The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2003
Randomized Controlled Trial Comparative Study Clinical TrialUse of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study.
Controversy continues with regard to the optimal postoperative care after open reduction and internal fixation of an ankle fracture. The hypothesis of this study was that postoperative treatment of an ankle fracture with a brace that allows active and passive range-of-motion exercises would improve the functional recovery of patients compared with that after conventional treatment with a cast. Thus, the purpose of this prospective, randomized study was to compare the long-term subjective, objective, and functional outcome after conventional treatment with a cast and that after use of functional bracing in the first six weeks following internal fixation of an ankle fracture. ⋯ The long-term functional outcome after postoperative treatment of an ankle fracture with a cast and that after use of a functional brace are similar. Although early mobilization with use of a functional ankle brace may have some theoretical beneficial effects, the risk of postoperative wound complications associated with this treatment approach is considerably increased compared with that after conventional cast treatment. Thus, the postoperative protocol of treatment with a functional brace requires refinement before it can be generally advocated for use after operative treatment of an ankle fracture.
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J Bone Joint Surg Am · Feb 2003
Total knee arthroplasty in patients with a prior fracture of the tibial plateau.
A fracture of the tibial plateau may predispose the knee to the development of posttraumatic arthritis. Malunion, intra-articular chondro-osseous defects, limb malalignment, retained internal fixation devices, and poor surrounding soft tissues may in turn compromise the outcome of total knee arthroplasty. The aim of our study was to evaluate the results of total knee arthroplasty in patients with a previous fracture of the tibial plateau. ⋯ The vast majority of patients treated with total knee arthroplasty after a previous fracture of the tibial plateau have substantial improvement in function and relief of pain. However, these patients are at increased risk for perioperative complications, as evidenced by the high reoperation rate of 21% in this study.
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J Bone Joint Surg Am · Feb 2003
Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy.
This study was performed to evaluate whether symptomatic anterior femoro-acetabular impingement due to acetabular retroversion can be treated effectively with a periacetabular osteotomy. ⋯ Periacetabular osteotomy is an effective way to reorient the acetabulum in young adults with symptomatic anterior femoro-acetabular impingement due to acetabular retroversion
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J Bone Joint Surg Am · Feb 2003
Randomized Controlled Trial Comparative Study Clinical TrialAutologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial.
Current methods used to restore the joint surface in patients with localized articular cartilage defects include transplantation of an autologous osteochondral cylinder and implantation of autologous chondrocytes. The purpose of this study was to evaluate the clinical and histological outcomes of these two techniques. ⋯ Both treatments resulted in a decrease in symptoms. However, the improvement provided by the autologous chondrocyte implantation lagged behind that provided by the osteochondral cylinder transplantation. Histologically, the defects treated with autologous chondrocyte implantation were primarily filled with fibrocartilage, whereas the osteochondral cylinder transplants retained their hyaline character, although there was a persistent interface between the transplant and the surrounding original cartilage. Limitations of our study included the small number of patients, the relatively short (two-year) follow-up, and the absence of a control group.
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J Bone Joint Surg Am · Feb 2003
Randomized Controlled Trial Comparative Study Clinical TrialPatellar resurfacing in total knee arthroplasty. A prospective, randomized study.
Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty. ⋯ As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible.