Mahmood Karimi Mobarakeh; Mohsen Mardani-Kivi
Abstract
Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole, but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament, quadriceps alignment ...
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Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole, but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament, quadriceps alignment and Q-angle and tibial plateau slope. The goal of high tibia osteotomy is more normal load distribution in nonarthritic knee in young persons, and slowing degeneration in arthritic knee in adults. All the high tibia osteotomies cause patellofemoral biomechanical changes, through tubercle displacement, or patellar tendon fibrosis or calcification. Q angle also increase with lateral displacement of tibial tuberosity when osteotomy is done proximal to the tibial tuberosity. The medial collateral ligament needs to be released in open wedge high tibia osteotiomy. If intact medial ligament is necessary, osteotomy should be done distal to medial collateral attachment. The proximal tibia configuration is roughly similar to a rectangle. Lateral cortex is in right angle to the posterior one. The posteromedial corner opens three times the anterior one in open wedge osteotomy otherwise there would be tibial slope change.
Firooz Madadi, MD; Mohammad Reza Abbassian, MD; Fooad Rahimi, MD; Farivar Abdollahzadeh Lahiji, MD; Armin Aalami Harandi, MD; Farzam Farahmand; Tahereh Yazdanyar; Firozeh Madadi; Reza Sadeghian
Abstract
Background: Several different methods for fixation of grafts in anterior cruciate ligament (ACL) reconstruction have been used. The purpose of present study is to compare two techniques of tibial fixation in hamstring quadruple graft reconstruction. Methods: In a randomized clinical trial study, 46 ...
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Background: Several different methods for fixation of grafts in anterior cruciate ligament (ACL) reconstruction have been used. The purpose of present study is to compare two techniques of tibial fixation in hamstring quadruple graft reconstruction. Methods: In a randomized clinical trial study, 46 cases of isolated tears were reconstructed using hamstring grafts. In 24 cases the tibial fixation sites were fixed with interference screw, and in 22 patients the remnant end of graft at tibia was passed through a bony tunnel and fixed with suture to the bone. The cases were all assessed with a mean follow-up of one year with “Cincinnati knee ligament rating scale” and “KT-2000” examination.Results: The score in 22 “target group” cases was 8, and in 24 “control group” was 9. In “KT-2000” examination, 11 patients of double fixation were excellent and 11 good. In control group 4 cases had excellent and 20 good results (p < /em>=0.01).Conclusions: Double tibial fixation for ACL reconstruction with Hamstring tendon graft has a better outcome on “Symptom” evaluation and “KT-2000” instrument compared to single tibial-site fixation.
Keivan Ahadi, MD; Somayeh Nabi, MD
Abstract
Background: MRI is widely used for diagnosis of traumatic intra-articular knee lesions. Its accuracy is variable in different studies and also accuracy of MRI in diagnosis of traumatic intra-articular knee lesions in our country is not clear. This study was performed to evaluate the accuracy of MRI in ...
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Background: MRI is widely used for diagnosis of traumatic intra-articular knee lesions. Its accuracy is variable in different studies and also accuracy of MRI in diagnosis of traumatic intra-articular knee lesions in our country is not clear. This study was performed to evaluate the accuracy of MRI in one of imaging centers in our country in detecting traumatic intra-articular knee lesions by comparing the results of MRI with subsequent arthroscopy as a gold standard.Methods: In a case series study, 33 patients with clinical diagnosis of traumatic intra-articular knee lesions underwent prearthroscopic MRI. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio of MRI were calculated relative to the findings during arthroscopy. The Measure of agreement of MRI with arthroscopy was calculated as well.Results: The accuracy of MRI for medial meniscus was 73%, lateral meniscus 82%, ACL 82%, PCL 97% and articular cartilage 85%. The agreement of MRI with arthroscopy in meniscal lesions was moderate and in ACL and articular cartilage was good.Conclusions: In this study, the accuracy of MRI for medial meniscus and ACL, the sensitivity of MRI for medial meniscus, and the specificity of MRI for lateral meniscus and ACL were significantly lower than the most of the studies. The result of MRI for articular cartilage is the similar to other studies. This issue should be considered by physicians that request MRI.
Hamidreza Aslani, MD; Hamed Vahedi, MD
Abstract
Background: Ipsilateral fractures of tibia and femur or’ “floating knee”, commonly occur as a result of high energy trauma. It is, therefore, associated with high chance of knee injuries. This articles looks at the prevalence of intra-articular knee injury in “floating knee” when the fractures ...
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Background: Ipsilateral fractures of tibia and femur or’ “floating knee”, commonly occur as a result of high energy trauma. It is, therefore, associated with high chance of knee injuries. This articles looks at the prevalence of intra-articular knee injury in “floating knee” when the fractures are extra-articular, both in tibia and femur.Methods: During a 3.5 year period of time (March 2002-Oct 2005), 61, out of total of 76 cases of “floating knees” that had extra-articular femur and tibia fractures, had no history of prior knee problems, and the fractures of both segments had been internally fixed were studied. Each knee was examined for any possible ligamentous injury, following rigid fixation of the fractures, under the same anesthesia. The findings were documented and the patients were later followed for any new findings or complaints up to nine months after the incident.Results: The mean age in these 61 cases (57 males, 4 females) was 29.3 (18-46). Lachman and Pivot tests were positive in 5 and Posterior Drawer test in 3 cases. Valgus instability in 9 and varus instability in 6 other cases were detected. After the 9-months follow-up, knee pain was the chief complaint in 19 patients, while the MRI study which was done in 16 cases was positive for meniscal damage in 13 patients.Conclusions: Concomitant knee insults are fairly common in “floating knee” injuries. A thorough knee examination, following fixation of "floating knee” fractures, while the patient is still under anesthesia is essential. Further evaluation during the course of fracture treatment for any knee complaint is also recommended.
Mahmood Karimi Mobarakeh, MD; Mohammad Hasan Fadaee, MD; Massoud Mehdinejad Yazdi, MD
Abstract
Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injuries around the knee including ligamentous injuries, delayed :::union:::, and more importantly, vascular ...
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Background: Ipsilateral fractures of femur and tibia, the so called “floating knee” are usually the result of high-energy trauma. They are associated with increased risk of local soft tissue injuries around the knee including ligamentous injuries, delayed :::union:::, and more importantly, vascular injuries.Methods: In a cross sectional study of “floating knee” injuries treated in a training hospital of Kerman-Iran over a 1 year period (2003 to 2004) was performed. Seventy eight patients (69 males, 9 females), with a maximum follow-up of 2 weeks entered the study and are reported here. The injury type and, in particular, the vascular status of the limb in terms of prevalence and the fate of limb in first two weeks were the points of concern. Seventy eight “floating knee” patients comprised the study group that was divided into six groups in accordance with the limb vascular status. Each “floating knee” case was further classified according to the level and type of each bone fracture.Results: Out of 78 cases 18 has no pulse and did not regain any hemodynamic stabilization, and 13 had angiography and 5 went directly for arterial exploration. In general 15 cases (19.2%) of “floating knees” had vascular compromise, 8 of whom ended up with amputation. The vascular damage had no direct correlation with age, or anatomic location of fractures.Conclusions: Simultaneous ipsilateral fractures of femur and tibia are associated with around 20 percent chance of vascular injury. Careful and immediate assessment of limb circulation is mandatory for any “floating knee” injuries.
