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1.
Sujith Subesinghe Sander van Leuven Leena Yalakki Shirish Sangle David D&#x;Cruz 《Autoimmunity reviews》2018,17(1):73-77
Objectives
We analysed the spectrum of clinical manifestations of cocaine associated pseudovasculitis.Methods
Clinical, serological, radiological and histological features of 14 patients with cocaine pseudovasculitis syndromes were included.Results
Twelve patients had significant sinus thickening or erosive disease. Other multi-system manifestations included vasculitic rashes, pulmonary lesions and peripheral neuropathy. All patients had positive ANCA titres at presentation. All patients were managed with corticosteroids +/? methotrexate and co-trimoxazole, 2 patients received cyclophosphamide.Conclusions
Advanced erosive nasal septal defects and atypical ANCA patterns are suggestive of cocaine induced pseudovasculitis. Complete drug cessation may negate the need for exposure to potent immunosuppressive agents. 相似文献2.
Background
Tendon harvesting for anterior cruciate ligament reconstruction often injures sensory branches of the saphenous nerve. The reports on the prevalence of these injuries are scarce, while the implications on patient satisfaction are not known. Our objective was to compare the prevalence of sensory nerve injuries in patellar to hamstring autograft harvesting for anterior cruciate ligament reconstructions and follow up their postoperative course.Methods
Between 2012 and 2014, patients who had a primary anterior cruciate ligament reconstruction with bone patellar tendon bone or hamstring autografts were included (n = 94). We evaluated and compared demographic details, level of activity and postoperative sensation disturbances between both groups. Data was analyzed retrospectively.Results
The mean postoperative follow-up time was 23 months. At the last follow-up 46 (77%) patients of the patellar tendon group and 22 (58%) of the hamstring tendons group reported on reduced sensation; however, in both groups a quarter of these patients experienced full recovery within an average of seven to eight months. There were more patients in the hamstring tendons group that reported on partial recovery. In most cases midline incisions for patellar tendons harvesting injured the infrapatellar branch and medial incisions for hamstring tendons harvesting injured the sartorial branch of the saphenous nerve.Conclusions
Harvesting tendon autografts for anterior cruciate ligament reconstructions by vertical incisions had high prevalence of saphenous nerve branches injury with a minor possibility for complete recovery within the first year. The loss of sensation was perceived by patients as a minor complication.Level of evidence
Level IV, therapeutic case series. 相似文献3.
Fangzhou He Chuanzhen Hu Yuhui Shen Qiyuan Bao Junxiang Wen Shijing Qiu Rong Wan Weibin Zhang 《The Knee》2018,25(5):952-958
Background
The proximal tibia is the second most common site of aggressive bone tumors. In proximal tibia resection, the patellar tendon is sectioned one to two centimeters from its insertion on the tibial tubercle, which makes it technically challenging to achieve an appropriate patellar height and firm fixation of the patellar tendon. The purpose of this study was to determine whether the patellar height influences knee function after proximal tibia endoprosthetic reconstruction (EPR).Methods
Twenty-nine patients with pathologically confirmed aggressive bone tumors in the proximal tibia were retrospectively analyzed. We used the Insall–Salvati ratio (ISR) and the Blackburne–Peel index (BPI) to radiographically analyze the patellar height. Functional outcomes were retrospectively assessed using the Musculoskeletal Tumor Society (MSTS) score, the Oxford Knee Score (OKS) and the range of motion (ROM) which was evaluated through extensor lag and active flexion. Univariate analysis with Pearson's correlation and a multivariate linear regression of patient characteristics and surgery-related changes were performed.Results
The postoperative ISRs were negatively correlated with the functionality domain of the MSTS score (function, gait, walking) and the OKS. Pearson's correlation analysis showed a significant correlation between the postoperative ISR and extensor lag. The change in patellar height had no impact on the active flexion of the knee.Conclusions
Patellar height is an independent factor contributing to knee function after proximal tibia EPR. The quality of patellar tendon reconstruction is a key point in proximal tibia EPR after tumor resection. 相似文献4.
