The Knee
-
Clinical Trial
Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone-patellar tendon-bone autograft.
We prospectively studied knee proprioception following ACL reconstruction in 40 patients (34 men and six women; mean age 31 years). The patients were allocated into two equal groups; group A underwent reconstruction using hamstrings autograft, and group B underwent reconstruction using bone-patellar tendon-bone autograft. Proprioception was assessed in flexion and extension by the joint position sense (JPS) at 15°, 45° and 75°, and time threshold to detection of passive motion (TTDPM) at 15° and 45°, preoperatively and at 3, 6 and 12 months postoperatively. ⋯ No statistical difference was found between the ACL-operated and the contralateral knees in TTDPM 15° at 6 and 12 months, nor regarding TTDPM 45° at 3, 6 and 12 months, in group A. No statistical difference was found in JPS and TTDPM between the two grafts, at any time period. Knee proprioception returned to normal with ACL reconstruction at 6 months postoperatively, without any statistically significant difference between the autografts used.
-
Comparative Study
The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement.
Post operative cognitive dysfunction (POCD) is common following lower limb arthroplasty. The prevalence varies from 41-75% at 7 days to 18-45% at 3 months post operatively. The wide range of prevalence is due to inconsistencies in defining and quantifying POCD. ⋯ The cause is undoubtedly multi-factorial; however we have demonstrated that procedure time may be a contributing factor. Our results suggest that using an intra-medullary femoral jig has no effect on POCD. Further research into the cognitive effects following TKR with and without a tourniquet would be of benefit.
-
Case Reports
Medial patellofemoral ligament reconstruction for subluxating patellofemoral arthroplasty.
Patellofemoral joint (PFJ) arthroplasty has become a successful operation for patellofemoral osteoarthritis. The post-operative complication of patella subluxation is uncommon. We report the stabilisation of a subluxating patella following PFJ arthroplasty using autogenous hamstring tendons. Medial patellofemoral ligament reconstruction may be considered a method of stabilising a subluxating patellofemoral replacement in patients for whom revision arthroplasty is not recommended.
-
Review Case Reports
A case for one-stage revision in infected total knee arthroplasty?
Infection in total knee replacement is a rare but devastating complication. The current literature tends to support a two-stage revision as definitive treatment of established deep infection. Despite the fact that single stage revision is a well recognised treatment for the infected hip replacement, it has not gained the same level of support in the knee. This article reviews the literature of two-stage and single stage revision and reports the senior author's experience with the latter.
-
The purpose of this study was to compare the biomechanical strength of four different fixation methods for a posteromedial tibial plateau split fracture. Twenty-eight tibial plateau fractures were simulated using right-sided synthetic tibiae models. Each fracture model was randomly instrumented with one of the four following constructs, anteroposterior lag-screws, an anteromedial limited contact dynamic compression plate (LC-DCP), a lateral locking plate, or a posterior T-shaped buttress plate. ⋯ It was found that the posterior T-shaped buttress plate allowed the least subsidence of the posteromedial fragment and produced the highest mean failure load than each of the other three constructs (P=0.00). There was no statistical significant difference between using lag screws or an anteromedial LC-DCP construct for the vertical subsidence at a 1500 N load and the load to failure (P>0.05). This study showed that a posterior-based buttress technique is biomechanically the most stable in-vitro fixation method for posteromedial split tibial plateau fractures, with AP screws and anteromedial-based LC-DCP are not as stable for this type of fracture.