Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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Knee Surg Sports Traumatol Arthrosc · Jul 2007
Traumatic knee extension deficit (the locked knee): can MRI reduce the need for arthroscopy?
In the present study we investigated the validity of magnetic resonance imaging (MRI) and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluated whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. The study consisted of 50 patients who had an acute, traumatic extension deficit of the knee. All patients were submitted to MRI prior to arthroscopy. ⋯ Assuming that arthroscopy was the gold standard, the following results were calculated for the overall appearance of a lesion able to cause locking: Positive predictive value = 0.85, negative predictive value = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (one bucket-handle lesion and one pathological synovial plica). MRI of the knee with acute, traumatic extension deficit is in the acute or subacute phase a safe method to identify the patients that have a mechanical reason for locking and therefore can benefit from arthroscopic treatment.
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Knee Surg Sports Traumatol Arthrosc · Jul 2007
Randomized Controlled TrialComparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial.
The aim of this prospective, randomized clinical study was to compare the effectiveness of two physical therapy treatment approaches for impingement syndrome, either by joint and soft tissue mobilization techniques or by a self-training program. Thirty patients (Group 1, n = 15; Group 2, n = 15) with the diagnosis of an outlet impingement syndrome of the shoulder were treated either by strengthening the depressors of the humeral head with a guided self-training program (Group 1, age 49.5 +/- 7.9 years), or by joint and soft tissue mobilization techniques (Group 2, age 48.1 +/- 7.5 years). Group 1 was instructed with the active range of motion (ROM), stretching and strengthening exercise program including rotator cuff muscles, rhomboids, levator scapulae and serratus anterior with an elastic band at home at least seven times a week for 10-15 min and Group 2 received a prescription for 12 sessions of joint and soft tissue mobilization techniques, ice application, stretching and strengthening exercise programs and patient education in clinic for three times per week. ⋯ There were statistically differences among the groups in function (P > 0.05). Group 2 showed significantly greater improvements in the Neer Questionnaire score and shoulder satisfaction score than Group 1. The patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength, decreasing pain and improving function earlier than with exercise program.
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Knee Surg Sports Traumatol Arthrosc · Jul 2007
Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation.
The purpose of this article is to describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fractures using folded surgical pin. This technique allows reduction and fixation of the bone fragment without using special equipment. After standard arthroscopic procedure to explore the knee and to remove fracture debris and blood clot, the bone block is reduced and advanced with the spike of the anterior cruciate ligament tibial drill guide. ⋯ Next, the other side is bent on the anterior tibial cortex and cut. This arthroscopic fixation allows elastic compression fragment stabilization that authorizes early weight bearing and rehabilitation programs. The material is extracted by traction after 6 months.