Background
Knee osteoarthritis has a lifetime risk of nearly one in two, with obese individuals being most susceptible. While exercise is universally recognized as a critical component for management, unsafe or ineffective exercise frequently leads to exacerbation of joint symptoms.Aim
Evaluate the effect of a 12 week lower body positive pressure (LBPP) supported low-load treadmill walking program on knee pain, joint function, and performance of daily activities in patients with knee osteoarthritis (OA).Design
Prospective, observational, repeated measures investigation.Setting
Community based, multidisciplinary musculoskeletal medicine clinic.Patients
Thirty-one patients, aged 50–75, with a BMI ≥ 25 kg/m2 and radiographic confirmed mild to moderate knee OA.Intervention
Twelve week LBPP treadmill walking exercise regimen.Outcome measures
The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Canadian Occupational Performance Measure (COPM) were used to quantify joint symptoms and patient function; isokinetic thigh muscle strength was evaluated; and a 10-point VAS was used to quantify acute knee pain while walking. Baseline and follow-up data were compared in order to examine the effect of the 12 week exercise intervention.Results
There was a significant difference between baseline and follow-up data: KOOS and COPM scores both improved; thigh muscle strength increased; and acute knee pain during full weight bearing walking diminished significantly.Conclusions
Participation in a 12 week LBPP supported treadmill walking exercise regimen significantly enhanced patient function and quality of life, as well as the ability to perform activities of daily living that patient's self-identified as being important, yet difficult to perform. 相似文献5.
William B. Ashford Thomas H. Kelly Russell W. Chapin John W. Xerogeanes Harris S. Slone 《The Knee》2018,25(6):1100-1106
Background
The objective of this study is to (1) compare the predicted cross-sectional area and diameter between quadriceps tendon and quadrupled hamstring autografts, and (2) assess the predicted size of the quadriceps tendon graft in patients with hamstrings that are insufficient for use in ACL reconstruction.Methods
A retrospective review of 54 knee 3D MRIs was conducted. Quadriceps tendon graft area was defined as a one-centimeter wide area of quadriceps tendon, measured three centimeters above the patella perpendicular to tendon axis. Quadrupled hamstring graft area was defined as double the combined areas of the gracilis and semitendinosus tendon, measured three centimeters above the joint line perpendicular to tendon axis. Pearson correlation was used to compare the quadriceps tendon and quadrupled hamstring grafts.Results
Mean cross-sectional area of quadrupled hamstring and quadriceps tendon grafts were 47.2?mm2 and 84.4?mm2 respectively. A statistically significant positive correlation exists between quadrupled hamstring graft and quadriceps tendon graft cross-sectional area (r?=?0.41; p?=?0.002). Nine of the 54 patients had predicted quadrupled hamstring grafts deemed insufficient for use in ACL reconstruction (< 8?mm diameter). All of these patients had predicted quadriceps tendon graft diameters > 8?mm.Conclusion
There is a positive correlation between predicted quadriceps tendon and quadrupled hamstring grafts. While 17% of patients in this series had predicted insufficient quadrupled hamstring grafts, all of the patients had predicted quadriceps tendon grafts of sufficient size for ACL reconstruction. Quadriceps tendon grafts are a viable alternative in patients at-risk for insufficient quadrupled hamstring grafts.Level of evidence
IV 相似文献6.
Alexandra Balbir-Gurman Ludmila Guralnik Mordechai Yigla Yolanda Braun-Moscovici Emilia Hardak 《Autoimmunity reviews》2018,17(2):87-93
Objective
Interstitial lung disease (ILD) is a frequent and severe complication of rheumatoid arthritis (RA), resulting in pulmonary fibrosis (PF) and respiratory failure.Methods
Chest computed tomography (CT-c) or high resolution CT (HRCT) is the main modality for assessment of ILD. We performed a systematic literature review on CT-c/HRCT findings in patients with ILD-RA, using the MEDLINE database for the period from 1991 to 2015.Results
Findings on CT-c/HRCT attributed to ILD-RA are variable (ground glass opacities, reticular and nodular pattern, as well as a combined pattern of emphysema and PF). Correlation of CT-c/HRCT findings with clinical data is inconsistent.Conclusions
ILD-RA is part of a general autoimmune inflammation and should be integrated into the decision-making process for the treatment of RA. There is an unmet need to design an algorithm which will allow prediction of CT-c changes compatible with ILD-RA with a high probability. Hopefully, this will enable treating patients with ILD-RA early, with possible halting of the progression of ILD-RA toward PF. 相似文献7.
