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Galán-Olleros M, Miranda-Gorozarri C, Rey-Cañas R, Alonso-Hernández J, Azorín-Cuadrillero D, Palazón-Quevedo Á. Hexapod Frame Correction of Proximal Tibial Recurvatum Caused Indirectly by a Femoral Aneurysmal Bone Cyst in an Adolescent: A Case Report and Systematic Review. JBJS Case Connect 2024; 14:01709767-202403000-00041. [PMID: 38452160 DOI: 10.2106/jbjs.cc.23.00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
CASE A 16-year-old boy presented with a recurrent distal femur aneurysmal bone cyst accompanied by a combined sagittal knee deformity (20° of femoral antecurvatum and 26.8° of tibial recurvatum) and limb shortening. After preoperative planning, the treatment involved new intralesional curettage, phenolization, and bone allograft filling. Additional procedures included distal extension femoral osteotomy with plate fixation, and proximal tibial osteotomy with, gradually corrected through a hexapod frame. At 2-year follow-up, lower limbs exhibited normoalignment and equal length. CONCLUSION Complex knee deformities may occur with tumoral lesions around the knee but can be effectively addressed through double osteotomy and application of a hexapod frame.
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Affiliation(s)
- María Galán-Olleros
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
| | - Carlos Miranda-Gorozarri
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
| | - Roberto Rey-Cañas
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario de Getafe, Madrid
| | - Javier Alonso-Hernández
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
| | | | - Ángel Palazón-Quevedo
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
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Saitoh A, Hiranaka T, Arimoto A, Tanaka A, Suda Y, Koide M, Fujishiro T, Okamoto K. Intraoperative avulsion fracture of the intercondylar eminence in Oxford mobile-bearing unicompartmental knee arthroplasty: Case report. Knee 2023; 40:220-226. [PMID: 36512893 DOI: 10.1016/j.knee.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/29/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) can provide good postoperative results and long term survival, but there may be complications. We present a rare case of avulsion fracture of the intercondylar eminence during UKA surgery. CASE PRESENTATION An 88-year-old man had right-knee pain with anteromedial osteoarthritis. Oxford partial knee UKA (Zimmer Biomet, Warsaw, IN) was performed by the senior author by the under-vastus approach using Microplasty instruments. During the final check of the range of motion, an avulsion fracture of the intercondylar eminence occurred at the terminal extension. A 4.0 mm cannulated cancellous screw was inserted into the intercondylar eminence from just in front of the anterior cruciate ligament to the posterior tibial cortex. Six months postoperatively, bony fusion was confirmed by lateral radiography. Two years after the surgery, the patient was fully satisfied. The flexion angle was 125°, but still with an extension limit of 10°. DISCUSSION Avulsion fracture of the intercondylar eminence can be caused by hyperextension and/or the ACL becoming tighter in full extension of the knee. In this patient, avulsion fracture also probably occurred due to increased tension of the ACL in the fully extended position. After making the horizontal cut, we inserted a thin metal plate to prevent deeper vertical cuts, but an excessive horizontal cut was a possible cause of the fracture. As treatment for avulsion fracture of the intercondylar eminence, fixation of the cannulated cancellous screw resulted in uneventful bone fusion. We recommend having a cannulated cancellous screw at hand for such complications and for other potential intraoperative problems, such as tibial plateau fracture. Further investigation into limited postoperative extension might be needed. CONCLUSION Our patient had intraoperative avulsion fracture of the intercondylar eminence, a relatively rare complication of Oxford UKA which is probably caused by the extension being tight and/or an excessive horizontal cut. Having a cannulated cancellous screw at hand is advised, and attention should be paid to postoperative limit of extension.
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Affiliation(s)
- Akira Saitoh
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan.
| | - Akihiko Arimoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Atsuki Tanaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Yoshihito Suda
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Motoki Koide
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
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Dierick F, Schreiber C, Lavallée P, Buisseret F. Asymptomatic Genu Recurvatum reshapes lower limb sagittal joint and elevation angles during gait at different speeds. Knee 2021; 29:457-468. [PMID: 33743261 DOI: 10.1016/j.knee.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic characteristics of walking with an asymptomatic genu recurvatum are currently unknown. The objective of this study is to characterize the lower limb sagittal joint and elevation angles during walking in participants with asymptomatic genu recurvatum and compare it with control participants without knee deformation at different speeds. METHODS The spatio-temporal parameters and kinematics of the lower limb were recorded using an optoelectronic motion capture system in 26 participants (n = 13 with genu recurvatum and n = 13 controls). The participants walked on an instrumented treadmill during five minutes at three different speeds: slow, medium and fast. RESULTS Participants with genu recurvatum showed several significant differences with controls: a narrower step width, a greater maximum hip joint extension angle, a greater knee joint extension angle at mid stance, a lower maximum knee joint flexion angle during the swing phase, and a greater ankle joint extension angle at the end of the gait cycle. Participants with genu recurvatum had a greater minimum thigh elevation angle, a greater maximum foot elevation angle, and a change in the orientation of the covariance plane. Walking speed had a significant effect on nearly all lower limb joint and elevation angles, and covariance plane parameters. CONCLUSION Our findings show that genu recurvatum reshapes lower limb sagittal joint and elevation angles during walking at different speeds but preserves the covariation of elevation angles along a plane during both stance and swing phases and the rotation of this plane with increasing speed.
