. One needs to consider the interaction of all of the factors affecting the extensor mechanism.

Historical perspectives of chondromalacia patellae.

Widespread misuse of the term chondromalacia has led to confusion regarding its true meaning. This term should not be used to diagnose patellofemoral pain, but to describe lesions of articular cartilage. Recent advances using stereophotogrammetry to evaluate the patellofemoral joint and its articular cartilage may lead to new insight into the etiology of these lesions.