Jelle P. van der List Dana L. Sheng Laura J. Kleeblad Harshvardhan Chawla Andrew D. Pearle 《The Knee》2017,24(3):497-507
Background
Aseptic loosening is a common failure mode in cemented unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This led to the development of cementless designs but the historical outcomes were poor. Recent developments in cementless designs have improved outcomes, but the current status is unknown. Therefore, a systematic review was performed to assess recent outcomes of cementless knee arthroplasty.Methods
A search was performed using PubMed, Embase and Cochrane systems and national registries for studies reporting outcomes since 2005. Fifty-two cohort studies and four registries reported survivorship, failure modes or functional outcomes of cementless UKA and TKA.Results
Nine level I studies, six level II studies, three level III studies, 34 level IV studies and four registries were included. Three hundred eighteen failures in 10,309 cementless TKA procedures and 62 failures in 2218 cementless UKA procedures resulted in extrapolated five-year, 10-year and 15-year survivorship of cementless TKAs of 97.7%, 95.4% and 93.0%, respectively, and cementless UKA of 96.4%, 92.9% and 89.3%, respectively. Aseptic loosening was more common in cementless TKA (25%) when compared to UKA (13%). Functional outcomes of cementless TKA and UKA were excellent with 84.3% and 84.5% of the maximum possible scores, respectively.Conclusions
This systematic review showed that good to excellent extrapolated survivorship and functional outcomes are seen following modern cementless UKA and TKA, with a low incidence of aseptic loosening following cementless UKA.Level of evidence
Level IV. 相似文献8.
M. Winnisch T.M. Tiefenboeck M. Steiger M. Komjati M. Hofbauer R. Kdolsky 《The Knee》2018,25(6):1115-1121
Background
The purpose of this study was to objectively evaluate the clinical functionality of the knee joint 30?years after surgical augmentation of the ACL with the “Kennedy Ligament Augmentation Device ®” (Kennedy LAD®).Methods
The patient collective consisted of 41 patients with an average age of 59.51?years (± 10.18 standard deviation). Included were all patients treated operatively with a Kennedy LAD® augmented reattachment of the ACL at the Department of Trauma Surgery between 1983 and 1985. The state of the knee joint was evaluated with the following measures: Knee injury and Osteoarthritis Outcome Score, Lysholm Score, Short Form (36) Health Survey, International Knee Documentation Committee Score (IKDC, objective?+?subjective form) and Tegner Activity Scale.Results
Seven patients (17%) sustained a re-rupture of the Kennedy LAD® augmented ACL after a mean time of 16.28?years. Five of them underwent revision surgery. Another four patients (9.76%) showed an ACL insufficiency in clinical examination. The average IKDC Score was 74.14?±?16.62, the average Lysholm Score was 86.83?±?14.10, the average Tegner Activity Scale was 4.34?±?1.11, and the average Knee injury and Osteoarthritis Outcome Score was 86.25?±?11.64 at final follow-up. The mean Kellgren Lawrence Score of the operated knee was 2?±?0.71.Conclusion
An overall good outcome 30?years after primary ACL augmented repair with the Kennedy LAD® with an implant survival rate of 73% could be reached. These results therefore support the trend of ACL augmentation in selected cases.Level of evidence
Retrospective study, Level IV. 相似文献9.
