Passive Knee Motion Research Articles

Comparison of fast track after total knee replacement surgery with continuous femoral nerve block analgesia and intravenous analgesia

Objective Comparing fast track after total knee arthroplasty(TKA) with continuous femoral nerve block(CFNB) analgesia and intravenous analgesia. Methods Sixty ASAⅠor Ⅱpatients, aged 45-78 years, undergoing unilateral TKA were randomly divided into 2 groups(n=30): patient controlled nerve block analgesia(PCNA) group and patient controlled intravenous analgesia(PCIA) group. All patients received spinal anesthesia combined with epidural anesthesia. In the postoperative period, the VAS in resting and exercise were recorded to evaluate the degree of postoperative pain, the numbers of patient-controlled analgesia(PCA) pressing and meperidine using, muscle strength of limb, the active movement angle, adverse reactions and analgesic associated complications were observed and recorded. Results In 6, 12, 24, 48 h postoperative resting state, there was no significant differences in pain score between CFNB group and PCIA group(P<0.05). There was significantly less VAS scores in the PCNA group comparing the PCIA group during the continuous passive movement of knee postoperatively at 24 h and 48 h[(3.6±0.5) vs(4.7±0.6), (3.4±0.5) vs (4.5±0.4)](P<0.05). The numbers of PCA pressing and meperidine using of PCNA group were significantly lower than that of PCIA group after surgery(P<0.05). Angle of knee active movement postoperatively at 24 h and 48 h in the PCNA group was larger than PCIA group(P<0.05). Blood glucose level of PCNA group was lower than that of PCIA group after surgery(P<0.05). Postoperative complications such as deep vein thrombosis, adverse reactions such as lethargy, respiratory depression were fewer in the PCNA group(P<0.05). Patients satisfaction scores in the PCNA group was higher than the PCIA group [(9.6±1.4) vs (7.9±1.2)](P<0.05). Conclusions CFNB has superior early analgesic effect to PCIA in total knee replacement surgery, as well as fewer adverse reactions, better knee function recovery, shorter hospital time and higher patient satisfaction. CFNB is in accordance with fast track surgery concept and it is a safe, practical and effective method for analgesia after TKA. Key words: Femoral nerve block; Intravenous analgesia; Total knee arthroplasty; Fast track

Length Changes of the Anterolateral Ligament During Passive Knee Motion

Background: Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction may be a result of unaddressed insufficiency of the anterolateral structures. Recent publications about the anatomy of the anterolateral ligament (ALL) have led to a renewed interest in lateral extra-articular procedures, and several authors have proposed ALL reconstruction to supplement intra-articular ACL reconstruction. However, only limited knowledge about the biomechanical characteristics of the ALL exists. Purpose/Hypothesis: The purpose of this study was to analyze length changes of the ALL during passive knee motion. The study hypothesis was that the ALL lengthens with knee flexion and internal tibial rotation. Study Design: Controlled laboratory study. Methods: The ALL of 6 cadaveric knees was dissected. Specimens were mounted in a specifically designed test rig that allowed unconstrained passive flexion/extension movement between 0° and 90° as well as external/internal tibial rotation of 25° at various flexion angles. Highly elastic, capacitive polydimethylsiloxane strain gauges were attached to the insertion sites of the ALL. Length changes were recorded continuously at flexion angles between 0° and 90° and during internal/external tibial rotation at 0°, 15°, 30°, 45°, 60°, 75°, and 90°. All measurements were calculated as the relative length change (%) of the ALL compared with 0° of flexion and neutral rotation. Results: The mean relative length of the ALL significantly increased with increasing knee flexion (P < .001), with an estimated mean length change of +0.15% per degree. Both internal and external tibial rotation were independent determinants for length change; internal rotation significantly increased the length of the ALL (P < .001), whereas external rotation significantly decreased its length (P < .001). The mean length change with internal rotation increased with knee flexion, with a significantly greater length change at 90° compared with 0° (P = .048), 15° (P = .033), and 30° (P = .015). The maximum mean length change was +33.77% ± 9.62%, which was observed at 25° of internal rotation and 90° of flexion. Conclusion: The ALL is a nonisometric structure that tensions with knee flexion and internal tibial rotation. Length changes with internal rotation were greater at higher flexion angles, with the greatest length change of the ALL observed at 90° of flexion. Clinical Relevance: The ALL can be considered a stabilizer against internal tibial rotation, especially at deep flexion angles. With regard to ALL reconstruction procedures, tensioning and fixation of the graft should be performed near 90° of flexion because graft tensioning near extension may cause excessive ligament strain with increasing knee flexion.