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Affiliation(s)
- Frédéric Dierick
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg; CeREF, Haute Ecole Louvain en Hainaut, Mons, Belgium; Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
| | - Céline Schreiber
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg
| | - Pauline Lavallée
- Laboratoire Forme et Fonctionnement Humain, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
| | - Fabien Buisseret
- CeREF, Haute Ecole Louvain en Hainaut, Mons, Belgium; Laboratoire Forme et Fonctionnement Humain, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium; Service de Physique Nucléaire et Subnucléaire, Université de Mons, UMONS Research Institute for Complex Systems, Mons, Belgium
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Smith PA, Thomas DM, Pomajzl RJ, Bley JA, Pfeiffer FM, Cook JL. A Biomechanical Study of the Role of the Anterolateral Ligament and the Deep Iliotibial Band for Control of a Simulated Pivot Shift With Comparison of Minimally Invasive Extra-articular Anterolateral Tendon Graft Reconstruction Versus Modified Lemaire Reconstruction After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:1473-1483. [PMID: 30926192 DOI: 10.1016/j.arthro.2018.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the deep fibers of the iliotibial band (dITB) or the anterolateral ligament (ALL) provides more control of a simulated pivot shift and whether a minimally invasive anterolateral reconstruction (ALR) designed to functionally restore the ALL and dITB is mechanically equivalent to a modified Lemaire reconstruction (MLR). METHODS Six matched pairs of cadaveric knees (N = 12) were subjected to a simulated pivot shift to evaluate anteroposterior translation; internal rotation; and valgus laxity at 0°, 30°, and 90° of flexion. The anterior cruciate ligament (ACL) was sectioned in all specimens, and retesting was performed. Within each pair, sequential sectioning of the ALL and dITB was performed, followed by testing; the contralateral knee was sectioned in reverse order. Knees underwent ACL reconstruction (ACLR) and repeat testing. Then, MLR (n = 6) or ALR (n = 6) was performed on matched pairs for final testing. RESULTS Sectioning of the dITB versus ALL (after ACL sectioning) produced significantly more anterior translation at all flexion angles (P = .004, P = .012, and P = .011 for 0°, 30°, and 90°, respectively). The ACL-plus-dITB sectioned state had significantly more internal rotation at 0° versus ACL plus ALL (P = .03). ACLR plus ALR restored native anterior translation at all flexion angles. ACLR plus MLR restored anterior translation to native values only at 0° (P = .34). We found no statistically significant differences between ACLR plus ALR and ACLR plus MLR at any flexion angle for internal rotation or valgus laxity compared with the native state. CONCLUSIONS ALR of the knee in conjunction with ACLR can return the knee to its native biomechanical state without causing overconstraint. The dITB plays a more critical role in controlling anterior translation and internal rotation at 0° than the ALL. The minimally invasive ALR was functionally equivalent to MLR for restoration of knee kinematics after ACLR. CLINICAL RELEVANCE The dITB is more important than the ALL for control of the pivot shift. A minimally invasive extra-articular tendon allograft reconstruction was biomechanically equivalent to a modified Lemaire procedure for control of a simulated pivot shift.
