The journal of knee surgery
-
Patellar instability is a common knee disorder encountered in young athletes. Patients with normal osseous anatomy and mechanical alignment of the lower extremity are candidates for soft-tissue reconstructive procedures. ⋯ Biomechanical research demonstrates that the medial patellofemoral ligament is the primary soft-tissue restraint to lateral subluxation of the patella, and the medial patellotibial ligament is an important secondary stabilizer. We present a novel physeal-sparing surgical technique that anatomically reconstructs both the medial patellofemoral and medial patellotibial ligaments using semitendinosus autograft.
-
Randomized Controlled Trial
Intraoperative music reduces perceived pain after total knee arthroplasty: a blinded, prospective, randomized, placebo-controlled clinical trial.
Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to severe postoperative pain. Using a multimodal pain management protocol, a blinded, randomized, placebo-controlled study was designed to evaluate the efficacy of patient-selected music on reducing perceived pain. ⋯ Postoperative pain scores, assessed with the visual analog scale, indicated the music group experienced less pain at 3 and 24 hours postoperatively than did the nonmusic group (at 3 hours: 1.47+/-1.39 versus 3.87+/-3.44, P=.01; at 24 hours: 2.41+/-1.67 versus 4.03+/-2.89, P=.04). Intraoperative music provides an inexpensive nonpharmacological option to further reduce postoperative pain.
-
Acute isolated rupture of the patellar tendon traditionally has been repaired via transpatellar suture tunnels. This retrospective study evaluated the demographics and epidemiology of this injury as well as the effectiveness and complication rates of our suture anchor technique. Between 1993 and 2005, a total of 82 cases of patellar tendon disruption in 71 patients were repaired. ⋯ The remaining 11 patients had excellent range of motion and strength and returned to their preoperative level of function. These results are comparable with other reports in the literature. The suture anchor technique thus represents a viable option for repair of patellar tendon ruptures and should be investigated further with a randomized, controlled trial.
-
Multicenter Study
Adverse effects of increased body mass index and weight on survivorship of total knee arthroplasty and subsequent outcomes of revision TKA.
To investigate the effects of increased weight and body mass index (BMI) on total knee arthroplasty (TKA) survivorship and on functional outcomes and quality of life following revision TKA, a prospective cohort study of 291 consecutive revision TKA patients was performed. Average patient BMI was 32.3 +/- 7.7, and 57% of patients were obese (BMI > or = 30). The obese group was not significantly different from the nonobese group regarding reasons for prosthesis failure; however, they were more likely to experience certain comorbidities. ⋯ In regression analysis, BMI was a significant predictor of Short Form-36, WOMAC difficulty of function, and KSS. Weight and BMI have deleterious effects on the longevity of primary TKA and functional and quality of life outcomes following revision TKA. These findings indicate a need for more effective management of these patients.
-
Isolated anterior cruciate ligament (ACL) reconstruction may provide long-term symptom relief and improved function in patients with medial knee arthrosis and ACL-deficiency, while delaying or possibly eliminating the need for further surgical intervention. Fifty-three patients who had medial unicompartmental arthrosis and chronic ACL-deficient knees underwent ACL reconstruction alone. Subjective evaluation at mean 10 years postoperatively indicated statistically significant improvement compared to preoperative evaluation and better scores for patients who obtained normal knee range of motion. ⋯ Isolated ACL reconstruction provides long-term symptomatic pain relief, increased activity, and improved function. Anterior cruciate ligament reconstruction can effectively provide stability to the ACL-deficient knee with degenerative medial arthrosis without compromising range of motion or strength. Obtaining and maintaining full range of motion equal to the normal knee is important for the optimal result.