The kinematic control during the backward gait and knee proprioception: insights from lesions of the anterior cruciate ligament.

An already existing large volume of work on kinematics documents a reduction of step length during unusual gaits, such as backward walking. This is mainly explained in terms of modifications of some biomechanical properties. In the present study, we propose that the proprioceptive information from the knee may be involved in this change of motor strategy. Specifically, we show that a non-automated condition such as backward walking can elicit different motor strategies in subjects with reduced proprioceptive feedback after anterior cruciate ligament lesion (ACL). For this purpose, the kinematic parameters during forward and backward walking in subjects with ACL deficit were compared to two control groups: a group with intact ACL and a group with surgically reconstructed ACL. The knee proprioception was tested measuring the threshold for detection of passive knee motion. Subjects were asked to walk on a level treadmill at five different velocities (1–5km/h) in forward and backward direction, thereby calculating the cadence and step length. Results showed that forward walking parameters were largely unaffected in subjects with ACL damage. However, they failed to reduce step length during backward walking, a correction that was normally observed in all control subjects and in subjects with normal proprioceptive feedback after ACL reconstruction. The main result of the present study is that knee proprioception is an important signal used by the brain to reduce step length during the backward gait. This can have a significant impact on clinical evaluation and rehabilitation.

Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion.

This study aimed to determine the influence of the head, upper trunk, and foot position on the passive knee extension (PKE) torque-angle response. PKE tests were performed in 10 healthy subjects using an isokinetic dynamometer at 2°/s. Subjects lay in the supine position with their hips flexed to 90°. The knee angle, passive torque, surface electromyography (EMG) of the semitendinosus and quadriceps vastus medialis, and stretch discomfort were recorded in six body positions during PKE. The different maximal active positions of the cervical spine (neutral; flexion; extension), thoracic spine (neutral; flexion), and ankle (neutral; dorsiflexion) were passively combined for the tests. Visual analog scale scores and EMG were unaffected by body segment positioning. An effect of the ankle joint was verified on the peak torque and knee maximum angle when the ankle was in the dorsiflexion position (P < 0.05). Upper trunk positioning had an effect on the knee submaximal torque (P < 0.05), observed as an increase in the knee passive submaximal torque when the cervical and thoracic spines were flexed (P < 0.05). In conclusion, other apparently mechanical unrelated body segments influence torque-angle response since different positions of head, upper trunk, and foot induce dissimilar knee mechanical responses during passive extension.

