Chronic Anterior Knee Research Articles

Sympathetically mediated pain in young adults with chronic anterior knee pain

Sympathetically mediated pain in young adults with chronic anterior knee pain

When is surgery indicated in anterior knee instability? Considerations on operative and functional treatment.

Rupture of the ACL may result in chronic anterior knee instability. However, in the majority of patients the secondary stabilizers of the joint such as collateral ligaments, menisci, and the capsule will compensate for this instability. We recommend surgical reconstruction of the acute rupture of the ACL only in the young, active athlete. Concomitant ruptures of capsuloligamentuous structures do not indicate surgical treatment: they may be treated by a plaster cast or a splint with good results. Chronic symptomatic anterior knee instability should first be treated by a vigorous muscle-training program. Surgery is performed only for those patients who cannot compensate for their instability after this rehabilitation program.

Controversy About Treatment of the Knee with Anterior Cruciate Laxity

A complete tear of the anterior cruciate ligament represents the initiation of a clinical syndrome characterized by a continuum of functional disability. The authors present here a risk factor checklist, based on statistics drawn from their previous articles, to identify those patients at significant risk for future joint arthrosis. Risk factors are grouped under the categories of activity level, symptoms, clinical laxity, meniscal damage, lower limb alignment, tibiofemoral crepitus, patellofemoral factors, rehabilitation, and patient compliance. They also present their subjective and functional rating system in which six activity levels are related to pain, swelling, and giving way. The functional disability of the anterior cruciate insufficient knee is activity-level related. Thus, activity levels must be rigorously and comprehensively defined for adequate appreciation of the degree of existing disability. The authors also examined the reasons for the conflicting opinions on the functional disability of the anterior cruciate ligament syndrome that exists in the literature. Differences in subjective and objective rating systems; failure to specifically define preinjury and postinjury activity levels and associated symptoms; and different populations as to laxity, giving way episodes, and type of athletic activity (jumping, twisting activities versus light recreational pursuits) are but a few of the important differences that make comparisons between studies often invalid. Long-range treatment guidelines are necessary for management of the acute and chronic anterior cruciate ligament insufficient knee.

Clinical Experience and Early Results of Carbon Fiber Augmentation of Anterior Cruciate Reconstruction of the Knee

Augmentation by autogenous tissue in the repair of acute anterior cruciate ligament injury has been found to be of benefit in providing a scaffold for the disrupted tissue and a stent to protect the repaired tissue, thereby ultimately increasing the strength of the repair. In both the acute setting and when autogenous tissue is used to reconstruct a chronic anterior cruciate-deficient knee, the substitute tissues require protection while revascularization and recollagenization take place. Potential solutions to these problems are sought in a ligament prosthesis, such as carbon fibers, that would be capable of providing both a stent for protection and an inducement for collagen ingrowth. Intra-articular reconstruction of the anterior cruciate ligament with autogenous tissue augmented by PLA-coated carbon fibers was performed in one group of ten patients. A second group of matched cases was similarly treated but without augmentation for controls. The results were analyzed at one year postoperation on both the 100-point protocol rating system and the authors' 200-point knee rating system. On the 100-point scale, the study group improved by 14.8% of the preoperative rating, while the comparison group improved by 23.3%. On the 200-point system, the study group improved by 21.9%, the comparison group by 22.6%. There was no demonstrable benefit in the use of carbon fiber to augment intra-articular, autogenous tissue anterior cruciate ligament reconstructions.

Treatment of Chronic Anterior Knee Instabilities with Combined Intra- and Extra-articular Transfer Augmented with Carbon-PLA Fibers

In the treatment of old chronic anterior knee instabilities by anterior cruciate ligament (ACL) insufficiency, isolated reconstruction of the ACL is insufficient because of an associated stretching of the lateral capsule and lateral collateral ligament. A combined intra- and extra-articular transfer (consisting of the central one-third of the patellar tendon, the prepatellar tissue, and the central one-third of the quadriceps tendon) is necessary to repair ACL instability. Augmentation of the autogenous transfer with polylactic acid-coated carbon fibers has several advantages. It improves the transfer's strength by reinforcing its weak zones; gives initial strength during graft remodeling and vascularization, thus avoiding cast immobilization; and allows early active rehabilitation and possibly return to sports activity. The surgical technique is based on biomechanical and biologic principles. The transfer remains attached to the tibial tubercle, passing through a tibial tunnel, through the intercondylar notch, behind the lateral femoral condyle in a bony groove, then on the lateral aspect of the condyle, beneath the lateral collateral ligament, and ending close to Gerdy's tubercle. The preliminary results in 30 patients are encouraging. The subjective and objective results are similar to those previously obtained with nonreinforced methods of repair, except that there is an early return to normal activities.

Functional disability in the anterior cruciate insufficient knee syndrome. Review of knee rating systems and projected risk factors in determining treatment.