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Affiliation(s)
- Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
| | - Dimitri M Thomas
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Ryan J Pomajzl
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; SSM Health Medical Group, Bridgeton, Missouri, U.S.A
| | - Jordan A Bley
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
| | - Ferris M Pfeiffer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
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Pregnancy Results in Lasting Changes in Knee Joint Laxity. PM R 2019; 11:117-124. [PMID: 29964215 DOI: 10.1016/j.pmrj.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/19/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Altered joint laxity can contribute to joint dysfunction. Knee joint laxity has been shown to increase during pregnancy, but its long-term persistence is unknown. OBJECTIVE To determine whether pregnancy leads to lasting increases in knee joint compliance and laxity that persist longer than 4 months postpartum. DESIGN Prospective cohort study. SETTING A motion analysis laboratory at an academic medical center. PARTICIPANTS Fifty healthy women in their first trimester of pregnancy (mean ± SD 29.2 ± 4.3 years old and baseline body mass index 26.0 ± 5.4 kg/m2 ) were recruited. INTERVENTION End-range knee laxity and midrange joint compliance were measured during the first trimester and 19 ± 4 weeks postpartum. Anterior-posterior and varus-valgus laxity were measured using 3-dimensional motion tracking while applying forces and moments in each respective plane using the Vermont Knee Laxity Device. Nonlinear models were constructed to assess relations between applied forces and joint translation, comparing early pregnancy with postpartum. OUTCOMES Multiplanar knee laxity and compliance. RESULTS Peak varus-valgus (20-22%; P = .001) and posterior translation (51%; P < .001) of the tibia relative to the femur decreased from baseline, with a concomitant decrease in laxity (P < .001) and compliance (P = .039) in the coronal plane and in the posterior direction in primiparous (P = .009) and multiparous (P = .014) women. For primiparous women, laxity (P < .001) and compliance (P = .009) increased in the anterior direction. CONCLUSIONS Pregnancy resulted in a lasting decrease in multiplanar knee laxity and compliance in the varus and posterior directions with an increase in anterior compliance. The effects of these changes in laxity and compliance of the passive stabilizers on knee loading patterns, articular contact stresses, and risk for osteoarthritis and other musculoskeletal disorders will require additional research. LEVEL OF EVIDENCE II.
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Barnds B, Bounajem G, Schroeppel JP, Mullen S, Heddings A, Tarakemeh A, Vopat BG. Simultaneous Bilateral Knee Dislocation During Weight Training: A Case Report and Review of the Literature. JBJS Case Connect 2019; 9:e5. [PMID: 30676343 DOI: 10.2106/jbjs.cc.18.00133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CASE We describe the clinical course and treatment of a patient who sustained simultaneous bilateral knee dislocation under low-velocity atraumatic conditions, and provide a review of the literature. Dislocations of the native knee joint are uncommon orthopaedic injuries but they are true emergencies because of the concern for concomitant neurovascular injury; therefore, they may be limb-threatening injuries. CONCLUSION To our knowledge, there are few reports of simultaneous bilateral knee dislocation and no reports of this occurring during weight training. The risk of knee dislocation can be reduced by avoiding locking and hyperextension of the knees during any type of leg press or squatting exercise.
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Affiliation(s)
- Brandon Barnds
- University of Kansas Medical Center, Kansas City, Kansas
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Teran-Yengle P, Cole KJ, Yack HJ. Short and long-term effects of gait retraining using real-time biofeedback to reduce knee hyperextension pattern in young women. Gait Posture 2016; 50:185-189. [PMID: 27637090 DOI: 10.1016/j.gaitpost.2016.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 07/28/2016] [Accepted: 08/19/2016] [Indexed: 02/02/2023]
Abstract
The use of real-time biofeedback has been shown to enable individuals to make changes to their gait patterns. It remains unknown whether the short-term improvements reported in previous studies are retained in the longer term. In this study, the paradigm used to investigate the short and long-term effects of real-time biofeedback was modifying knee range of motion during gait to prevent knee hyperextension in women. The purpose of this study was to investigate the short-term (1-month follow up) and long-term (8-month follow up) effects of a gait retraining program using real-time biofeedback to correct knee hyperextension in young women. Seventeen healthy women, ages 18-35 years, with asymptomatic knee hyperextension underwent a three-week (6 sessions) treadmill gait retraining program. Real-time feedback of kinematic data (Visual 3D) was provided during treadmill training. Knee extension range of motion was monitored during overground gait evaluations and training sessions. Gait evaluations were performed pretraining, posttraining (2days after), and 1-month, and 8-month after the last training session. This study showed significant reduction in knee hyperextension patterns immediately following training (mean±SD, 10.9°±4°), and at 1-month (7.5°±5°) and 8-month (6.3°±3.5°) follow ups. There was an increase in knee extension between posttraining and 1-month follow up (3.4°±5°). Reduction in knee hyperextension range of motion was retained at 8-month follow up evaluation. The present study shows the effects of real-time biofeedback in facilitating the acquisition and retention of proficiency in reducing knee hyperextension gait patterns, documenting that the retention is sustained for up to 8 months.
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Affiliation(s)
- Patricia Teran-Yengle
- School of Physical Therapy and Rehabilitation Science, University of South Florida, Tampa, FL, USA.
| | - Kelly J Cole
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.
| | - H John Yack
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
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Laurà G. Is LOE test useful to recognize LCA insufficiency? J Orthop Traumatol 2014; 15:141. [PMID: 24481995 PMCID: PMC4033799 DOI: 10.1007/s10195-013-0285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/27/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Giuseppe Laurà
- Knee Surgery Department, Istituto Clinico Città Studi, Milan, Italy,
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