B-25 Free Communication/Poster - Balance and Flexibility

The transient increase in femoral artery blood flow (BF) during passive knee extension and flexion has been well established. With the absence of neural drive and metabolic byproducts the hyperemic response is believed to be due to cardio-acceleration via activation of type III fibers, mechanically induced vasodilation and muscle pump activity. However, the cardiovascular responses to passive limb movement (PLM) in the upper body and with smaller muscle mass have not been established. PURPOSE: To determine if the hyperemic response to PLM is consistent between limbs in the upper and lower body. METHODS: Sixteen participants underwent a PLM protocol in which the wrist, elbow, ankle and knee joints were passively extended and flexed at 1Hz for 60 seconds. HR, MAP and BF were measured and conductance (CON) calculated for a 30 second baseline period and throughout the 1 minute PLM bout. BF measurements for the wrist, forearm, ankle and knee were obtained by Doppler ultrasound measurements of the brachial, subclavian, popliteal and femoral arteries, respectively. Results were averaged into three second blocks for data analysis. Paired samples t-tests were used to determine if the relative changes in BF, HR and CON were different between limbs. RESULTS: Passive movement of all joints resulted in significant increases in BF, HR and CON from baseline (p<.05). Passive knee movement resulted in a blood flow increase of 296 ml/min (+211%) which was significantly greater than the response of the wrist (27.6 ml/min, +49.9%, p=0.03) and ankle (36.9 ml/min, +69.4%, p=0.01) but not for the elbow (52.4 ml/min, 75.7%, p=0.07). Similarly, no significant differences between changes in HR (p=0.8) and CON (p=0.08) were observed between the knee and elbow, but the knee showed greater changes in HR and CON compared to wrist (p=0.04 and p=0.04) and ankle (p=0.01 and p=0.01), respectively. CONCLUSIONS: PLM of the ankle and wrist resulted in similar increases in BF, HR and CON but not to the extent of the knee and elbow. The reduced response with PLM of wrist and ankle is likely due to reduced muscle mass about that joint. Although the upper arm has reduced muscle mass compared to the thigh the PLM of the elbow may have elicited a greater sympathetic response resulting in a similar cardiovascular response compared to passive knee movement.

A soft tissue artefact model driven by proximal and distal joint kinematics

When analysing human movement through stereophotogrammetry, skin-markers are used. Their movement relative to the underlying bone is known as a soft tissue artefact (STA). A mathematical model to estimate subject- and marker-specific STAs generated during a given motor task, is required for both skeletal kinematic estimators and comparative assessment using simulation. This study devises and assesses such a mathematical model using the paradigmatic case of thigh STAs. The model was based on two hypotheses: (1) that the artefact mostly depends on skin sliding, and thus on the angles of hip and knee; (2) that the relevant relationship is linear. These hypotheses were tested using data obtained from passive hip and knee movements in non-obese specimens and from running volunteers endowed with both skin- and pin-markers.Results showed that the proposed model could be calibrated with small residuals and that the thigh artefacts were mostly due to skin sliding, not only ex-vivo, as expected, but also in-vivo. This was corroborated by the observation that in-vivo, the portion of the artefact not reconstructed by the model fell within a frequency band compatible with soft tissue wobbling and carried a relatively small portion of total mean power (13%, on average). Thus, the architecture of our model is feasible both ex-vivo and in-vivo and can, in principle, be used in skeletal kinematics estimators. The generalizability of a calibrated model across different movements was proved doable, albeit limited to movement patterns similar to those of the calibration movement, even if joint rotation ranges can be remarkably different. Therefore, such a calibrated model can be used for generating realistic STAs for simulation purposes.

Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non-Operatively

Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.

The effect of knee brace and knee sleeve on the proprioception of the knee in young non-professional healthy sportsmen

BackgroundProprioception has been defined as the capacity to feel the position of a joint in space as sensed by the central nervous system. Prophylactic knee braces are supposed to help in knee injury prevention not just with a mechanical support of the joint but also improving proprioception. The main aim of this study was to determine the effects of a knee brace and a knee sleeve on knee proprioception. The secondary aim was to determine if different starting angles of the knee and different movement directions influence knee proprioception. MethodsWe tested a group of twenty healthy male sport students without knee injuries. They were tested with the brace, with the sleeve and without support. The threshold of detection of passive knee movement with a starting knee angle of 30° and 60°, both in flexion and extension was determined. ResultsWe did not find any statistically significant change in the threshold of detection of passive knee movement wearing the brace or the sleeve compared to the unsupported condition (p=0.462, α=0.05). We found a significantly lower proprioceptive sensitivity starting at the more flexed knee angle (p=0.005, α=0.05) and moving in extension than in the other test situations (p=0.001, α=0.05). ConclusionMovement direction and starting position appear to influence the threshold of detection of passive knee movement. The results of this study also suggest that knee supports do not influence either positively or negatively knee proprioception of uninjured active subjects.

