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Knee Exam

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13101. The posterolateral corner of the knee: repair versus reconstruction. Full Text available with Trip Pro

with 64 posterolateral corner tears were included in this study, with 39 posterolateral corner repairs and 25 reconstructions using the modified 2-tailed technique. Patients were evaluated with clinical and KT-2000 arthrometer examinations, as well as with Lysholm, International Knee Documentation Committee, and Short Form-36 scores.Fifty-six patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months). Acute primary repairs were performed on 35 patients, with 22 (...) The posterolateral corner of the knee: repair versus reconstruction. Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear.Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol.Cohort study; Level of evidence, 2.Sixty-three patients

2005 American Journal of Sports Medicine

13102. Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. (Abstract)

is comparable to conventional inside-out suture repair in accomplishing long-term healing of meniscal tears.Case series; Level of evidence, 4.This study is an extended follow-up of an original series of 32 patients with outcomes analysis. All patients underwent meniscal repair with exclusive use of the arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, arthrometry, the International Knee (...) Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness.The Meniscus Arrow

2005 American Journal of Sports Medicine

13103. Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair. Full Text available with Trip Pro

Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair. Injuries to the popliteomeniscal fascicles of the lateral meniscus are difficult to identify from physical examination and magnetic resonance imaging scans. To our knowledge, there have been no described physical examination techniques to identify symptomatic isolated popliteomeniscal fascicle tears. The popliteomeniscal fascicles have been demonstrated (...) to be important for lateral meniscus stability, and it has been reported that tears can lead to painful symptoms.Popliteomeniscal fascicle tears cause symptomatic lateral compartment knee pain and can be diagnosed by physical examination. Surgical repair can improve patient function.Case series; Level of evidence, 4.Six patients with isolated tears of the popliteomeniscal fascicles, which caused lateral joint line knee pain, were identified by positive figure-4 test results.All patients were found to have

2005 American Journal of Sports Medicine

13104. The effect of posterior cruciate ligament deficiency on knee kinematics. (Abstract)

imaging, weightbearing in a squat, through the arc of flexion from 0 degrees to 90 degrees in 6 patients with isolated rupture of the posterior cruciate ligament in one knee and a normal contralateral knee. Passive sagittal laxity was assessed by performing the posterior and anterior drawer tests while the knees were scanned, again using the same magnetic resonance imaging scanner. The tibiofemoral positions during this stress magnetic resonance imaging examination were measured from midmedial (...) The effect of posterior cruciate ligament deficiency on knee kinematics. Alteration of the kinematics of the PCL-deficient knee might be a factor in producing the articular damage. Very little is known about the in vivo weightbearing kinematics of the PCL-deficient knee.Isolated rupture of the posterior cruciate ligament alters knee kinematics, predisposing the patient to development of early osteoarthritis.Case series.Tibiofemoral motion was assessed using open-access magnetic resonance

2004 American Journal of Sports Medicine

13105. A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the knee. (Abstract)

of images obtained with multiple pulse sequences and in several imaging planes. A systematic approach will facilitate an accurate and timely evaluation of this complex examination and will ensure that all of the clinically relevant structures are adequately assessed. This article will provide a systematic approach to the interpretation of a magnetic resonance examination of the knee. The normal imaging appearance of each anatomical structure will be described, and the optimal pulse sequence and imaging (...) A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the knee. Magnetic resonance imaging is performed more commonly on the knee than on any other joint, and it is an excellent diagnostic tool that can aid in the evaluation of a host of sports-related injuries involving the ligaments, tendons, menisci, osseous structures, and articular surfaces. A thorough evaluation of the images, however, can be a daunting task, as the study often contains dozens

2005 American Journal of Sports Medicine

13106. Quadriceps contusions: clinical results of immediate immobilization in 120 degrees of knee flexion. (Abstract)

and who were treated identically and followed by serial examinations until the return to unrestricted full athletic activities.United States Naval Academy (USNA), Annapolis, Maryland.USNA midshipmen who sustained quadriceps contusions while participating in sports activities. Inclusion criteria were (1) stated inability at the time of the injury to continue participation and (2) the inability to perform a pain-free, isometric quadriceps contraction and maintain the knee in full extension (...) of the injury to return to unrestricted full athletic activities with no disability.The average time to return to unrestricted full athletic activities with no disability was 3.5 days (range of 2 to 5 days). Radiographic examination of the first 23 midshipmen at 3 and 6 months following the injury revealed 1 case of myositis ossificans.Placing and holding the knee in 120 degrees of flexion immediately following a quadriceps contusion appears to shorten the time to return to unrestricted full athletic

