Seyed Amir Mahlisha Kazemi Sheshvan; Behnam Panjavi; *Saeed Reza Mehrpour; Mohammad Naghi Tahmasebi
Abstract
True duplication of the patella is extremely rare. We describe a case of duplication of the patella in an eight-year-old boy with the history of progressive deformity of his left knee.
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True duplication of the patella is extremely rare. We describe a case of duplication of the patella in an eight-year-old boy with the history of progressive deformity of his left knee.
Azin Zargham; Karim Leilnahari; Soheil Mehdipoor; Elnaz Nouri; Sohrab Keihani
Abstract
Background: Anterior cruciate ligament (ACL) tear is a common injury in sports. Different technigues for reconstruction of this ligament have been suggested. This paper compares the knee kinematics between "single bundle" and "double bundle" ACL reconstruction with hamstring tendon in a computerized ...
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Background: Anterior cruciate ligament (ACL) tear is a common injury in sports. Different technigues for reconstruction of this ligament have been suggested. This paper compares the knee kinematics between "single bundle" and "double bundle" ACL reconstruction with hamstring tendon in a computerized knee model. Methods: A computer-knee modle was constructed. Then "single bundle" and "double bundle" ACL reconstruction was performed. The knee stability and ligament tension were tested in 3 different settings: 1) At 30° knee flexion under isolated postero-anterior load, valgus and rotational torque was applied, 2) In weight-bearing flexion range (from extension to 70° of flexion) an anterior load of 134 Newton was applied, 3) Knee model was loaded by a non-contact pivot farce to produce ACL rupture. Results: The results showed no significant difference between "single bundle" and "double bundle" under isolated loading. The second and third model, however, showed 4 times greater tension on the ligament in "single bundle". The "single bundle" in the second technique of testing (weight bearing) showed at most 7 mm more displacement compared with "double bundle". In the third testing technique "double bundle" was stronger than "single bundle" in valgus torque resistance. The internal rotation stability was also more in "double bundle". Conclusion: Functional stability of knee model of ACL reconstruction with a "double bundle" graft is superior to a "single bundle" graft.
Seyyed Morteza Kazemi; Siyavosh Hemmati Eslamlou; Arash Maleki; Reza Zandi; Mohammad Ali Jalili; Keyghobad Ashoori; Farshad Safdari
Abstract
Background: The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury. Methods: In a case control study, 61 consecutive cases with ACL injury, who were ...
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Background: The role of increased posterior tibial slope in rupture of the anterior cruciate ligament (ACL) is controversial. The purpose of current study was to determine the effect of posterior slope on the ACL injury. Methods: In a case control study, 61 consecutive cases with ACL injury, who were candidates for reconstruction, were compared with 61 persons with normal knees who were matched for age and sex, over a 2-year period at a teaching hospital in Tehran, Iran. The posterior tibial slope angles were measured on true lateral radiographs on all the cases. The measurement variations were analyzed between the two groups. Results: The mean posterior tibial slope was 9.4±1.8 degrees in controls and 12.3±4.4 in patients with ruptured ACL (p < .001). The incidence of tibial slope greater than 10 degrees in patients with ruptured ACL was 3.1 times greater than that of the controls. Conclusion: This study suggests that increased tibial slope angle may contribute to increased risk for ACL rupture.
Mohsen Mardani Kivi; Ali Karimi; Keyvan Hashemi Motlagh
Abstract
Background: The purpose of clinical examination is to make a correct diagnosis. There are several clinical tests with different diagnostic values for meniscus injuries. The aim of the present study was to evaluate the diagnostic value of modified "axial loading McMurray test". Methods: In a cross sectional ...