Botulinum Toxin A Does Not Improve the Results of Cast Treatment for Idiopathic Toe-Walking

Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toe-walking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Bilateral Congenital Posterior Cruciate Ligament Hypoplasia: A Case Report.

Congenital aplasia or hypoplasia of the cruciate ligaments is an infrequent condition. The absence of the posterior cruciate ligament (PCL) is extremely rare and is usually associated with other congenital abnormalities of the lower limb such as anterior cruciate ligament (ACL) agenesis, absence of one or both menisci, and absence or dysplasia of the patella1-7. To the best of our knowledge, only one case of a unilateral PCL absence8 and one case of bilateral PCL hypoplasia9 have been reported in the literature. We present the case of a professional athlete with bilateral congenital PCL hypoplasia without other associated congenital anomalies. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A twenty-nine-year-old female professional athlete, who had played handball from the age of twelve years and had competed in the premier league from the age of sixteen years, sustained a twisting injury to the right knee while landing. Seven days later, examination revealed a minimal right knee effusion and a positive Lachman test with a soft end point. The posterior drawer sign had a hard stop, and the posterior sag sign was negative. No lateral or medial instability was observed. Active and passive knee motion was intact. The patient denied any family history of skeletal congenital abnormalities; no abnormalities had been noted during pregnancy, childbirth, or childhood. Five years prior to this event, she had given birth to a healthy girl who had normal physical and mental development. Magnetic resonance imaging (MRI) of the right knee (Figs. 1-A, 1-B, and 1-C) demonstrated a recent ACL tear with a fully disorganized and partially retracted ligament as well as associated intra/periligamentous edema. The PCL did not have a normal appearance; there was only a thin, hypointense bandlike structure, …

Managing lower extremity muscle tone and function in children with cerebral palsy via eight-week repetitive passive knee movement intervention

This study used a repeated measures design to assess the effect of an eight-week repetitive passive movement (RPM) intervention on lower extremity muscle tone and function in children with cerebral palsy (CP). Eighteen children (aged 9.5 ± 2.1 years) with spastic CP were randomly assigned to a knee RPM intervention condition of 3 times a week for 8 weeks or a control condition. The 8 weeks were followed by 4 weeks of washout period, after which the participants were crossed over to the other group. In the RPM condition, each subject's knees were intervened with continuous passive motion device (at a velocity of 15°/s) for 20 min. The subjects were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, after, 1 day after, and 3 days after each intervention. Repeated-measures statistical analyses found significant differences between condition variable on active range-of-motion of the knee (AROM, increased), relaxation index (RI, increased), Modified Ashworth Scale (MAS, decreased), timed up-and-go (TUG, decreased), 6-min walk test (6 MWT, increased); and significant differences among time variable including RI, MAS, and 6 MWT. No difference was found in passive range-of-motion measurements. Repetitive passive movement reduced lower extremity spastic hypertonia in children with cerebral palsy, and it also improved ambulatory function in terms of walking speed. Effects of this treatment protocol on ambulation lasted up to 3 days post intervention. Findings of this study provide clinicians and patients an alternative, effective and efficient strategy for spastic control and ambulatory improvement.