2006 Clinical Journal of Sport Medicine

13107. Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. (Abstract)

open magnetic resonance imaging.Controlled laboratory study.Eighteen subjects with anterior cruciate ligament-deficient knees and 18 with normal knees were recruited. We administered the Slocum anterolateral rotatory instability test in the open magnetic resonance imaging scanner and scanned the sagittal view of the knee. The anterior displacements of the tibia at the medial and lateral compartments were measured. Furthermore, we examined 14 anterior cruciate ligament-deficient knees twice (...) Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. In the clinical evaluation of the anterior cruciate ligament-deficient knee, anterolateral rotatory instability is assessed by manual tests such as the pivot-shift test, which is subjective and not quantitative.The anterolateral rotatory instability in an anterior cruciate ligament-deficient knee can be quantified by our newly developed method using

2007 American Journal of Sports Medicine

13108. Reliability of the international knee documentation committee radiographic grading system. (Abstract)

Reliability of the international knee documentation committee radiographic grading system. The International Knee Documentation Committee (IKDC) forms are commonly used to measure outcomes after anterior cruciate ligament (ACL) reconstruction. The knee examination portion of the IKDC forms includes a radiographic grading system to grade degenerative changes. The interrater and intrarater reliability of this radiographic grading system remain unknown.We hypothesize that the IKDC radiographic (...) grading system will have acceptable interrater and intrarater reliability.Case series (diagnosis); Level of evidence, 4.Radiographs of 205 ACL-reconstructed knees were obtained at 5-year follow-up. Specifically, weightbearing posteroanterior radiographs of the operative knee in 35 degrees to 45 degrees of flexion and a lateral radiograph in 30 degrees of flexion were used. The radiographs were independently graded by 2 sports medicine fellowship-trained orthopaedic surgeons using the IKDC 2000

2007 American Journal of Sports Medicine

13109. Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side. (Abstract)

anterior cruciate ligament reconstruction. Physical examination included the International Knee Documentation Committee score, isokinetic strength testing, KT-2000 arthrometer testing, radiography (including varus stress), and magnetic resonance imaging scan. Patients were evaluated subjectively with several surveys.Mean objective evaluation occurred for 17 patients at 4.6 years postoperatively, and 21 subjective evaluations occurred for 21 patients at 5.6 years postoperatively. The objective overall (...) Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side. Knee dislocations with lateral side injury are rare and disabling if not treated.An en masse surgical technique to repair the lateral side will provide good stability, and the posterior cruciate ligament will heal when left in situ.Case series; Level of evidence, 4.Twenty-three patients underwent an en masse lateral side repair after knee dislocation injury; all but 1 patient had

2007 American Journal of Sports Medicine

13110. Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen. (Abstract)

and Lysholm scores at a mean of 66 months (range, 11-142) after treatment.In all cases, treatment of infection was successful; overall, a mean of 2.2 operations were required. In 7 cases, it was possible to salvage the graft. The Tegner activity level before the knee injury was 6.1 points. At follow-up, the average score was 3.8 points. The postoperative subjective International Knee Documentation Committee score averaged 64. The mean Lysholm score was 65.6. On clinical examination, a mean extension (...) Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen. Septic arthritis is a rare complication after anterior cruciate ligament surgery. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11.A stage-adapted treatment regimen for septic arthritis after anterior cruciate ligament surgery can provide reliable results.Case series; Level of evidence, 4.From June 1993 to May 2003, 24

2007 American Journal of Sports Medicine

13111. Accuracy of stress radiography techniques in grading isolated and combined posterior knee injuries: a cadaveric study. (Abstract)