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Background: The purpose of clinical examination is to make a correct diagnosis. There are several clinical tests with different diagnostic values for meniscus injuries. The aim of the present study was to evaluate the diagnostic value of modified "axial loading McMurray test". Methods: In a cross sectional diagnostic study, 146 patients (120 male, 26 female) with a mean age of 35 years who had clinical symptoms of knee meniscus injury and were candidates for arthroscopic evaluation entered the study in a teaching hospital in Guilan-Iran. "Axial loading Mc Murray – ALMM" test was performed in all the cases just before doing arthroscopic evaluation of the knees. The accuracy, sensitivity, specificity, positive and negative predictive values of the ALMM in relation to the later arthroscopic findings were analyzed. Results: From the 146 patients, 92 had evidence of meniscus tear on ALMM testing. The arthroscopy was, however, positive in 82 patients. In the remaining 54 cases with negative ALMM test, 38 patients had meniscus tear at arthroscopy. 56% of tears were seen in medial meniscus, 75% of which were in posterior horn. The ALMM test had 67.1% accuracy, 68.3% sensitivity, 61.5% specificity, 89.1% predictive positive value and 29.6% negative predictive value. Conclusion: Positive "Axial loading Mc Murray" for knee meniscus injury is expected to show meniscal tear in 89% of cases
Sohrab Keyhani, MD; Seyyed Reza Sharifzadeh, MD; Mohammad Reza Abbasian, MD; Touraj Shafaghi, MD; Soheil Mehdipour, MD; Farshad Safdari, MSc
Abstract
Background: The purpose of this study was to evaluate the functional outcome of arthroscopic treatment of chondral and osteochondral lesions of the knee with arthroscopic osteochondral autograft transfer (Mosaicplasty), and to evaluate the factors affecting the treatment outcome.Methods: In a before ...
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Background: The purpose of this study was to evaluate the functional outcome of arthroscopic treatment of chondral and osteochondral lesions of the knee with arthroscopic osteochondral autograft transfer (Mosaicplasty), and to evaluate the factors affecting the treatment outcome.Methods: In a before and after clinical trial, 56 patients with grade 4 full thickness chondral lesion (outer bridge classification) were treated by the arthroscopic mosaicplasty technique over a 4-year period at an hospital in Tehran, Iran. The mean time of follow-up was 21±4 months (16-32 months). The patients were assessed by International Knee Documentation Committee (IKDC) and Lyshom knee scoring scale (LKSS). The impact of age, site of chondral lesion (medial or lateral femoral condyle), extent of the lesion (number of plugs) and associated lesions, preoperative active levels, tourniquet time and surgery complications were studied. In 3 cases, second-look arthroscopy was performed.Results: The result of 78.6% was excellent and 21.4 good, based on IKDC. Preoperative Lysholm score was 67.1±17.6 and postoperative score increased to 93.2±6.5 (p < /em>=.0004). Clinical outcomes were better significantly in patients with associated articular lesions, lateral condyles lesions, professional athletes and younger patients, also in cases with lower plug numbers and sport injuries (p < /em>
Ali Akbar Esmailijah, MD; Seyyed Mohammad Jazaeri, MD; Seyyed Mehdi Hosseini Khameneh, MD; Firooz Madadi, MD; Sohrab Keihani, MD; Keyghobad Ashoori, MD; Pooran Hakimi, MD; Reza Zandi, MD; Mehdi Rahimi, MD; Farshad Safdari, MSc
Abstract
Background: Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions.Materials: In a cross-sectional study, the CT image positions of the tibial ...
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Background: Incorrect tunneling is one of the concerns in arthroscopic anterior cruciate ligament reconstruction. The purpose of the current study was to determine the incidence of the correct femoral and tibial tunnel positions.Materials: In a cross-sectional study, the CT image positions of the tibial and femoral tunnels in 40 patients that had undergone arthroscopic ACL reconstruction using single-bundle hamstring tendon were studied. The parameters that were evaluated were: tibial tunnel position in axial and sagittal cuts, femoral tunnel position in axial cut, appropriate thickness of the posterior cortex at the intercondylar notch, and femoral exit point.Results: The correct position of the tibial and femoral tunnels, appropriate thickness of the posterior cortex at the intercondylar notch, and the correct position of the "femoral exit point" were respectively recognized in 60%, 52.5%, 70%, and 67.5%. In total, the correct position of the femoral and tibial tunnels was seen on 37.5% of patients. These parameters were compared with known standard anatomic positions.Conclusion: Although the incidence of correct tibial and femoral tunnel positioning in ACL reconstruction, when viewed separately, was acceptable when looked at as one tunnel was not satisfactory. More precise attention and expertise seem necessary for the operating orthopaedic surgeons.