Enthesopathy of the Distal Biceps Femoris Tendon Insertion: An Unusual Case of Posterolateral Knee Pain

To the best of our knowledge, insertional tendinopathy (enthesopathy) of the distal biceps femoris tendon insertion has not been described in the literature. We present a patient with this condition who experienced pain in the posterolateral part of the knee. After an unsuccessful course of physical therapy, surgical debridement of the degenerative tendon led to complete resolution of the symptoms and a return to full sporting activities. The patient was informed that data concerning his case would be submitted for publication, and he provided consent. A thirty-four-year-old man presented to our clinic with two months of posterolateral right knee pain. The pain had started abruptly after a full day of playing in the surf at the beach. The pain was localized to the posterolateral part of the knee and worsened with deep knee flexion. There were no mechanical symptoms or instability on knee examination, and there was no effusion. Several courses of anti-inflammatory medication did not relieve the pain. ### Medical History The medical history included hypertension, dyslipidemia, and intermittent low back pain. The only prior surgery was an inguinal hernia repair. The musculoskeletal history included a diagnosis of iliotibial band tightness, which had been treated with stretching exercises at home. Three years earlier, he had sustained a torsional injury to the right knee while skiing. A magnetic resonance imaging (MRI) study at that time showed minor lateral meniscal fraying, but no substantial intra-articular pathology. He had been treated with a course of anti-inflammatory medications and physical therapy and had completely recovered. ### Physical Examination The patient was 175 cm tall and weighed 73 kg, with a body mass index of 23.8. The right knee had full active and passive knee motion from 5° of hyperextension to 135° of flexion. There was no knee effusion. The results of Lachman, anterior drawer, and posterior drawer tests were …

Myofascial force transmission between the human soleus and gastrocnemius muscles during passive knee motion

The plantarflexors of the lower limb are often assumed to act as independent actuators, but the validity of this assumption is the subject of considerable debate. This study aims to determine the degree to which passive changes in gastrocnemius muscle length, induced by knee motion, affect the tension in the adjacent soleus muscle. A second aim is to quantify the magnitude of myofascial passive force transmission between gastrocnemius and adjacent soleus. Fifteen healthy volunteers participated. Simultaneous ultrasound images of the gastrocnemius and soleus muscles were obtained during passive knee flexion (0-90°), while keeping the ankle angle fixed at either 70° or 115°. Image correlation analysis was used to quantify muscle fascicle lengths in both muscles. The data show that the soleus muscle fascicles elongate significantly during gastrocnemius shortening. The approximate change in passive soleus force as a result of the observed change in fascicle length was estimated and appears to be <5 N, but this estimate is sensitive to the assumed slack length of soleus.

Auricular acupressure for managing postoperative pain and knee motion in patients with total knee replacement: a randomized sham control study.

Background. Postoperative pain management remains a significant challenge for all healthcare providers. A randomized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement (TKR). Method. Sixty-two patients who had undergone a TKR were randomly assigned to the acupressure group and the sham control group. The intervention was delivered three times a day for 3 days. A visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire were used to assess pain intensity. Pain medication consumption was recorded, and the knee motion was measured using a goniometer. Results. The patients experienced a moderately severe level of pain postoperatively (VAS 58.66 ± 20.35) while being on the routine PCA. No differences were found in pain scores between the groups at all points. However, analgesic drug usage in the acupressure group patients was significantly lower than in the sham control group (P < 0.05), controlling for BMI, age, and pain score. On the 3rd day after surgery, the passive knee motion in the acupressure group patients was significantly better than in the sham control group patients (P < 0.05), controlling for BMI. Conclusion. The application of auricular acupressure at specific therapeutic points significantly reduces the opioid analgesia requirement and improves the knee motion in patients with TKR.

Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement

Background:Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique.Aims:Post-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention.Settings and Design:Randomised, controlled, non-blinded study done in a tertiary care private hospital.Methods:Forty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration.Statistical Analysis:Mean VAS score at 6, 6–24, 24–48 and 48–72 h were considered. Significance was assessed at the 5% level.Results and Conclusion:VAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.