The complete tear of the anterior cruciate ligament initiates the clinical syndrome represented by continued functional disability. The precise degree of functional disability is highly debated. Agreement is elusive due to the lack of uniform and scientific methodology. An historical review and analysis of functional and subjective rating systems is reported, and the strengths of previous systems are identified. A subjective and functional rating system is proposed in which 6 activity levels are related to pain, swelling, giving-way and overall activity. This is important because of the marked dependence of the functional disability of the anterior cruciate insufficient knee on the activity level of the patient. Thus, activity levels must be rigorously and comprehensively defined. In addition, we propose the utilisation of a risk factor checklist, based on the statistics drawn from our previous articles, to identify those patients at significant risk for future joint arthrosis. Risk factors are grouped under the categories of activity level, symptoms, clinical laxity, meniscal damage, lower limb alignment, tibiofemoral crepitus, patellofemoral factors, rehabilitation and patient compliance. Thirdly, we examine controversial aspects of the anterior cruciate ligament syndrome existing in the literature today and demonstrate why contrasting opinions are not mutually exclusive. Finally we propose our treatment guidelines for management of the acute and chronic anterior cruciate ligament insufficient knee.

The synovial shelf syndrome.

The Journal of Bone and Joint Surgery. British volumeVol. 64-B, No. 4 ArticlesFree AccessThe synovial shelf syndromeT Vaughan-Lane, DJ DandyT Vaughan-LaneSearch for more papers by this author, DJ DandySearch for more papers by this authorPublished Online:1 Aug 1982https://doi.org/10.1302/0301-620X.64B4.7096427AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByA 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries6 December 2019 | CARTILAGE, Vol. 13, No. 1_supplSymptomatic medial synovial plica of the knee joint: an underestimated pathology in young patients20 August 2019 | Archives of Orthopaedic and Trauma Surgery, Vol. 139, No. 11Arthroscopic treatment of symptomatic lateral synovial plica of the knee12 March 2019 | Journal of Orthopaedic Surgery, Vol. 27, No. 1Nonligamentous Soft Tissue Pathology About the Knee: A ReviewOrthopedics, Vol. 39, No. 1Characteristics of medial plica syndrome complicated with cartilage damage22 April 2015 | International Orthopaedics, Vol. 39, No. 12‘The Sneaky Plica’ revisited: morphology, pathophysiology and treatment of synovial plicae of the knee5 February 2013 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 22, No. 2Disorders of the inert structuresKniegelenkArthroscopic resection of medial plica of the knee in young adultsThe Knee, Vol. 17, No. 2Arthroscopic treatment of symptomatic type D medial plica28 August 2007 | International Orthopaedics, Vol. 32, No. 6Current Concepts in Synovial Tissue of the Knee JointOrthopedics, Vol. 31, No. 2Synovial plicae of the kneeCurrent Orthopaedics, Vol. 18, No. 3Histological changes in the symptomatic mediopatellar plicaThe Knee, Vol. 11, No. 2Anteriorer Knieschmerz — Fehlbelastungsfolgen im SportNatural History of Anterior Knee Pain: A 14- to 20-Year Follow-up of Nonoperative ManagementJournal of Pediatric Orthopaedics, Vol. 18, No. 1Anteromedial Tibial Tubercle Transfer in Patients with Chronic Anterior Knee Pain and a Subluxation-Type Patellar Malalignment23 April 2016 | The American Journal of Sports Medicine, Vol. 25, No. 3SYNOVIAL PLICAE OF THE KNEEClinics in Sports Medicine, Vol. 16, No. 1Symptomatic type D (separated) medical plica: Clinical features and surgical resultsArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 10, No. 3Synovial plicae of the kneeThe Knee, Vol. 1, No. 1Symptomatic synovial plicae of the knee.The Journal of Bone & Joint Surgery, Vol. 75, No. 10The Plica SyndromeOrthopedic Clinics of North America, Vol. 23, No. 4Arthroscopic Evaluation and Treatment of the Patellofemoral JointOrthopedic Clinics of North America, Vol. 23, No. 4Bad results after anterior advancement of the tibial tubercle for patello-femoral pain syndromeArchives of Orthopaedic and Trauma Surgery, Vol. 111, No. 4Managing Plica Syndrome of the Knee12 July 2016 | The Physician and Sportsmedicine, Vol. 18, No. 7The pathological plica in the kneeArchives of Orthopaedic and Trauma Surgery, Vol. 108, No. 5The plica syndromeInjury, Vol. 19, No. 5Plica mediopatellaris ?Arthroscopic resection under local anesthesiaArchives of Orthopaedic and Traumatic Surgery, Vol. 106, No. 1Arthroscopy in the Treatment of Young Patients with Anterior Knee PainOrthopedic Clinics of North America, Vol. 17, No. 2 Vol. 64-B, No. 4 Metrics Downloaded 139 times History Published online 1 August 1982 Published in print 1 August 1982 InformationCopyright © 1982, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download