Firooz Madadi, MD; Jaafar Tavakolian, MD; Arash Maleki, MD; Mehdi Rahimi, MD; Reza Zandi, MD; Mohammad Reza Bigdeli, MD
Abstract
Background: The anterior cruciate ligament is the primary structure that controls anterior displacement in the unloaded knee. Anterior cruciate ligament reconstruction may return normal functions of the knee. The aim of the present study was to compare three different femoral fixation techniques in anterior ...
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Background: The anterior cruciate ligament is the primary structure that controls anterior displacement in the unloaded knee. Anterior cruciate ligament reconstruction may return normal functions of the knee. The aim of the present study was to compare three different femoral fixation techniques in anterior cruciate ligament reconstruction.Methods: In a clinical trial study, 120 patients that were candidates for ACL reconstraution were randomly divided into 3 groups of 40 individuals. The femoral fixations were by the three methods of "Aperfix", "Rigidfix" or "Endobutton". The cases were re-examined 12 months after surgery and evaluated by Lysholm score as well as with KT-1000 machine. The results were compered together for the three above methods.Results: The Lysholm score showed improvement from pre-operative values in all three techniques: From 63.21±18.59 to 90.64±9.47 in "Endobutton" group, from 65.72±18.74 to 96.22±5.35 in "Aperfix" and from 69.21±17.45 to 90.64±9.47 in the "Rigifix" group. There were 6 failures in "Endobutton", 4 in "Rigidfix" and one in "Aperfix" group. The anterior displacement tibia was 3.96±1.58 millimeters in "Endobutton", 4.28±1.48 in "Rigidfix", and 4.03±1.79 millimeters in "Aperfix" group. There was no significant difference in the operating time in the 3 groups.Conclusion: Regarding the instant stability of the graft, the "Aperfix" method seemed stranger. Further investigations with larger number of cases and longer duration of follow up are recommended.
Amir Reza Kachooei, MD; Shiva Razi, MD; Reza Mahdavian Naghashzargar, MD; Hadi Makhmalbaf, MD
Abstract
Background: Posterior cruciate ligament (PCL) injury is reported in 3% to 23% of knee injuries. Ligament rupture usually requires reconstructive surgery. Avulsion injuries in acute cases, however, are often treated by fixation of avulsed bone and ligament. Fixation of avulsions in chronic cases is somewhat ...
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Background: Posterior cruciate ligament (PCL) injury is reported in 3% to 23% of knee injuries. Ligament rupture usually requires reconstructive surgery. Avulsion injuries in acute cases, however, are often treated by fixation of avulsed bone and ligament. Fixation of avulsions in chronic cases is somewhat controversial.Methods: In a descriptive study, from 40 male patients with mean age of 27.87 years old who had undergone fixation of PCL avulsion with maleolar screw and washer through a posteromedial approach, 20 cases with a mean of 40±16.02 weeks follow-up were studied. Twelve cases had received early fixation and 8 had fixation 8 weeks or longer after the injury. The cases were evaluated with clinical evaluation of stability as well as assessment of patients’ satisfaction and return to sports or regular activities.Results: Improvement in “posterior drawer test” was observed in all the cases. The ones who had early surgery, as well as the ones with isolated PCL injury had better results in comparison with late avulsion fixation or combined ligament injuries. Eight cases had no problem in knee function, 7 cases had some limitation in sporting, and 5 in some regular daily activities. Conclusion: Screw fixation of PCL avulsion through a posterio-medial approach, even in delayed cases, is safe, easy and effective. Associated other knee injuries are detrimental for good results.
