scholarly journals Increasing posterior condyle cut for high-flex knee prosthesis may injure popliteus tendon origin: a cadaveric study

2020 ◽  
Vol 4 (1) ◽  
pp. 1-5
Author(s):  
Ong-art Phruetthiphat
Keyword(s):  
Standard Model ◽  
Knee Prosthesis ◽  
Femoral Condyle ◽  
Tendon Injury ◽  
Left Knee ◽  
Popliteus Tendon ◽  
Posterior Condyle ◽  
Total Knee ◽  
The Mean ◽  
The Right

Background: High-flex total knee prosthesis designs were proposed to improve flexion in total knee replacement (TKA). One of high-flex features is increasing posterior condyle cut which put popliteal tendon in higher risk of injury and may result in gap changes. Methods: Thirty-six popliteal origin sites from eighteen fresh cadavers were measured distances between the posterior rim of popliteal tendon origin and posterior border of the lateral femoral condyle (distance A) using digital “Vernier caliper”. The mean distances were compared to posterior condyle thickness of different prosthesis designs. Results: The mean of distance A on the right knee was 9.59 ±1.66 mm (6.03-12.70) while the mean of distance A on the left knee was 9.13 ± 1.78 mm (5.80-11.07). Posterior condyle thickness of the femoral prostheses varies upon their design and size from 7.4 to 10 mm for standard model and from 8.2 to 12.5 mm for high-flex design. Possibilities of popliteal tendon injury during posterior condyle bone cut were 16.7% to 66.7% for standard model and 27.8% to 97.2% for the high-flex design. Conclusion: High-flex TKA prosthesis with thicker posterior condyle relates to higher possibility of popliteal tendon origin injury compared to standard one.

Prevelance of Fabella: An MRI Study in The Eastern Anatolia Region Of Turkey

2021 ◽  
Vol 17 ◽  
Author(s):  
Huseyin Akdeniz ◽  
Sezai Ozkan ◽  
Cihan Adanas
Keyword(s):  
Femoral Condyle ◽  
Left Knee ◽  
Final Decision ◽  
Eastern Anatolia ◽  
Orthopedic Surgeons ◽  
Expert Radiologist ◽  
Number Of Patients ◽  
And Gender ◽  
The Right ◽  
Mri Study

Background: The fabella, which is generally located in the lateral head of the gastrocnemius muscle, is a sesamoid bone that articulates with the posterior face of the lateral femoral condyle. As traditional information, the prevalence of fabella is between 10–30% in the population and is usually present in both knees. Introduction: The objective of this study was to investigate the knee MRIs in the Eastern Anatolia Region of Turkey subjects in order to assess the prevalence of the fabella and analyse the differences between gender, age and laterality and its symmetry pattern. Methods: This study was a retrospective study in patients older than 18 years whose knee MRIs were taken between February 2014 and February 2016. In this study, a total of 531 patients [290 females and 241 males] were included. The radiographs were examined by two orthopedic surgeons and the fabella was located. Later, an expert radiologist made the final decision and confirmed the results. Results: The number of patients included in the study was 531. We detected os fabella in 59 (11.1%) patients. Of the 59 os fabella, 33 were in the right knee and 26 were in the left knee, 38 were female and 21were male. Conclusion: In this study, we investigated the age and gender differences besides the prevalence and the symmetry pattern of the fabella in the Eastern Anatolia Region of Turkey’s population. Prevalence of the fabella was found to be 11.1% which is different than previously published studies.

scholarly journals Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0019
Author(s):  
MJ Reid ◽  
SM Thompson ◽  
R Dawahn ◽  
M Jones ◽  
A Williams
Keyword(s):  
Knee Pain ◽  
Femoral Condyle ◽  
Arthroscopic Surgery ◽  
Clinical Findings ◽  
Left Knee ◽  
Injury Pattern ◽  
Medial Femoral Condyle ◽  
Duration Of Symptoms ◽  
Elite Level ◽  
The Mean