Michael E. Hantes Vasilios A. Raoulis Nikolaos Doxariotis Athanasios Drakos Theofilos Karachalios Konstantinos N. Malizos 《The Knee》2017,24(3):588-593
Background
To report the incidence of septic arthritis after anterior cruciate ligament (ACL) reconstruction and management of this complication using a specific treatment protocol.Methods
All primary ACL reconstructions performed in our institution between January 2002 and January 2014 were included in this study. Time to presentation, clinical symptoms, and culture results of all infected patients were analyzed. According to our protocol, an arthroscopic debridement and irrigation of the knee joint was performed immediately after a diagnosis of infection was made. In case of recurrence, knee irrigation with hardware and graft removal and later re-implantation was performed. Patients were evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) Form, KT 1000 arthrometer and radiographic evaluation.Results
Postoperative septic arthritis occurred in seven of 1242 patients (0.56%). After initial arthroscopic debridement, infection recurred in six out of seven cases (85%). Graft and hardware removal was performed in these patients. Graft re-implantation was performed in four patients at an average five months after infection. At the final follow-up (mean 6.3 years) all patients had full range of motion, while in patients with graft re-implantation the mean Lysholm score was 92, and the mean IKDC score was 87. Radiographs demonstrated that three patients had normal knees and one patient had a grade one, knee arthritis according to Kellgren–Lawrence classification.Conclusions
Management of septic arthritis after ACL reconstruction using a specific surgical protocol which includes graft removal in case of infection recurrence with later re-implantation, can provide good and excellent results.Level of evidence
Level IV, case series. 相似文献10.
Background
Open wedge high tibial osteotomy (HTO) can influence the tibial slope and thereby the landmarks of currently used patellar height indices. The purpose of this retrospective study was to compare and validate a new femur-referenced patella height measurement method to currently used patellar height indices in a cohort of HTO patients.Methods
Patellar height (Caton–Deschamps, Blackburne–Peel and Insall–Salvati Indices and our newly developed Femoral Patellar Height Index) as well as tibial slope were analysed. Full-weight-bearing long-leg anteroposterior radiographs as well as anteroposterior and lateral radiographs of the knee in 0° of extension were used. Radiographs were performed preoperatively, and at six weeks, three, six, 12 and 18 months postoperatively. Measurements were recorded twice by two observers. The second observation was performed after a delay of three months.Results
A total of 99 patients with a mean age of 46.2 ± 8 years were included. A statistically significant pre- to postoperative increase in tibial slope was found in all methods. Patellar height decreased according to Caton–Deschamps and Blackburne–Peel Indices. The Insall–Salvati Index as well as the novel Femoral Patellar Height Index remained unchanged. Intra-rater (interclass correlation coefficient (ICC) 0.914–0.998) and inter-rater (ICC 0.955–0.989) reliability were highest in the new index.Conclusion
Detected changes of patellar height following open wedge HTO depend on the method used. Tibial slope increases following surgery. Our new index with a femoral reference for measuring patellar height was validated and good to excellent intra- and inter-rater reliability were demonstrated. Following HTO, the Femoral Patellar Height Index can be recommended as a standardized method to measure patellar height. 相似文献11.
Paul Decker Pierre Olivier Jessie Risse Stéphane Zuily Denis Wahl 《Autoimmunity reviews》2018,17(4):353-360
Background
Relapses upon corticosteroids tapering and immunosuppressive agents are frequent in Takayasu arteritis (TA). Interleukin-6 is highly involved in physiopathology of TA. Many reports showed efficacy of tocilizumab (TCZ) in refractory TA cases. We report four cases and an updated literature review on the TCZ efficacy and safety in patients with TA.Methods
Patients with TA defined by ACR 1990 criteria were included. Clinical, biological and imaging data were retrospectively reported. Disease activity was analyzed before TCZ and during the follow-up. Medline database was searched for systematic literature review.Results
One hundred and five patients (median age 28 years [22–38]) were included, mostly refractory cases (76 patients, 72%). Median TCZ duration was 12 months [6–20]. Among 105 patients, 90 patients (85.7%) had an initial clinical response within three months [3–6] and 43/66 patients (65.2%) had a radiological improvement. Only seven patients (9%) showed relapse on therapy. Corticosteroid dose reduction was obtained in 75/83 patients (90.4%). Relapse after TCZ discontinuation was observed in six patients (46%), with a median time of five months [2–9]. Twenty-four side-effects were noted in 18 patients (18%), with TCZ interruption in seven cases (7%): 10 infections, five cytopenia, six hepatitis, one pancreatitis, one cutaneous rash and one breast cancer.Conclusions
This review confirms that TCZ is safe and effective in refractory cases of TA and TCZ is a corticosteroid-sparing therapy in patients with or without previous TNFα blockers therapy. However relapses after TCZ discontinuation are frequent. 相似文献12.