Seyyed Morteza Kazemi, MD; Reza Minaei, MD; Mohammad Ali Okhovatpoor, MD; Ramin Farhang Zanganeh, MD; Mohammad Reza Bigdeli, MD; Seyed Reza Aghapour, MD
Abstract
Background: The role of a mobile-bearing knee arthroplasty is still not clear. This study was designed to compare the mobile and fixed-bearing prosthesis.Methods: In 30 knees a fixed-bearing and in 38 knees a mobile-bearing prosthesis was used. The results were compared using the "Knee Society Scoring ...
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Background: The role of a mobile-bearing knee arthroplasty is still not clear. This study was designed to compare the mobile and fixed-bearing prosthesis.Methods: In 30 knees a fixed-bearing and in 38 knees a mobile-bearing prosthesis was used. The results were compared using the "Knee Society Scoring System".Results: The mobile-bearing group of patients had an average age of 65 and 34 months average follow-up. The fixed-bearing group had an average age of 69 years and a mean follow-up of 30 months. The average knee score, functional score and overall score in the mobile-bearing group rose from 29, 45, 73 to 64, 67, 128 and in the fixed-bearing group from 31.7, 34, 65.9 to 68, 57, 125 prospectively. The difference between two groups was not significant statistically.Conclusion: Although in both groups the average knee scores increased after the operation, there were, however, no significant difference between knee scores in the two types in short-term, and no preference between two types of prosthesis.
Fereidoon Mojtahed Jaberi, MD; Hooman Abbasi, MD; Nasrin Saki; Amir Lotfazar; Ahmad Ensafdaran, MD; Soraya Saki; Mehrad Mojtahed Jaberi
Abstract
Background: This study presents a modification of tibial inlay technique in posterior cruciate ligament (PCL) reconstruction and evaluates the structural properties of tibial side fixation of the graft, comparing tibial inlay technique and a new modification, that is interference screw fixation of tibial ...
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Background: This study presents a modification of tibial inlay technique in posterior cruciate ligament (PCL) reconstruction and evaluates the structural properties of tibial side fixation of the graft, comparing tibial inlay technique and a new modification, that is interference screw fixation of tibial side of the graft in suggested supine position which is more applicable, with less potential intraoperative neurovascular complications.Methods: Forty fresh calf knees that were prepared from 20 healthy 3 years old calves which were between 200 and 220 kg were the subject of this study. The tibias were separately used simulating tibial side PCL reconstruction with tibial tuberosity-patellar tendon–patellar bone graft. Tibial side of the graft was fixed using two cancellous screws in 20 tibiae and with interference screw in obliquely oriented canal in another 20 tibiae. Load-to-failure test was carried out on ten samples from each group. The remaining samples were used for cycling loading. Structural properties of each group were compared.Results: No significant differences were observed between two methods at load-to-failure test but mean elongation at 1,000 cycles of new modification was significantly lower than tibial inlay technique.Conclusion: In this biomechanical experimental study there found no significant differences between two methods at load-to-failure tests. Maximum load (N) was different between the tibial inlay method and the modified method but the difference was not statistically significant. Yield load and linear stiffness and deformation at the yield point were also not different between the two methods. The only important difference between the two methods was at cyclic loading test where the mean elongation at 1,000 cycles of the modified technique group was significantly lower than tibial inlay technique (p < /em>= .01).
Ahmad Ensafdaran, MD; Amir Reza Vosoughi, MD; Mohammad Reza Ensafdaran, MD; Hamid Reza Ensafdaran, MD; Amir Reza Vosoughi, MD
Abstract
Background: Meniscal injury is a major cause of functional impairment of the knee. Total meniscectomy was the treatment of choice for many years, but long-term results were not satisfactory. Nowadays, minimal partial meniscectomy performed arthroscopically, or meniscal repair when practically, have become ...