Accuracy of stress radiography techniques in grading isolated and combined posterior knee injuries: a cadaveric study. Stress radiography techniques have been shown to be superior to the arthrometer and clinical examination in evaluating the posterior cruciate ligament-deficient knee, but no precise relationship has been established between the extent of the lesion and the laxity measured by stress radiography.It is possible to establish a precise relation between posterior laxity (...) and the anatomical lesions of the posterior cruciate ligament and posterior structures using stress radiography.Controlled laboratory study.Measurements were performed on 15 fresh-frozen cadaveric knee specimens. A partial posterior cruciate ligament lesion was created by sectioning the anterolateral bundle, followed by a complete section. Then the lateral collateral ligament and the posterolateral corner were transected, and finally the medial collateral ligament and the posteromedial corner were sectioned

2007 American Journal of Sports Medicine

13112. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. (Abstract)

information prospectively on all cases of cruciate ligament reconstruction surgery in Norway. Information on the details of surgery is gathered through a registration form completed by the surgeon postoperatively, and a validated knee outcome score form is completed by the patients preoperatively and at follow-ups on all patients at 2, 5, and 10 years postoperatively. Hospital compliance was examined in 2005 and 2006.A total of 2793 primary cruciate ligament reconstruction surgeries were registered by 57 (...) Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. No prospective surveillance system exists for monitoring the outcome of cruciate ligament surgery.This article is intended to describe the development and procedures of the Norwegian National Knee Ligament Registry (NKLR), including baseline results from the first 2 years of operation.Cohort study (prevalence); Level of evidence, 1.The NKLR was established on June 7, 2004 to collect

2008 American Journal of Sports Medicine

13113. Histologic and immunohistochemical characteristics of failed articular cartilage resurfacing procedures for osteochondritis of the knee: a case series. Full Text available with Trip Pro

Histologic and immunohistochemical characteristics of failed articular cartilage resurfacing procedures for osteochondritis of the knee: a case series. The histologic appearance of the repair tissue after articular cartilage resurfacing procedures in humans is not well documented.The histologic and immunohistochemical appearance of the repair tissues in failed articular cartilage resurfacing procedures will be similar, regardless of the procedure that was done, and will not resemble normal (...) articular cartilage.Case series; Level of evidence, 4.Graft tissue from 10 patients who underwent an autologous chondrocyte implantation (n = 6), microfracture (n = 3), or periosteal transplantation (n = 1) procedure to treat symptomatic osteochondritis dissecans of the medial femoral condyle was processed for histologic examination after failure of the articular cartilage resurfacing procedure. Serial sections from all slabs were stained with hematoxylin and eosin and toluidine blue and were

2008 American Journal of Sports Medicine

13114. Cartilage damage determines intermediate outcome in the late multiple ligament and posterolateral corner-reconstructed knee: a 5- to 10-year follow-up study. (Abstract)

knee.Case series; Level of evidence, 4.Twenty-one patients were available from an original 27 treated between 1995 and 2000. All patients were assessed preoperatively and postoperatively by physical examination and by applying 4 different knee rating scores. All patients were assessed at a mean follow-up of 39 months (range, 14-75 months) and 87 months (range, 62-123 months).At the first follow-up, all knee rating scores had improved significantly (P < .0003) compared with preoperatively; 84 (...) Cartilage damage determines intermediate outcome in the late multiple ligament and posterolateral corner-reconstructed knee: a 5- to 10-year follow-up study. Patients with chronic ruptures of 1 or both cruciate ligaments in combination with posterolateral rotatory instability of the knee often have some degree of cartilage damage at the time of surgery.Chondrosis at the time of reconstruction does not influence early and intermediate functional outcome of the multiple ligament reconstructed

2008 American Journal of Sports Medicine

13115. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Full Text available with Trip Pro

aspirations failed to resolve the recurrent fluid collections; return to play was immediate thereafter in each case.In football, Morel-Lavallee lesion of the knee usually occurs from a shearing blow from the playing field. Diagnosis is confirmed when examination reveals a large suprapatellar area of palpable fluctuance. Elite athletes are typically able to return to practice and game play long before complete resolution of the lesion. Recurrent fluid collections can occur, necessitating aspiration (...) Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion.To review the authors' experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct

