Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2014
Low inter- and intraobserver variability allows for reliable tunnel measurement in ACL reconstruction using the quadrant method.
Correct anatomic tunnel positions are essential in anterior cruciate ligament (ACL) reconstruction. To establish recommendations for tunnel positioning based on anatomical findings and to compare tunnel positions with clinical results, different radiological measurement methods as the quadrant method exist. Comparing the data of different observers requires the validation of the reliability of measurement methods. The purpose of this study therefore was to determine the reliability of the quadrant method to measure tunnel positions in ACL reconstruction. The hypothesis was, that the quadrant method shows a low inter- and intraobserver variability. ⋯ We confirmed the hypothesis that the quadrant method has a low inter- and intraobserver variability. Based on the presented validation data, the quadrant method can be recommended as reliable method to radiographically describe insertion areas of the ACL as well as to determine tunnel positions in ACL reconstruction intra and postoperatively.
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Arch Orthop Trauma Surg · Apr 2014
Comparative Study Clinical TrialThe effect of femoral component design on patellar tracking in total knee arthroplasty: Genesis II prosthesis versus Vanguard prosthesis.
The Genesis II knee system incorporates 3° of external rotation into the femoral component and the femoral component is implanted in neutral rotation to the femur. The purpose of this study was to compare patellar tracking of the Genesis II knee system with that of the Vanguard knee system, in which the femoral component is routinely implanted in a 3° externally rotated position to the posterior condylar axis (PCA) of the femur. ⋯ Prospective cohort study, Level II.
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Arch Orthop Trauma Surg · Apr 2014
Comparative StudyThe influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods.
Restoring the joint line (JL) in primary as well as revision total knee arthroplasty (TKA) influences clinical results as well as long-term survival rates. Whereas studies agree about the negative effect of JL alteration, the reference system of choice is unclear. The purpose of the present study was to evaluate the effect of JL allocation comparing a ratio to a distance method on clinical outcome following revision TKA. ⋯ We recommend the epicondylar ratio to calculate the physiological JL rather than JL allocation by a distance.
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Arch Orthop Trauma Surg · Apr 2014
Intramedullary control of distal femoral resection results in precise coronal alignment in TKA.
There is still a relevant rate of outliers in coronal alignment >3° when the conventional technique is used, potentially accompanied by a poorer long-term clinical outcome and a reduced longevity of the implant. Intraoperative implementation of preoperative planning and above all checking of the bone resections carried out are decisive for reinstating a straight leg axis. Intramedullary control of femoral resection has not been described to date. The objective of this study was to present a new technique for the intramedullary control of femoral resection and the results obtained using this method. ⋯ The new technique of intramedullary control of distal femoral resection, together with preoperative planning, leads to a precise alignment of the femoral component in the coronal plane. Thus, for the first time, a simple and effective tool for checking distal femoral resection is available for standardized use.
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Arch Orthop Trauma Surg · Apr 2014
Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability.
Congenital dislocation of the patella and recurrent symptomatic dislocation in adolescents are difficult pathologies to treat. Stanisavljevic described an extensive release procedure essentially involving medializing the entire lateral quadriceps and medial soft tissue stabilization. There are no significant series reporting the success of this method. This procedure has been performed in our institution over several years and we report our results. ⋯ The Stanisavljevic procedure produces a mediocre success rate with our long-term follow-up series showing a failure rate up to 80 %. We therefore recommend more specific procedures dealing with the anatomical deformity such as trochleaplasty to produce superior success rates.