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Background: Meniscal injury is a major cause of functional impairment of the knee. Total meniscectomy was the treatment of choice for many years, but long-term results were not satisfactory. Nowadays, minimal partial meniscectomy performed arthroscopically, or meniscal repair when practically, have become the standard choice.Methods: One hundred and ten patients with stable knee and history of pain, giving way, and locking, which their MRI showed only medial meniscus tear, were selected for partial meniscectomy. Evaluation included a patient radiological evaluation by Fairbanks classification for operated and non-operated knee, physical examination and Lysholm score before and 6, 18, 36 months after operation.Results: Only 87 patients (78 men, 9 women) were available for follow-up. Mean age for men was 27.8 years (18-53 years) and for women 36.9 years (22-50 years). Meniscus tear was bucket handle in 54%, flap in 10.4%, radial in 8%, and complex in 27.6% of cases. Mean Lysholm score was 48.4 (range: 41-55) before operation which increased to 80.87 (range: 73-85), 90.6 (range: 78-95), and 90.87 (range: 68-95) 6, 18, and 36 months after operation, respectively (p < /em>
Seyyed Morteza Kazemi, MD; Reza Minaei, MD; Ramin Zanganeh, MD; Mohammad Reza Miniator Sajadi, MD; Mohammad Ali Okhovatpoor, MD
Abstract
Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence ...
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Background: Change in the position of the patella in relation to the tibiofemoral joint (PB/PPB) is an important but often neglected complication of total knee arthroplasty. Such change may result in pain and decreased knee range of motion after surgery. The aim of this study is to measure the incidence of patella baja and pseudo-patella baja after total knee arthroplasty. Methods: In a retrospective study, 60 patients (49 women, 11 men) who had knee arthroplasty between 1992 and 2002 at Akhtar teaching Hospital in Tehran were studied for patellar problem. At the time of the study, patients were at least one year and at most eleven years from their operation. All measurements were made by a single person. All the patients received posterior cruciate ligament retaining prosthesis knees through a medial parapatellar arthrotomy. The average age at the time of the study was 62.5 years and the average follow-up was 27.5 months. The Knee Society Scoring System was used to score the knees. Patients' radiographs were examined using the Insall Salvati and Blackburne Peel methods. Results: Pseudo-patella baja was found in 15 (25%) patients while simultaneous baja and Pseudo-patella baja in 2 (3%) patients. While patella baja or Pseudo-patella baja were associated with more incidence of knee pain or limitation of motion, no relation was seen with final knee society scores.Conclusion: Patella baja or Pseudo-patella baja after knee arthroplasty may cause pain or limitation in knee range of motion. Attention to proper bone cuts and patellar tracking during surgery is suggested.
Ahmad Ensafdaran, MD; Amir Reza Vosoughi, MD; Mohammad Reza Ensafdaran, MD; Amir Reza Vosoughi, MD
Abstract
Background: Osteoarthritis is common especially in over 50 years of age patients. There are several non–surgical treatment modalities such as non-steroid anti-inflammatory drugs, physiotherapy, and intra-articular injection of steroids and Hyaluronic Acid. Surgical procedures include arthroplasty, ...