Managing spastic hypertonia in children with cerebral palsy via repetitive passive knee movements

Most children with cerebral palsy have increased muscle tension in the lower extremities, which inevitably leads to abnormal gait characteristics. Proper management of excessive muscle tension is therefore of great importance. The aim of this study was to explore the effects of continuous passive motion on children with cerebral palsy, regarding their lower extremity spastic hypertonia and ambulatory function. A repeated measures design. Sixteen children with cerebral palsy. Intervention was applied to the subject's knees with a continuous passive motion device (at velocities of 15 and 0º/s) for 20 min. Effects were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, immediately after, and 30 min after intervention. For the 15º/s intervention, significant differences were found in time, intervention, and interaction among variables, including active range-of-motion of the knee (increased), relaxation index (increased), Modified Ashworth Scale (decreased), Timed Up-and-Go (decreased), and 6-Minute Walk test (increased). No difference was found in passive range of motion measurements. For the 0º/s control condition, none of the dependent variables demonstrated statistically significant differences. Repetitive passive movement can reduce lower extremity spastic hypertonia in children with cerebral palsy, and improve ambulatory function in terms of walking speed.

Asymptomatic Bilateral Patella Alta After Surgical Repair of Traumatic, Sequential Bilateral Patellar Tendon Rupture

Bilateral patellar tendon rupture is rare, and usually occurs in patients with ligamentous laxity, a predisposing rheumatologic disorder, chronic renal failure, or exogenous corticosteroid use1-3. We describe a patient who sustained traumatic bilateral patellar tendon ruptures nearly ten years apart. Surgical repair of each knee was successfully performed with use of an open technique, and the patient was followed for more than two years after each procedure. The most recent radiographs demonstrated bilateral patella alta; however, the patient was asymptomatic. To our knowledge, this is the first case report of an individual with asymptomatic bilateral patella alta after surgical repair of bilateral patellar tendon rupture. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-seven-year-old man sustained a patellar tendon rupture in each knee, with the ruptures occurring ten years apart. Both tendon ruptures were repaired surgically. No previous knee problems were reported. He had no other medical conditions or surgical procedures and was on no medication. He had no personal or family history of ligamentous laxity. He denied using corticosteroids, tobacco, alcohol, and recreational drugs. He was physically active regularly and worked on his feet daily as a manual laborer. The right patellar tendon ruptured in 2000, after a fall from a standing height; it was repaired acutely at another institution with use of nonabsorbable sutures tied superiorly through transpatellar bone tunnels with no operative or postoperative complications. The patient wore a knee immobilizer for eight weeks postoperatively, and was fully compliant with weight-bearing as tolerated. After eight weeks, he was allowed full active and passive knee motion and experienced no pain. Physical examination ten years later revealed full active knee extension and lower-extremity strength. He was able to actively flex the hip and lift the …

Effects of medial patellofemoral ligament reconstruction on patellar tracking

Medial patellofemoral ligament (MPFL) reconstruction has been performed to treat recurrent patellar dislocation. However, the effects on patellar tracking have not been well documented, particularly in patients. The purpose of this study is to compare patellar tracking pattern and chondral status at MPFL reconstruction with those at second-look arthroscopy. Between 1999 and 2008, 71 patients with recurrent patellar dislocation underwent MPFL reconstruction using a double-looped semitendinosus tendon. Of these, 25 knees in 24 patients underwent second-look arthroscopy (at 6-26 months after initial surgery), forming the subject for the present study. No other surgical procedures such as tibial tuberosity transfer, lateral release, or osteotomy were performed in any patients. To assess the patellar tracking pattern, the position of the patella on femoral groove was evaluated arthroscopically during passive knee motion through lateral suprapatellar portal. Before MPFL reconstruction, the patella in all patients was shifted laterally throughout the entire range of knee motion. Immediately after MPFL reconstruction, patellar malalignment was corrected in all cases. On second-look arthroscopy, two different patellar tracking patterns were observed. In 9 knees, the patella was located on the center of the femoral groove throughout the range of motion. Meanwhile, in the remaining 16 knees, the patella was shifted laterally at knee extension and migrated to the center of femoral groove with increased knee flexion. No significant deteriorations in chondral status were seen on second-look arthroscopy. The present study revealed that not all improved patellar trackings after MPFL reconstruction remained intact at follow-up. Chondral status in patellofemoral joint was not aggravated by MPFL reconstruction. Therapeutic studies, Level IV.