2007 American Journal of Sports Medicine

13116. Knee cartilage morphologic characteristics and muscle status of professional weight lifters and sprinters: a magnetic resonance imaging study. (Abstract)

correlate more strongly with muscle force than with muscle cross-sectional areas.Cross-sectional study; Level of evidence, 3.Fourteen young, healthy adult professional athletes (7 weight lifters and 7 bobsled sprinters) were examined and compared with 14 adult nonathletic volunteers who had never performed strength training. Muscle moments were measured with a dynamometer and muscle cross-sectional areas and knee cartilage morphologic characteristics with magnetic resonance imaging.Weight lifters (...) Knee cartilage morphologic characteristics and muscle status of professional weight lifters and sprinters: a magnetic resonance imaging study. Whereas muscle and bone mass have been shown to strongly depend on mechanical stimulation (loading history), this relationship has not been established for articular cartilage.Subjects with high muscle strength display thicker knee cartilage and larger joint surface areas than nonathletic volunteers, and knee cartilage morphologic characteristics

2007 American Journal of Sports Medicine

13117. Knee and hip loading patterns at different phases in the menstrual cycle: implications for the gender difference in anterior cruciate ligament injury rates. (Abstract)

, hip internal rotation moment, knee flexion moment, knee abduction moment). Men were tested once. Women were tested twice for each phase of the menstrual cycle (follicular, luteal, ovulatory), as determined from serum analysis. An analysis of variance was used to examine differences between phases of the menstrual cycle and between groups (alpha = .05).No significant differences in moments or knee angle were observed between phases in either female group or between the 2 female groups or between (...) Knee and hip loading patterns at different phases in the menstrual cycle: implications for the gender difference in anterior cruciate ligament injury rates. Menstrual cycle phase has been correlated with risk of noncontact anterior cruciate ligament injury in women. The mechanism by which hormonal cycling may affect injury rate is unknown.Jumping and landing activities performed during different phases of the menstrual cycle lead to differences in foot strike knee flexion, as well as peak knee

2007 American Journal of Sports Medicine

13118. Control of laxity in knees with combined posterior cruciate ligament and posterolateral corner deficiency: comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction combined with modified Larson posterolateral corner reco (Abstract)

not differ significantly from normal.In combined PCL plus PLC deficiency, combined PCL plus PLC reconstruction restored all major laxity limits to normal across the range of knee flexion examined. Double-bundle PCL reconstruction was not better than single-bundle reconstruction in this context.The added complexity of double-bundle reconstruction does not seem to be justified by these results. In combined PCL plus PLC-deficient knees, combined single-bundle PCL plus modified Larson PLC reconstruction (...) Control of laxity in knees with combined posterior cruciate ligament and posterolateral corner deficiency: comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction combined with modified Larson posterolateral corner reco Although many posterior cruciate ligament (PCL) injuries are in combination with posterolateral corner (PLC) injuries, there has been little research on combined injury reconstruction; the literature includes differing recommendations.Combined

2008 American Journal of Sports Medicine

13119. Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. (Abstract)

a primary reconstruction in 7 patients and a revision in 6 patients. Anterior cruciate ligament ruptures were found in 7 patients and bicruciate ruptures in 5 patients, all of which were reconstructed. The rehabilitation protocol allowed immediate knee motion from 0 degrees to 90 degrees but included protection against lateral joint loads to prevent graft stretching and failure. The results were determined by a knee examination, stress radiography, KT-2000 arthrometer, the Cincinnati Knee Rating System (...) Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. The authors have long advocated a graft reconstruction of the fibular collateral ligament, believing that direct suture repair or augmentation procedures do not provide a stable construct.To describe an operative technique and determine the clinical outcome of a bone-patellar tendon-bone graft anatomical replacement of the fibular collateral ligament

2007 American Journal of Sports Medicine

13120. Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. (Abstract)

cadaveric knees were tested at (1) intact, (2) anterior cruciate ligament-deficient, (3) double-bundle anterior cruciate ligament reconstruction with the anteromedial and posterolateral grafts fixed at 60 degrees of flexion and full extension, respectively (fixation 60/FE), and (4) double-bundle anterior cruciate ligament reconstruction with both grafts fixed at 30 degrees of flexion simultaneously (fixation 30/30). Two external loading conditions simulating clinical examinations were used: (1) 134-N (...) Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. In double-bundle anterior cruciate ligament reconstruction, overloading either 1 of the 2 grafts should be avoided to decrease the risk of graft failure.Overloading of the posterolateral graft may occur when it is fixed at 30 degrees of knee flexion because the posterolateral bundle is elongated as the knee approaches extension.Controlled laboratory study.Ten human

2006 American Journal of Sports Medicine

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