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Background: Osteoarthritis is common especially in over 50 years of age patients. There are several non–surgical treatment modalities such as non-steroid anti-inflammatory drugs, physiotherapy, and intra-articular injection of steroids and Hyaluronic Acid. Surgical procedures include arthroplasty, osteotomy of tibia and arthroscopic débridement. Careful selection of patients in particular, for arthroscopic débridement is a very important point.Methods: In a prospective study, 88 patients with mean age of 55.28 (55-63 years) with knee osteoarthritis who had failed non-surgical treatments were selected for arthroscopic débridement. Radiographic inclusion criteria were presence of 3-4 millimeters of joint space, less than 10 degrees flexion contracture and varus/valgus malalignment, and at least 100 degrees of flexion. The treatment results were assessed annually in 3 successive years, using Lysholm knee Scale. Seventy-four patients (43 females, 31 males) had complete follow-up and are reported here.Results: The pre operative Lysholm score of 37.2 (range: 26-55) increased to 81.9 (range: 70-90) in first year, to 82.9 (range: 70-95) by the second year and to 78.5 (60-90) in the third year (p < /em>
Sohrab Keyhani, MD; Ali Akbar Esmaieliejah, MD; Mehran Soleimanha, MD; Ali Akbar Esmaieliejah, MD; Seyed Morteza Kazemi, MD; Mohammad Reza Abbassian, MD; Reza Rokni, MD
Abstract
Background: The purpose of this study was to evaluate the short-term outcomes after one-stage arthroscopic reconstruction in chronic multiligamentous knee injuries.Methods: In a prospective study, 15 men with chronic multiligamentous knee injuries underwent one-stage reconstruction with autogenous semitendinosus ...
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Background: The purpose of this study was to evaluate the short-term outcomes after one-stage arthroscopic reconstruction in chronic multiligamentous knee injuries.Methods: In a prospective study, 15 men with chronic multiligamentous knee injuries underwent one-stage reconstruction with autogenous semitendinosus and gracilis grafts for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Any associated other ligamentous injuries were repaired by Achilles tendon allografts. The results were assessed by IKDC, and Lysholm score and ligament integrity by MRI with a mean follow-up of 9 (4-19) months. Clinical examination, regular radiography and a subjective questionnaire completed the evaluation procedures. Results: With a mean age of 23 (18-35) years, the final IKDC score was normal (grade A) in 1, nearly normal (grade B) in 10, abnormal (grade C) in 3 and grossly abnormal (grade D) in 1 patient. The mean subjective IKDC score was 83±14. The preoperative Lysholm score of 62±13 become 94±5 in follow-up.Conclusions: Multiple ligament injuries of knee can be successfully treated arthroscopically with autologous hamstring tendon graft, and if necessary, additional of Achilles tendon allograft.
Mohammad Naghi Tahmassebi, MD; Shahriar Jalali Mazlouman, MD; Mahdi Aarabi, MD
Abstract
Background: Nativization is modification of the components of a system in accordance with the needs of a society without altering its original function. We hypothesized that an index that incorporates Iranian society native specifications would be more sensitive in measurement of hip and knee osteoarthritis ...
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Background: Nativization is modification of the components of a system in accordance with the needs of a society without altering its original function. We hypothesized that an index that incorporates Iranian society native specifications would be more sensitive in measurement of hip and knee osteoarthritis severity in comparison to common international indices.Methods: Thirty patients with primary osteoarthritis of hip or knee that underwent total joint arthroplasty and fulfilled the criteria were enrolled. Patients were studied using WOMAC, Lequesne, Modified Doyle index, nativized WOMAC index and patient and interviewer global assessment preoperatively and also 6 weeks, 3 months and 6 months post-operatively. "50 feet walking time" and knee range of motion were also studied. The results were analyzed using parametric and nonparametric tests and Pearson coefficient of correlation.Results: The nativized index improved from mean 118 (99-136) pre-operatively to 53.4 (41-68) at 6 weeks post-operatively and 31.5 (23-44) at 6 months. WOMAC and Lequesne improved from mean pre-operative values of 75.6 (55-92) and 18.6 (11-24) to 18.8(17-24) and 6.6 (3-11) at 6 months. Doyle index also improved significantly. Interviewer and patient global assessment improved from mean pre-operative value of 3.4 and 3.9 respectively to 1.5 and 1.9 at 6 weeks and 0.7 and 0.8 at 6 months post-operatively respectively. The most sensitive indices were nativized WOMAC and Lequesne indices.Conclusions: Nativized WOMAC index in knee and hip osteoarthritis demonstrates the severity of symptoms with more sensitivity than other common international indices.