Objectives: Cricket is one of the world’s most popular team sports. In the past it was described as a sport of moderate risk for injury however at elite level, the international cricket timetable has massively expanded to encompass several new formats leaving very little time for recuperation. We report on a series of seven elite level fast bowlers that presented with a similar injury pattern to the antero-medial femoral condyle of the knee in the leading leg. We describe the presentation, investigation and treatment of this lesion and discuss the possible aetiology. This injury pattern has not previously been reported in the literature. Methods: 7 international level fast bowlers (two Indian and 5 English) presented to our clinic with knee pain in the lead leg (the right knee for left hand bowlers and the left knee for right handed). The mean age of the patients was 27 (20-32) and the mean duration of symptoms was 9 months (2 weeks to 2 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. The main complaint was that of anterior knee pain which was restricting them from bowling. It was associated with a minor fixed flexion in three of the patients and all patients had an effusion at the time of presentation. There were no other symptoms. All patients underwent an MRI scan. A classical appearance of oedema within the medial femoral condyle (Figure 1) was noted. In 4 patients there was ascociated cartilage loss. The injury was also identified on SPECT scan (Figure 2) 3 patients were managed nonoperatively but due to more significant MRI and clinical findings Four went on to require arthroscopic surgery (Figure 3) in the form of microfracture of the lesion. Results: All patients returned to International cricket with a mean of 6 months in the non-operative group and 8 months in the operative group. Conclusion: Anterior impingement from the antero-medial tibia and femur can be a potentially career ending lesion in the fastbowler. A strong index of suspicion has to be exercised when a bowler attends with an effusion associated with episodic pain and localisation (which may be difficult to ascertain). This lesion may be present in the asymptomatic bowler, presenting with an associated injury in the same knee. This lesion is typical in this elite group and as such training schedules and medical staff need to be aware of it as a cause of significant injury.

scholarly journals Result of posteromedial capsule and superficial medial collateral ligament release on gap and alignment in total knee arthroplasty in varusknee deformity by computer assisted surgery measurement: a retrospective stud

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0006
Author(s):  
Pruk Chaiyakit ◽  
Ittiwat Onklin ◽  
Weeranate Ampunpong
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Computer Assisted Surgery ◽  
Varus Deformity ◽  
Flexion Contracture ◽  
Computer Assisted ◽  
Total Knee ◽  
The Mean ◽  
Lateral Gaps

Soft tissue release and gap balancing in total knee arthroplasty (TKA) are important issue and lack of conclusive result. We performed posteromedial capsule (PMC) and superficial medial collateral ligament (sMCL) release by preservation of anterior attachment of pes anserine. Gaps and alignment were recorded by computer assisted surgery measurement. Results: T: The mean correction of varus deformity after PMC release and sMCL release were 4.88 ± 2.82° and 3.39 ± 1.7 respectively with the mean FC after PMC and sMCL release correction of 5.57 ± 3.5 and 1.34 ± 2.9° respectively. The mean medial gap changes on full extension after PMC and sMCL release was 1.83 ± 1.39 and 1.67 ± 1.04 mm. respectively with the mean medial gaps at 90 degree flexion after PMC and sMCL release changes of 0.73 ± 0.9 and 5.14 ± 2.11 mm. respectively. The mean lateral gap changes on extension after PMC and sMCL release were -1.3 ± 1.83 and -1.1 ± 1.6 mm. respectively with the mean lateral gaps at 90 degree flexion after PMC and sMCL release changes of -0.19 ± 1.03 and 0.06 ± 1.75 mm. here were 21 patients (16 female and 5 male) with mean age of 68 (48-78) years. The mean body mass index was 28.49 (20.70 – 39.95) kg/m2. The mean preoperative hip-knee-ankle angle was varus 8.12 (3.5-16.0) degrees with mean flexion contracture of 11.3 (3.5-16.0) degrees. Sixteen knees were implanted with Fixed bearing knee prosthesis and five knees were implanted with Mobile bearing knee prosthesis (Table.1). We performed PMC release in all patients, and combined PMC and sMCL release in fourteen patients. The mean correction of varus deformity after PM release and sMCL release were 4.88 ± 2.82 and 3.39 ± 1.7 degrees respectively. While the mean correction of flexion contracture after PMC release and sMCL release were 5.57 ± 3.5 and 1.34 ± 2.9 degrees respectively (Fig.8). The mean medial gaps change on extension after PMC and sMCL release were 1.83 ± 1.39 and 1.67 ± 1.04 mm. respectively. The mean medial gaps change at 90 degree flexion after PMC and sMCL release were 0.73 ± 0.9 and 5.14 ± 2.11 mm. respectively (Fig.9). The mean lateral gaps change on extension after PMC and sMCL release were 1.3 ± 1.83 and -1.1 ± 1.6 mm. respectively. The mean lateral gaps change at 90 degree flexion after PMC and sMCL release were -0.19 ± 1.03 and 0.06 ± 1.75 mm. (Fig.9). There is no instability of knee after PMC and sMCL release. Materials and Methods: Twenty one patient had been operated on. TKA with computer assisted surgery was performed using PMC and sMCL release by preservation of anterior attachment of pes anserine. Alignment, medial and lateral gaps were measured by computer assisted surgery. The mean age was 68 (48-78) years with the mean preoperative hip-kneeankle angle of 8.12 (3.5-16.0) degrees and the mean flexion contracture (FC) of 11.3 (3.516.0) degrees. Conclusion: We believe that sMCL release with preservation of anterior attachment of pes anserinus in total knee arthroplasty has additional effect on varus knee correction after PMC release without creation of knee instability.

