Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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Knee Surg Sports Traumatol Arthrosc · Aug 2008
Free bone cement fragments after minimally invasive unicompartmental knee arthroplasty: an underappreciated problem.
The minimally invasive implantation of unicompartmental knee arthroplasty (UKA) leads to excellent functional results, but due to the reduced intraoperative visibility the removal of excessive cement may be difficult. In a retrospective study we assessed radiologically the incidence of loose and excess bone cement in 120 UKAs and correlated it to the thickness of the tibial cement layer. In 25 cases loose or attached excess cement was seen. ⋯ But it was significantly higher in the group with excess cement bodies [3.3 (2.3-5.0) mm] compared to the group without excess cement [3.0 (1.7-4.1) mm] (P < 0.05). Symptomatic free cement bodies need to be removed immediately, if necessary arthroscopically, in order to avoid damage to the implants. To avoid this problem in minimally invasive UKA, intraoperative fluoroscopy, a dental mirror or a nerve hook seem to be useful tools to identify and remove loose or excess cement.
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Knee Surg Sports Traumatol Arthrosc · Jul 2008
Review Case ReportsSternoclavicular physeal fracture associated with adjacent clavicle fracture in a 14-year-old boy: a case report and literature review.
We report a very rare association of a physeal fracture of the medial clavicular growth plate with a fracture of the adjacent clavicle in a 14-year-old boy who fell on his shoulder while playing football. Clinical, radiographic and computed tomographic (with three-dimensional reconstruction) features are described. Open reduction, internal fixation of the lateral fracture (with a reconstructive plate) and suture of the periosteum were performed.
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Knee Surg Sports Traumatol Arthrosc · Jul 2008
Intra-articular knee injuries in patients with knee extensor mechanism ruptures.
The knee extensor mechanism is composed of the quadriceps tendon, patella and patellar tendon. Rupture of either the quadriceps tendon or patella tendon is a rare but significant injury. The purpose of our study is to determine if there are any associated injuries with these ruptures necessitating the need for further evaluation such as MRI or arthroscopy. ⋯ The most common associated injuries in patients with patellar tendon ruptures were tears of the anterior cruciate ligament (18%) and medial meniscus (18%). We recommend that consideration be given in obtaining a MRI or diagnostic arthroscopy in patients with patellar tendon ruptures especially those with high-energy direct impact mechanism. To our knowledge this has not previously been documented in the literature.
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Knee Surg Sports Traumatol Arthrosc · Jun 2008
Randomized Controlled TrialArthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study.
Both mechanical shavers and radiofrequency-based devices are used to treat symptomatic partial thickness chondral lesions. Controversy exists as to which mode of treatment provides better outcomes. The purpose of this study was to compare clinical results after bipolar radiofrequency-based chondroplasty (RFC) to mechanical shaver debridement (MSD). ⋯ At 1 year, RFC patients had significantly better Tegner score (4.1 +/- 0.8 vs. 2.8 +/- 0.6, P < 0.001) and KOOS domain scores for pain, symptoms, ADL, QOL, respectively (81.1 +/- 8, vs. 59.4 +/- 12.8; 80.7 +/- 7.5 vs. 59.6 +/- 7.5; 81.5 +/- 6.5 vs. 60.1 +/- 6.9; 80 +/- 10 vs. 61.3 +/- 12.5; P < 0.001) than MSD patients. Significantly fewer RFC patients (2% vs 23%, p = 0.026) reported using NSAIDS for knee pain at 1 year. Patients undergoing radiofrequency-based chondroplasty for ICRS grade III medial femoral condyle chondral lesions in conjunction with partial meniscectomy had significantly better clinical outcomes through 1 year than patients with similar pathology receiving chondral debridement using the mechanical shaver.
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Knee Surg Sports Traumatol Arthrosc · Jun 2008
Randomized Controlled TrialEffects of biophysical stimulation in patients undergoing arthroscopic reconstruction of anterior cruciate ligament: prospective, randomized and double blind study.
Pre-clinical studies have shown that treatment by pulsed electromagnetic fields (PEMFs) can limit the catabolic effects of pro-inflammatory cytokines on articular cartilage and favour the anabolic activity of the chondrocytes. Anterior cruciate ligament (ACL) reconstruction is usually performed by arthroscopic procedure that, even if minimally invasive, may elicit an inflammatory joint reaction detrimental to articular cartilage. In this study the effect of I-ONE PEMFs treatment in patients undergoing ACL reconstruction was investigated. ⋯ The results of this study show that patient's functional recovery occurs earlier in the active group. No side effects were observed and the treatment was well tolerated. The use of I-ONE should always be considered after ACL reconstruction, particularly in professional athletes, to shorten the recovery time, to limit joint inflammatory reaction and its catabolic effects on articular cartilage and ultimately for joint preservation.