Ali Akbar Esmaieliejah, MD; Mohammad Reza Abbassian, MD; Hamid Reza Hosseinzadeh, MD; Seyed Mohammad Jazayeri, MD; Mehrnoosh Hasas Yeganeh, MD; Nima Mohsseni, MD
Abstract
Background: Osteoarthritis is a relatively common ailment of human beings. The aim of this study is to compare the short-term effects of oral non-steroid anti-inflammatory medications with intra-articular injections of Hyaluronic Acid or Methyl Prednisolone acetate.Methods: In a clinical trial study, ...
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Background: Osteoarthritis is a relatively common ailment of human beings. The aim of this study is to compare the short-term effects of oral non-steroid anti-inflammatory medications with intra-articular injections of Hyaluronic Acid or Methyl Prednisolone acetate.Methods: In a clinical trial study, 40 female patients with moderate or severe knee osteoarthritis received Hyaluronic Acid intra-articular injections. They were compared with 16 cases who had intra-articular Prednisolone injection and 36 female patients who received non-steroid anti-inflammatory oral medication. The results were evaluated in 6 and 24 weeks by Visual Analogue Scale and Western Ontario & McMaster Universities (WOMAC) functional score.Results: Pain relief in 6 and 24 weeks post injection were 4.9 and 4.7 for Hyaluronic Acid, and 1.5 and 1.6 for Prednisolone. The figures for oral non-steroidal anti-inflammatory medication were 5.2 and 4.9 respectively. Subjective patient’s satisfaction was expressed in 28 (70%) of Hyaluronic Acid group and 16 (100%) of Prednisolone group.Conclusions: After 6 and 24 weeks following intra-articular steroid injection in female patients with knee osteoarthritis, pain relief and subjective patient satisfaction is more favorable compared to intra-articular Hyaluronic Acid injection. These two are both more effective than oral anti-inflammatories. This statement does not include the potential side-effects of intra-articular steroid injection in long-term.
Javad Afzali B, MD; Yoosef Sarvari, MD; Mohammad Gharedaghi, MD; Seyed Reza Sharifi, MD; Javad Mozafari, MD
Abstract
Background: The term “floating knee” is used to describe the flail knee separated from the ipsilateral hip and ankle. Its various forms are expressed in the classification framework. The objective of this research was to review the authenticity of previous floating knee classifications.Methods: In ...
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Background: The term “floating knee” is used to describe the flail knee separated from the ipsilateral hip and ankle. Its various forms are expressed in the classification framework. The objective of this research was to review the authenticity of previous floating knee classifications.Methods: In a retrospective study, 74 patients (64 males, 10 females) with floating knee, the epidemiology of this trauma and the prevalence of its various kinds of fractures were studied in relation to the five existing classifications. The study was done in two educational trauma centers in Mashhad, in a two year period at one and 3 year period at the other hospital. The mean age of the patients was 25.6 years.Results: In classification of patients, there was some non-conformity with the previous classifications. In previous classifications there are some weaknesses such as not to have location for open fractures, cases with both injured epiphyses and cases that have more than two fractures around the knee. In the new classification ''the floating knee'' has been divided into three types: Conventional floating knee (A,B,C), Complex knee fractures (D,E) and variant floating knee (the hip and ankle ipsilateral fractures). Each subgroup is marked with one of the numerical codes (0,I,II) which determines the open or closed status of the fracture(s). In this research 12% of injuries were complex knee fractures.Conclusions: In the new classification, fractures’ types are classified as relatively comprehensive and simple and are coded.
Mahmood Karimi Mobarakeh, MD; Alireza Saeed, MD; Ali Nemati, MD
Abstract
Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Methods: In a clinical ...