Isolated popliteus tendon injury does not lead to abnormal laxity in posterior-stabilised total knee arthroplasty

2015 ◽  
Vol 23 (6) ◽  
pp. 1763-1769 ◽  
Author(s):  
K. M. Ghosh ◽  
N. Hunt ◽  
A. Blain ◽  
K. K. Athwal ◽  
L. Longstaff ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tendon Injury ◽  
Popliteus Tendon ◽  
Total Knee

Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

2019 ◽  
Vol 33 (07) ◽  
pp. 678-684 ◽  
Author(s):  
Fahad Hossain ◽  
Sujith Konan ◽  
Babar Kayani ◽  
Christina Kontoghiorghe ◽  
Toby Barrack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractThe use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

scholarly journals Radiological Assessment of Femoral Bicondylar Angle among Persons Attending a Tertiary Health Care

2019 ◽  
Vol 21 (1) ◽  
pp. 44-47
Author(s):  
Allin Pradhan ◽  
CP Lama ◽  
S Dhungel ◽  
SK Ghosh
Keyword(s):  
Health Care ◽  
Knee Joint ◽  
Left Knee ◽  
Knee Joints ◽  
Teaching Hospitals ◽  
Radiological Assessment ◽  
Left Femur ◽  
The Mean ◽  
The Difference ◽  
The Right

 Femoral bicondylar angle is the angle between an axis through the shaft of the femur and a line perpendicular to the infracondylar plane. This study aims to assess femoral bicondylar angle measured from radiograph of femur and knee joints obtained from teaching hospitals in Kathmandu Nepal. Total of two hundred AP view radiograph of knee joint were collected, out of which, 50 each were of male right and left knee joint and 50 each were of female right and left knee joint. The mean angle for the right male femur was 7.86° with the range of 5°-10° and mean angle for the right female femur was 8.82° with the range of 6°-11°. On the left side, bicondylar angle ranged in male from 6° -10° with the average of 7.46° and in female range was 6°-11° and average was 8.66°. The bicondylar angle was higher in female on both the side, the difference was statistically significant on the left side (P=0.004) and significant on the right side (P=0.001). The finding of the study showed the femoral bicondylar angles were greater in right femur than left femur in both sexes. The difference in the bicondylar angle between the right and left femur was statistically insignificant in both sexes. (male p=0.144, female p=0.541). The result from this study has shown that femoral bicondylar angles were generally greater amongst the females as compared to the males; greater in right femur than left femur in both sexes.

scholarly journals Iatrogenic popliteus tendon injury during total knee arthroplasty results in decreased knee function two to three years postoperatively

2012 ◽  
Vol 36 (10) ◽  
pp. 2061-2065 ◽  
Author(s):  
Vito de Simone ◽  
Guillaume Demey ◽  
Robert A. Magnussen ◽  
Sebastien Lustig ◽  
Elvire Servien ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tendon Injury ◽  
Knee Function ◽  
Popliteus Tendon ◽  
Total Knee

scholarly journals The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Collateral Ligament ◽  
Lower Limbs ◽  
Lateral Femoral Condyle ◽  
Popliteus Tendon ◽  
Femoral Bone ◽  
Collateral Ligament ◽  
Bone Resection ◽  
Total Knee ◽  
Resection Area

