The journal of knee surgery
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Case Reports
Traumatic neuroma of the infrapatellar branch of the saphenous nerve after hamstring harvesting.
We describe a case of a 47-year-old man with radiating pain and a palpable subcutaneous nodule on the medial side of the upper leg 10 years after hamstring anterior cruciate ligament reconstruction. Clinical and radiological investigations were highly suggestive for a neuroma of the infrapatellar branch of the saphenous nerve. After surgical excision, the diagnosis of traumatic neuroma was confirmed by pathology evaluation. To our knowledge, no similar case has previously been reported.
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The purpose of this study was to document the pattern of ligament and meniscal injuries that occur during high-energy tibial plateau fractures. One hundred three patients with fractures due to high-energy mechanisms were evaluated with knee magnetic resonance imaging (MRI). All studies were read by a single musculoskeletal radiologist who was blinded to surgical and physical exam findings. ⋯ Tibial plateau fractures frequently have important soft tissue injuries that are difficult to diagnose on physical examination. High-energy fracture patterns (AO/OTA type 41C or Schatzker type IV, V, VI) clearly have a significantly higher incidence of ligament injury, and these patients should be carefully evaluated to rule out a spontaneously reduced knee dislocation. We believe MRI scanning should be considered for tibial plateau fractures due to high-energy mechanism, allowing identification and treatment of associated soft tissue injuries.
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Case Reports
Bicondylar Hoffa fracture: open reduction internal fixation using the swashbuckler approach.
Coronal plane fractures of the femoral condyle are infrequent injuries and are often missed. Unilateral bicondylar coronal plane fractures are even rarer, with only eight reported cases in scientific literature, and are often associated with other injuries. We present here a case of unilateral bicondylar Hoffa fracture that presented in our emergency department and was managed with open reduction and internal fixation by lateral parapatellar arthrotomy using the swashbuckler approach with satisfactory results.
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Acute compartment syndrome can complicate fractures of the tibial plateau and must be recognized early so that timely fasciotomy can be performed. The presence of the open fasciotomy wound complicates management of the underlying proximal tibial fracture, which ideally needs early anatomic reconstruction of the articular surface and stable metaphyseal fixation. The purpose of this review is to highlight the importance of this problem, understand treatment strategies, and review outcomes.
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Arthritis treatment in young patients remains a challenge. Joint replacement surgery offers excellent pain relief but is controversial with this age group because of long-term wear and loosening. Recently, biological reconstructive techniques have become available to improve traditional treatment methods such as osteotomies. ⋯ At average follow-up of 24 months, patients experienced significant improvements in the IKDC, Lysholm, and KOOS functional scores. Six of 7 patients were able to return to unrestricted activities; 1 patient experienced mild pain with high-impact activities. Combined treatment with meniscal transplantation, cartilage repair, and osteotomy demonstrated promising clinical results of unicompartmental arthritis treatment in young patients.