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Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Methods: In a clinical trial and prospective study, 54 patients (11 males, 43 females) with knee disease who underwent joint replacement from 2001 to 2006 in a Teaching hospital in Kerman, were studied. Mean age was 65 years (41-80) and mean follow-up 34.4 months (3 months to 5 years). 46 cases had osteoarthritis and 8 rheumatoid arthritis. The pre and post operative findings were assessed using the ‘Knee Society’ evaluation system. The opposite knees were used to compare the patients’ satisfaction from the procedure.Results: In a study on 54 cases, the pain score of ‘Knee Society’ improved from 33 to 77 and the functional score improved from 41 to 72. Ninety six percent of the cases were satisfied with their surgeries. The complications included 1 deep and 1 superficial infection, 2 wound healing problem and one patellar dislocation. Three revisions become necessary: 2 due to infection, one for loosening and deformity in tibial component.Conclusions: Knee replacement in Kerman is associated with high satisfaction rate in short-term. Early failure is mostly related to infection or technical errors in surgery.
Fardin Mirzatolouei, MD; Ahmadreza Afshar, MD
Abstract
Background: We evaluated the short term results of reconstruction of anterior cruciate ligament ruptures using a four strand hamstring autograft and cross pin femoral fixation.Methods: In a cross-sectional study 24 patients (1 female, 23 males) with mean age of 25 years (20-34) with chronic ACL ruptures ...
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Background: We evaluated the short term results of reconstruction of anterior cruciate ligament ruptures using a four strand hamstring autograft and cross pin femoral fixation.Methods: In a cross-sectional study 24 patients (1 female, 23 males) with mean age of 25 years (20-34) with chronic ACL ruptures were studied in a hospital in Urmia. The patients were treated with a four-strand hamstring autograft, cross pin femoral fixation (transfix) and an interference srcrew on the tibial side. Eight patients received simultaneous treatment for meniscal pathology. Final evaluation was performed 9 months after surgery, using the Lysholm and tegner scales, radiographs and a simple arthrometer.Results: The Lysholm score was good or excellent in 22 petients, fair in one and poor in one patient. Mean Lysholm score was 85.9. Tegner activity scores demonstrated that 16 patients had moved at least one level up, and the remaining cases stayed at their pre-operative level. Arthrometer showed a significant decrease in anterior tibial translation. Two patients developed septic arthritis one of whom required graft, pin and screw removal. Because of graft harvest failure, hamstring graft was taken from the contra lateral side in 2 patients.Conclusions: Reconstruction of ACL using four-strand hamstring tendons and cross pin femoral fixation results in considerably high success rate in short term. Infection and graft harvest failure are the major complications.
Fardin Mirzatolouie, MD
Abstract
Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well-known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. ...
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Background: Recurrent patellar subluxation is clinically manifested by slippage of patella and positive apprehension test. Fulkerson osteotomy of tibial tubercle is a well-known surgery for this type of patellar malalignment. Little data is available for changes of apprehension test after Fulkerson operation. The goal of this survey was assessment of Fulkerson surgery for patellar instability and its effect on apprehension test.Methods: In a clinical trial study, 12 patients (9 females, 3 males) with mean age of 38.3 years (28-60 years) underwent tibial tubercle osteotomy for symptomatic patellar subluxation. Mean follow-up time was 10 months (6-18 months). The pre and post operative assessment of change in “apprehension test”, knee function and radiographic changes were respectively evaluated by visual analog scale (VAS) and with Bristol pain score, Fulkerson scoring and lateral pattelo-femoral angle or Merchant view.Results: The results in 8 patients were excellent or good, 3 fair and one poor. Eight cases believed the surgery had been effective. The Fulkerson score of 48.75 improved to 71.6, while Bristol pain score of 7.3 decreased to 4.1 and VAS for apprehension test of 7.5 decreased to 5.16. The “Apprehension test” did not change in 3 patients, and one case developed significant limitation of motion.Conclusions: Fulkerson tibial tubercle osteotomy in selected patients improves knee function and decreases pain in short-term, but does not improve patellar alignment.