Abstract Background The popliteus tendon (PT) or lateral collateral ligament (LCL) stabilizes the postero-lateral aspects of the knees. When surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injuries are a risk because the femoral attachments are relatively close to the femoral bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used (average age: 80.3). Whole length lower limbs were resected from the pelvis. All the surrounding soft tissue except the PT, knee ligaments and meniscus were removed from the limb. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a 1.5 mm K-wire. Computed tomography (CT) scanning of the whole lower limb was then performed. The CT data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image of the femur, the shortest length between each footprint and the bone resection area were calculated.Results PT and LCL footprint were detected in all knees. The area of the PT and LCL footprints was 38.7±17.7mm2 and 58.0±24.6mm2, respectively. The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm, respectively. The length between most distal and most posterior point of the lateral femoral condyle and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm, respectively. Under TKA simulation, the shortest length between the PT footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 4.3±2.5mm and 3.2±2.9mm, respectively. The shortest length between the LCL footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 7.2±2.3mm and 5.6±2.1mm, respectively. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knees, respectively.Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. To prevent postero-lateral instability in TKA, careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

scholarly journals Bilateral Periprosthetic Knee Fracture with the Right Floating Total Knee and Left Periprosthetic Patella Fracture Management Strategy: A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lavindra Tomar ◽  
Gaurav Govil ◽  
Pawan Dhawan
Keyword(s):  
Case Report ◽  
Management Strategy ◽  
Knee Injury ◽  
Distal Femur ◽  
Femur Fracture ◽  
Left Knee ◽  
Patellar Fracture ◽  
Distal Femur Fracture ◽  
Total Knee ◽  
The Right

Introduction: Periprosthetic fractures (PPFs) in total knee replacement are an uncommon condition. The floating knee injury around total knee arthroplasty (TKA) is even rare and poses challenges in management. Incidence is increasing due to growing primary joint arthroplasties and revision procedures. We report a case of bilateral PPF with a floating total knee. Case Report: A 74-year-old female involved in a violent car accident sustained bilateral knee injuries, facial, and hand injury. In the emergency room, the initial resuscitation and trauma protocol stabilization were done and she was provisionally immobilized for her limb injuries. She presented with the right-sided floating total knee involving periprosthetic periarticular comminuted distal femur fracture and midshaft comminuted fracture tibia fibula. The patient also had left knee lower pole periprosthetic patellar fracture. The patient had a history of bilateral TKA around 2 years back. She underwent surgical management of the right floating total knee by stabilization of distal femur fracture and tibial shaft fracture fixation with locking plates. She underwent primary autologous bone grafting for both fracture sites. The left knee patellar fracture was managed conservatively in a brace. At 8 months follow-up, the patient was pain free and had consolidation of fractures. The patient walked without any walking aids. At 18 months, she had regained her pre-injury functional status. Conclusion: Each fracture in a floating total knee injury is unique and treatment should be decided based on individual analysis and the extent of soft-tissue injuries. An uncommon occurrence highlights the complex injury patterns involving PPF requiring individualized case specific management strategy. Keywords: Floating total knee, Periprosthetic knee fracture, floating knee.

scholarly journals Multiple Osteochondritis Dissecans in Multiple Joints

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Takuto Takeda ◽  
Ryuichiro Akagi ◽  
Yusuke Sato ◽  
Takahiro Enomoto ◽  
Ryosuke Nakagawa ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Contralateral Side ◽  
Left Knee ◽  
Medial Femoral Condyle ◽  
The Body ◽  
Mri Scan ◽  
Femoral Trochlea ◽  
History Of ◽  
The Right

Background. Osteochondritis dissecans (OCD) rarely occurs in multiple joints. Furthermore, the existence of left-right asymmetric OCDs in different joints of the contralateral side of the body and lesions occurring with a temporal difference is rare. Here, we report a rare case with multiple OCDs sequentially detected in various joints. Case Presentation. The 15-year-old male patient was referred to our hospital for an OCD in the medial femoral condyle of the left knee. He had a history of an OCD in his right elbow, and his father had a history of surgically treated OCDs in both knees. One year and five months after, surgery was performed to the lesion in his left medial femoral condyle, a new OCD lesion occurred in the femoral trochlea of the same knee, which was again treated surgically. Five months after the second surgery, the patient returned with pain in the right knee, and an OCD on the right femoral trochlea was detected by an MRI scan. This lesion remained stable without any further restriction in physical activities for 17 months until detachment occurred and was again treated surgically. Conclusion. In cases with history and a family history of multiple OCDs, in particular, with a short stature, an MRI scan should be performed for the symptomatic joint to detect and treat the lesion before progression.

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