Background
The present study assessed the inter- and intra-observer reliability of tibial and femoral rotation measures after total knee arthroplasty (TKA), and evaluated the correlation between these measurement techniques and their clinical relevance.Methods
Femoral rotation and tibial rotation were determined on 42 2D CT-scans made three-months after TKA. Reliability of the radiological measurements (including Berger's method, the anatomical tibial axis and the tibial tuberosity trochlear-groove) was assessed with 15 randomly selected patients measured twice by three observers. Functional outcomes were scored one-year postoperatively with the KSS, VAS pain, VAS satisfaction, KOOS, and Kujala.Results
The inter- and intra-observer reliability of the rotational measurements ranged from good to excellent (ICC 0.67–0.98). Tibial rotation measured with the Berger technique was most reliable (ICC inter?=?0.91; ICC intra?=?0.96). No strong correlations were found between the different rotational measures or the clinical outcomes and rotational outliers.Conclusions
Tibial rotation is most reliable measured with the technique described by Berger. There were no strong correlations found between the different tibial rotation measures or between the clinical outcomes and the rotational outliers. Further research is needed to gain more insight into optimal positioning and measuring rotation in TKA for clinical practice. 相似文献13.
Background
This level IV study describes a new one-stage procedure for revision ACL reconstruction in cases with extreme tunnel widening.Methods
Eight consecutively treated subjects requiring ACL revision and presenting with excessive tunnel widening (87.5% to 250% tunnel enlargement) were included in this study. The graft-tunnel mismatch was resolved in this one-stage revision procedure by the use of custom-made eight to 10?mm cylindrical shaped bone allografts in a press-fit construct with the ACL-graft in combination with the usual fixation devices for ACL-reconstruction. All subjects were evaluated pre-operatively and at a minimum follow-up of one year by the IKDC objective and subjective scores, KOOS, and Tegner activity scale.Results
Mean improvement was 24.8?±?16.1 on the KOOS evaluation (P-value 0,006) and 38.1?±?16.8 on the IKDC subjective score (P-value 0,001). The objective IKDC scores improved significantly with an average of one grade (P-value 0,038). Anterior laxity as determined on the KT-1000 arthrometer improved with an average of 3.63?mm compared to the situation before primary reconstruction, and the Pivot-shift test was negative in all but one patient after the revision procedure while positive in all patients before primary reconstruction.Conclusion
This new surgical technique using eight to 10?mm allograft bone cylinders for the management of excessive tunnel enlargement at single stage revision ACL reconstruction delivers excellent results after minimum one year of follow-up. The results of this study have the potential to lower the threshold for one-stage surgery in ACL revision complicated by extreme tunnel widening. 相似文献14.
Karolina Orywal Wojciech Jelski Tadeusz Werel Maciej Szmitkowski 《Advances in medical sciences》2018,63(1):1-4
Purpose
In a previous study we showed that the total activity of alcohol dehydrogenase (ADH) and its isoenzyme class I was significantly higher in renal cancer (RCC) cells compared to normal kidney. The aim of this study was to compare the activities of ADH isoenzymes and aldehyde dehydrogenase (ALDH) in the sera of patients with different stages of RCC and healthy subjects.Materials and methods
Serum samples were taken from 54 patients with clear cell RCC (17 patients in stage II, 22 in stage III and 15 in stage IV) and 52 healthy patients. Class III, IV of ADH and the total ADH activity was measured by the photometric method. For the measurement of ADH class I, II and the total ALDH activity we employed the fluorometric method.Results
The total activity of ADH and its isoenzyme class I were significantly higher in the sera of patients with every stage of RCC compared to healthy subjects. The analysis of ALDH activity did not indicate significant differences between tested groups.Conclusions
The increased activity of total ADH and its isoenzyme class I in the sera of patients with RCC, seems to be caused by isoenzymes being released from cancerous cells and may be useful for diagnostics of renal cancer. 相似文献15.