Functional Lateralization of Sensorimotor Cortex in Infants Measured Using Multichannel Near-Infrared Spectroscopy

Multichannel near-infrared spectroscopy (MNIRS) was used for the functional imaging of the sensorimotor cortex of newborn infants during passive knee and elbow movement under sedated sleep. Contralateral knee and elbow movement caused a marked increase in the concentration of oxyhemoglobin ([oxyHb]) from the baseline values at site within the sensorimotor area in all infants. During ipsilateral knee and elbow movement, [oxyHb] showed smaller changes, equivalent to 64 ± 23 and 66 ± 28% of the changes that occurred with contralateral stimulation, respectively. The mean times corresponding to maximal changes in [oxyHb] were 16.1 ± 3.3 s for contralateral knee movement and 17.9 ± 5.7 s for contralateral elbow movement. No significant difference was noted between the mean latencies showing the maximal changes in [oxyHb] between contralateral and ipsilateral movement. There was a significant difference in the area and degree of response between the contralateral and ipsilateral movement. MNIRS could be a useful tool to understand the pathophysiology of the developing brain and monitor cortical responses in various clinical situations.

Minimal-invasive retrograde Anbohrung der Osteochondrosis dissecans des Femurkondylus mit einem speziellen Zielinstrumentarium

Retrograde drilling for penetration of subchondral sclerotic bone in osteochondrosis dissecans (OCD) of the femoral condyle with preserved cartilage integrity. Hereby, revascularization of the OCD and immigration of bone marrow cells to achieve stable reintegration of the OCD into the surrounding subchondral bone. Stable juvenile and adult osteochondrosis dissecans (stage I-II of the International Cartilage Repair Society (ICRS) classification) of the medial and lateral femoral condyle with an intact articular surface and surrounding sclerosis zone, which is visible in the x-ray. OCD stage III-IV of the ICRS grading scale. Relative contraindication: preceding retrograde drilling. Arthroscopic inspection and palpation of the cartilage defect. Minimal incision over the M. vastus medialis (when the defect is located in the medial condyle) or the M. vastus lateralis (when the defect is located in the medial condyle). Preparation and dissection of the fascia of the vastus muscle. Insertion of retractors underneath the vastus muscle to expose the metaphysis of the distal femur. Intraarticular positioning of the arthroscopic drill guide, placement of the wire guide and a Kirschner(K) wire on the femur metaphysis and retrograde drilling with a 2.0-2.2 mm K wire under radiographic visualization. Length measurement of the intraosseous wire distance. Switch the guide mechanism to a multiple hole drill guide and, depending on the defect size, insertion of a further 7-10 K wires of same thickness and defined length. Sterile bandage and slightly compressive dressing. Continuous active and passive knee motion. Weight bearing of 20 kg for 6 weeks, with subsequent transition to continuous weight bearing. Radiographic controls at 6 and 12 weeks postoperatively. In case of a persistent sclerosis zone in the control x-ray or clinical abnormalities, control MRI is indicated. A total of 55 patients with a mean age of 19.6 years were treated using the described technique: 49 patients (89.1%), and 54 knees respectively (35 juvenile OCD, 19 adult OCD), were seen with a mean follow-up of 37.9 months. An improvement was observed in 81.6% of the knees using the radiographic score, i.e., a mean improvement of 1.13 of the radiographic score published by Rodegerdts and Gleissner (preoperative 3.04 vs. postoperative 1.91). Juvenile OCD showed better radiographic results overall (88.2% healing) than adult OCD (66.7% healing).