Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 5 Articles
Background: A screening of ulnar collateral ligament insufficiency is required for overhead throwers, since secondary\r\npathologic changes result from an increased elbow valgus laxity. We developed a new manual method for assessing\r\nelbow valgus laxity and investigated the reliability of this method and its correlation with ultrasonographic assessment.\r\nMethods: We defined elbow valgus laxity as the difference between the shoulder external rotation angle (ER\r\nangle) measured with the elbow in 90 degrees flexion and that measured with the elbow in extension because ER\r\nangle measured with the elbow in 90 degrees flexion includes elbow valgus laxity and ER angle with the elbow in\r\nextension does not include it. ER angle measurement with the elbow in extension involved the use of a custom\r\narm holder. Three examiners each measured elbow valgus laxity by the new method in 5 healthy volunteers.\r\nIntraobserver and interobserver reliability was evaluated by calculating the intraclass correlation coefficient. We\r\nthen assessed 19 high-school baseball players with no complaints of shoulder or elbow pain. Elbow\r\nultrasonography was performed with a 10-MHz linear transducer with the elbow in 90 degrees flexion, and the\r\nforearm in the neutral position, and the width of the medial joint space at the level of the anterior bundle was\r\nmeasured. Elbow valgus laxity assessed by ultrasonography was defined as the difference between the medial joint\r\nspace width with gravity stress and that without gravity stress. Increased elbow valgus laxity assessed by both our\r\nmethod and ultrasonography was defined as the difference between the laxity of the elbow on the throwing side\r\nand that on the contralateral side. Pearson�s correlation coefficient (r) was calculated to evaluate the relationship\r\nbetween increased elbow valgus laxity obtained by our manual method and that by ultrasonography.\r\nResults: Intraobserver reliability ranged from 0.92 to 0.98, and interobserver reliability was 0.70. The increased\r\nelbow valgus laxity assessed by our method was significantly correlated with that assessed by ultrasonographic\r\nassessment (P = 0.019, r = 0.53).\r\nConclusions: Elbow valgus laxity can be assessed by our method. This method may be useful for screening for\r\ninsufficiency of the ulnar collateral ligament....
Background: Recent years have seen anterior cruciate ligament (ACL) reconstruction being performed in a broad\r\nrange of patients, regardless of age, sex and occupation, thanks to great advances in surgical techniques, surgical\r\ninstruments and basic research. In cases of ACL reconstruction, bone-patellar tendon-bone (BTB) graft or hamstring\r\ngraft are frequency used. However, potential complications associated with tunnel enlargement due to soft tissue\r\ngraft such as hamstring were reported. On the other hand, an altered rotational axis resulting in significantly\r\ngreater translation of the lateral compartment in the single bundle compared with double bundle ACL\r\nreconstruction was reported.\r\nMethod and procedure: A reconstruction procedure was modified for the ACL using a double bundle that is the\r\ncombination of BTB and gracilis tendon composite autograft. Two tibial and two femoral bone tunnels are used to\r\nreconstruct two bundles of ACL; an anteromedial bundle (AMB) and a posterolateral bundle (PLB). The femoral\r\nbone tunnels are created just posterior to the resident�s ridge. The tibial bone tunnels are created at the center of\r\nAM and PL tibial attachment, respectively. BTB is fixed in the AM tunnels produced on the anatomical points of\r\ntibia and femur. The gracilis graft is fixed in an anatomical PL tunnel produced. The mean width of BTB is 7 mm,\r\nsince10 mm graft is sometimes not suitable for patients, especially small Asian people and females. For these\r\npatients, 10 mm graft is bigger than one third of patella tendon width.\r\nConclusion: The devised surgical procedure based on a combination of BTB and gracilis autograft is suitable\r\nreconstruction method for patients who have small or medium width of patellar tendon such as Asian people and\r\nfemales. This technique is also applicable to revision surgery....
A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA;\r\nOxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed\r\nanteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple\r\naspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All\r\nlaboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy\r\ndemonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis\r\nwas ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then,\r\nhemarthrosis has not recurred....
Anterior cruciate ligament (ACL) injuries continue to present in epidemic-like proportions, carrying significant shortand\r\nlonger-term debilitative effects. With females suffering these injuries at a higher rate than males, an abundance\r\nof research focuses on delineating the sex-specific nature of the underlying injury mechanism. Examinations of sexdimorphic\r\nlower-limb landing mechanics are common since such factors are readily screenable and modifiable.\r\nThe purpose of this paper was to critically review the published literature that currently exists in this area to gain\r\ngreater insight into the aetiology of ACL injuries in females and males. Using strict search criteria, 31 articles\r\ninvestigating sex-based differences in explicit knee and/or hip landing biomechanical variables exhibited during\r\nvertical landings were selected and subsequently examined. Study outcomes did not support the generally\r\naccepted view that significant sex-based differences exist in lower-limb landing mechanics. In fact, a lack of\r\nagreement was evident in the literature for the majority of variables examined, with no sex differences evident\r\nwhen consensus was reached. The one exception was that women were typically found to land with greater peak\r\nknee abduction angles than males. Considering knee abduction increases ACL loading and prospectively predicts\r\nfemale ACL injury risk, its contribution to sex-specific injury mechanisms and resultant injury rates seems plausible.\r\nAs for the lack of consensus observed for most variables, it may arise from study-based variations in test\r\npopulations and landing tasks, in conjunction with the limited ability to accurately measure lower-limb mechanics\r\nvia standard motion capture methods. Regardless, laboratory-based comparisons of male and female landing\r\nmechanics do not appear sufficient to elucidate causes of injury and their potential sex-specificity. Sex-specific in\r\nvivo joint mechanical data, if collected accurately, may be more beneficial when used to drive models (e.g.,\r\ncadaveric and computational) that can additionally quantify the resultant ACL load response. Without these steps,\r\nsex-dimorphic landing mechanics data will play a limited role in identifying the aetiology of ACL injuries in women\r\nand men....
Trochleoplasty is the theoretical solution to persistent symptoms (pain and/or instability) related to trochlear\r\ndysplasia where there is not only a trochlear flatness but also a trochlear prominence. The threshold of\r\nprominence indicating surgical intervention has as yet not been determined. A bump of 5 mm is generally\r\naccepted as the inferior limit. Given the interventional nature of this demanding procedure, it should be proposed\r\nin selected cases after considerable discussion with the patient. Trochleoplasty is indicated as a primary procedure\r\nfor major trochlear dysplasia with a prominence > 5 mm. Stabilization is obtained in most of the cases with the\r\nrisk of residual mild anterior knee pain. It is also indicated as a salvage procedure when a previous surgery failed.\r\nDespite the reputation of the procedure, the published results are encouraging in terms of prevention of redislocation,\r\nsatisfaction index, and radiological outcomes. Post-operative stiffness is the main complication, which\r\nmay require manipulation under anaesthesia or arthroscopic arthrolysis. There are few other complications reported\r\nand to date secondary necrosis of the trochlea has not been reported. Technically speaking, the deepening\r\ntrochleoplasty is a difficult procedure without reliable landmarks. We propose a recession wedge trochleoplasty\r\nwhich is an easier procedure. It is never undertaken as an isolated procedure, but always in conjunction with other\r\nrealignment procedures of the extensor apparatus according to the ââ?¬Å?a la carteââ?¬Â surgery concept...
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