Background
This study describes the epidemiology and patient reported outcomes following juvenile osteochondritis dissecans (JOCD) of the knee.Methods
Medical records and radiographs of patients aged 10–18 years diagnosed with JOCD between 2010 and 2016 were retrospectively reviewed. The lesions were classified according to the International Cartilage Repair Society's classification. The results were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and a Visual Analogue Scale (VAS) for pain.Results
Seventy patients with 87 JOCDs were identified. The annual incidence was 11.5 (95% confidence interval 10.7–12.2) per 100,000 inhabitants younger than 19 years. Fifty-two (74.3%) of the 70 patients returned the questionnaires on average 48 months (five to 117) after diagnosis. The median Lysholm score was 84 for patients with grade I–II lesions and 80 for patients with grade III–IV lesions. The median Lysholm score was 84.5 for patients who were treated conservatively and 79.5 for patients who were treated operatively. The median VAS score was 2.0 for all groups, except for patients treated conservatively (median score 1.5). Conservative treatment was successful in 78% of grade I–II lesions. There was a fivefold increased risk of failing conservative treatment with a stage III–IV lesion, compared to stage I–II (Odds ratio = 5.5, p = 0.02).Conclusions
The results following JOCD are good to excellent for the majority of patients. Grade I–II lesions are successfully treated conservatively in 78% of cases. Grade III–IV lesions have a high failure rate.Level of evidence
Level III, retrospective cohort. 相似文献16.
Paula Calori Domingues Felipe de Souza Serenza Thiago Batista Muniz Luciano Fonseca Lemos de Oliveira Rodrigo Salim Fabricio Fogagnolo Mauricio Kfuri Aline Miranda Ferreira 《The Knee》2018,25(4):588-594
Objectives
The objective of this study was to evaluate the dynamic balance of the injured and uninjured limb before and after the anterior cruciate ligament (ACL) reconstruction and compare with the control group.Study design
Prospective longitudinal.Setting
Biomechanics laboratory.Participants
Participants are 24 males (mean age, 27.5?years) with unilateral ACL injury (ACLG) and 24 male healthy volunteers (CG).Main outcomes measures
The modified star excursion balance test (SEBT) and isokinetic knee extensor and flexor strength were applied in the ACLG preoperatively and after surgery. The dominant limb of CG was evaluated at a single time.Results
There was no difference between the injured and the uninjured limb of the ACLG (P?>?0.05) before and after surgery. Preoperatively, both ACLG limbs had a significantly lower reach distance in posteromedial (PM) and posterolateral (PL) directions and in composite reach (CR) score compared to the control group (P?<?0.001). Postoperatively, no significant differences were found between ACLG and CG (P?>?0.05). There was a positive correlation between preoperative PL (0.59) and CR (0.51), postoperative PM (0.36), PL (0.36) and CR (0.46) with flexor strength at 12 months after surgery.Conclusion
Patients with ACL injury presented a worse performance in the SEBT in the preoperative period compared to the control group. After ligament reconstruction, the performance in the SEBT became equivalent to that of the control group. The strong correlation between flexor strength and posterior directions of the injured limb demonstrates the importance of the knee flexor muscles in the neuromuscular control of patients submitted to ACL reconstruction. 相似文献17.
