Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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Knee Surg Sports Traumatol Arthrosc · Dec 2009
Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button.
The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III-V) and arthroscopically treated with a coracoclavicular double flip button are presented. ⋯ The technique presented here proved to be safe and minimally invasive while delivering good aesthetic results and allowing for the treatment of associated lesions. Furthermore, the technique could benefit from more advanced retention devices, which ought to reduce or avoid migration of the flip buttons.
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Knee Surg Sports Traumatol Arthrosc · Dec 2009
Rotator cuff repair with periosteum for enhancing tendon-bone healing: a biomechanical and histological study in rabbits.
During rotator cuff repair surgery, fixation and incorporation of ruptured rotator cuff tendon into the bone is a major concern. The repair usually fails at the tendon-bone interface, especially in cases where the tear is massive. The periosteum contains multipotent stem cells that have the potential to differentiate into osteogenic and chondrogenic tissues, which may restore the original structure at the tendon-bone interface, fibrocartilage. ⋯ Histological examination revealed that the cambium layer of the periosteum could serve as a potent interface layer and become progressively mature and organized during the healing process, resulting in fibrocartilage formation and the subsequent integration of the disrupted tendon into the bone. Biomechanical testing revealed a progressive increase in the attachment strength with time indicating the progressive tendon-bone incorporation. When performing rotator cuff repair in a large or massive tear, a periosteal flap can be sutured onto the torn end of tendon to enhance tendon-bone healing.
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Knee Surg Sports Traumatol Arthrosc · Oct 2009
Case ReportsJuvenile Tillaux fracture with disrupted anteroinferior tibiofibular ligament: a case report.
The juvenile Tillaux fracture is an avulsion fracture of the anterolateral corner of the distal tibial epiphysis. This type of fracture occurs when the anteroinferior tibiofibular ligament, with the foot position of supination-eversion or external rotation, avulses an epiphyseal fragment. Therefore, the anteroinferior tibiofibular ligament plays an important role in this injury, and usually remains intact. Here, we present a case in which the distal epiphyseal fragment was severely displaced and inverted, and the anteroinferior tibiofibular ligament was totally disrupted.
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Knee Surg Sports Traumatol Arthrosc · Oct 2009
Catastrophic thinking about pain as a predictor of length of hospital stay after total knee arthroplasty: a prospective study.
This study prospectively investigates whether catastrophizing thinking is associated with length of hospital stay after total knee arthroplasty. Forty-three patients who underwent primary total knee arthroplasty were included in this study. Prior to their operation all patients were asked to complete the pain catastrophizing scale, and a Western Ontario McMaster Universities Osteoarthritis index. ⋯ Reducing catastrophizing thinking about pain through cognitive-behavioral techniques is likely to reduce levels of fear after total knee arthroplasty. As a result, pain and function immediately post-operative might improve, leading to a decrease in length of hospital stay. Although during the last decades the duration of hospital stay is significantly reduced, this study shows that this can be improved when taking into account the contribution of psychological factors such as pain catastrophizing.
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Knee Surg Sports Traumatol Arthrosc · Oct 2009
Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging.
Different surgical techniques have been described to correct trochlear dysplasia, without clear descriptions of the various types of trochlear dysplasia. In describing trochlear dysplasia, there exist no clear criteria to distinguish between decreased trochlear depth (heightened trochlea floor) and flattened lateral and/or medial condylar height. The current study aims to build a database of axial MRI measurements of normal and abnormal trochlear shape to create a foundation for the selection of the necessary surgical correction to more normal trochlear anatomy. ⋯ The resultant percentages of all three height measurements, the lateral, central, and medial heights, were greater in males than in females. The intraobserver reliability was perfect for all investigated parameters. In conclusion, (1) the presented measurement scheme on axial MRI is a reliable method to calculate the height of the trochlea in different locations, (2) a more objective assessment of the trochlear pathology is possible, (3) in five of six cases the pathology is located in the center and/or medial trochlea, and (4) in our series of patellofemoral instability patients, most would benefit from a deepening trochleaplasty as the surgical procedure of choice to correct dysplasia.