Kazunori Hino Tatsuhiko Kutsuna Kunihiko Watamori Yasumitsu Ishimaru Hiroshi Kiyomatsu Yoshitaka Shiraishi Hiromasa Miura 《The Knee》2018,25(5):897-902
Background
Proper soft tissue balance is crucial for a successful clinical outcome after total knee arthroplasty (TKA). Bi-cruciate substituting (BCS)-TKA has been developed to more closely approximate normal knee characteristics. The purpose of the present study was to evaluate midflexion laxity before and after BCS-TKA using a navigation system, and assess the correlation between intraoperative laxity and the maximum flexion angle after surgery.Methods
Fifty-one knees in 46 patients with osteoarthritis replaced with BCS prosthesis were assessed. Manual mild passive internal–external rotational and varus–valgus stress was applied to the knees, and the maximum total laxity was measured automatically by a navigation system before and after TKA. The correlations with the range of motion (ROM) were evaluated using Spearman's correlation coefficients (ρ).Results
Internal–external stress assessment revealed no statistically significant difference at each flexion angle before and after BCS-TKA. In contrast, the varus–valgus stress assessment revealed that BCS-TKA had significantly decreased varus–valgus laxity from preoperative levels at 20–120° flexion angles. Furthermore, the maximum flexion angle at six months after surgery significantly correlated with the intraoperative laxity at deep flexion range.Conclusion
BCS-TKA stabilized varus–valgus laxity to better than preoperative levels at midflexion range. 相似文献18.
Tomoyuki Kamenaga Takafumi Hiranaka Yuichi Hida Takaaki Fujishiro Koji Okamoto 《The Knee》2018,25(4):715-721
Background
There have been very few reports on isolated medial tibial plateau osteonecrosis, and the condition has not been clearly described. Unicompartmental knee arthroplasty (UKA) may be an appropriate treatment method for this condition. The aims of this study were to report our experience of using mobile-bearing knee implants for osteonecrosis of the medial tibial plateau and to discuss the etiology and treatment of this type of osteonecrosis.Methods
This study included six consecutive patients with isolated medial tibial plateau osteonecrosis treated with an Oxford mobile-bearing knee implant. The average age was 71.0?years. We preoperatively graded the tibial necrosis lesion using radiographic findings. We also assessed the area and size of necrosis, extent of the surrounding high-density area, and the presence of any meniscal lesions by preoperative magnetic resonance imaging (MRI), and pre- and postoperative Oxford Knee Scores (OKS) were evaluated.Results
MRI findings revealed that all patients had meniscal lesions in addition to a necrotic lesion. All patients significantly improved in their OKS. No knees required revision for either infection or loosening.Conclusions
The etiology of these cases of necrosis is still unclear, but the current study suggested an association with medial meniscal lesions. The results of the study were promising, showing a good short-term clinical outcome of Oxford mobile-bearing UKA for this type of osteonecrosis. 相似文献19.
Jigar Chhapan Sukesh Rao Sankineani T. Chiranjeevi Maryada V. Reddy Diwakar Reddy A.V. Gurava Reddy 《The Knee》2018,25(1):192-194
Background
Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare complication and results in significant morbidity and severe functional limitations. Quadriceps tendon rupture in the early postoperative period after TKA is one limitation about which there is a significant paucity of available information.Methods
In this retrospective study of 2404 patients who underwent primary TKA between June 2015 to May 2016, there were 10 quadriceps tendon ruptures in seven patients (three bilateral, four unilateral) presented within 3 months after surgery. The rupture was due to a sudden fall while walking or getting up from a chair. All seven patients presented with haematoma formation around the knee, inability to get up and inability to walk. Diagnosis was confirmed by ultrasonography and managed by exploration and end-to-end tendon repair by suturing.Results
In our study, incidence of quadriceps tendon tear in the early postoperative period (within 3 months) after TKA is 0.29% (seven of 2404). All patients had rupture within 90 days of primary TKA; early primary repair was performed in all cases. All patients achieved preoperative range of motion without extension lag or restriction in range of movement within 6 months of repair of the quadriceps tendon.Conclusion
Early identification and prompt treatment of quadriceps tendon injury followed by controlled postoperative rehabilitation results in excellent short-term and mid-term outcomes. 相似文献20.
Andrea Antonio Maria Bruno Alexander Kirienko Andrea Peccati Paolo Dupplicato Massimo De Donato Enrico Arnaldi Nicola Portinaro 《The Knee》2017,24(1):91-99