Defect of the femoral condyle in the knee after patellectomy

PURPOSE OF THE STUDYThe aim of this study is to show new possibilities for the treatment of anterior cruciate ligament injuries. For many years, the long-established rules have been followed. However, throughout history, treatment strategies have been gradually modified. The advent of new modern technologies now makes it possible to perform reconstructive procedures already in the acute phase, and thus shorten the treatment time significantly. MATERIAL AND METHODS85 patients were followed after an acute knee injury with an isolated anterior cruciate ligament (ACL) lesion. There were 51 men and 34 women with the average age of 32 years. All patients underwent an acute knee arthroscopy with subsequent ACL reconstruction according to the type of lesion. The results were evaluated according to the clinical examination, Lysholm and Tegner activity scores. We compared 2 surgical techniques (Internal Brace, All-Inside ACL reconstruction) and assessed the possible occurrence of complications. RESULTSThe injury was most often observed in patients aged 20-40 years, when mainly sports activities put a major strain on the knee joint. After performing ACL reconstruction, all patients reported a subjective improvement in the overall condition. The number of complications was very low -only in connection with a slower warm-up of the knee joint after surgery. DISCUSSIONAll patients achieved full stabilization of the knee joint, which is objectified by an increase in the Lysholm score. The improvement in patient's subjective feelings is also confirmed by the increase in Tegner activity scores. Only a few patients experienced a slight restriction of movement in the 8 th week after surgery, but thanks to intensive rehabilitation the function of the knee joint was completely restored within 3 months of the operation. CONCLUSIONSOur study proves that if the set rules are followed, it is possible to perform the ACL reconstruction already in the acute phase. However, in order to choose this approach, the patient's motivation, gently performed procedure and early intensive rehabilitation are necessary. When meeting these criteria, the patient is able to return to normal life, including sports activities, quite early and there is no increased risk of complications.

Section: úVod Anatomie a Biomechanikaunclassified

“…První operační výkon léze LCA byl popsán v roce 1895 (Mayo-Robson, Leeds) (5). Na počátku 20. století se objevují první rekonstrukční výkony pomocí autologních štěpů, jejichž různé varianty implantace používáme dodnes.…”

Section: Historieunclassified

Early Operative Treatment of Anterior Cruciate Ligament Lesions: 3-Year Experience

Kulhánek¹,

Heblt²

2021

“…Z hlediska biomechanických vlastností se jeví jako výborná alternativa k autologním štěpům šlacha musculus tibialis anterior (MTA), (9,11). V recentní literatuře najdeme několik studií zabývajících se alogenním štěpem MTA -výsledky však nejsou jednoznačné a doporučení se mnohdy výrazně liší (od propagace dalšího užívání až po nedoporučení používat tuto techniku zejména u mladých lidí), (11,19,27,28).…”

Section: Původní Práceunclassified

“…V současnosti je známo přes 22 odběrových míst využitelných pro plastiku PZV. Mezi nejpoužívanější patří ligamentum patellae, Achillova šlacha, šlachy MTA, musculus tibialis posterior, musculus peroneus longus, fascia lata anebo hamstringy (9). Zdálo by se, že nejvhodnějším aloštěpem bude BPTB (bone-patellar tendon-bone), ale ukázalo se, že BPTB štěpy mají horší biomechanické vlastnosti, protože se na nich negativně podílí jak vyšší věk dárce, tak menší průměr tkáně na přechodu kost-šlacha, která je navíc oslabena při remodelaci a ligamentizaci (29,31).…”

Section: Původní Práce Original Paperunclassified

Evaluation of Anterior Cruciate Ligament Reconstruction Using Anterior Tibial Muscle Tendon Allograft

Kozak¹,

Gallo²,

Langová³

et al. 2013

PURPOSE OF THE STUDYInjury to the anterior cruciate ligament (ACL) frequently results in the development of knee instability. This is managed by ACL reconstruction using autogenous or allogeneic grafts. This study presents a comprehensive evaluation of the patients with ACL reconstruction using a tendon allograft harvested from the anterior tibial muscle (ATM). MATERIAL AnD METHODSThe group under study comprised 53 patients, 33 men and 20 women, with unilateral ACL reconstruction while the other knee was intact. The average age was 32.4 years (17 to 51) and the average follow-up was 33,4 months (21 to 53). Clinical evaluation included the Tegner and Lysholm scores and questionnaire-based satisfaction rating. Functional assessment included measurements of the range of motion and thigh circumference. Knee stability was determined using the pivot shift test, Lachman test and one-leg hop test. ACL laxity was measured on a GnRB ® arthrometer. Placement of the tibial and the femoral tunnel on radiographs was assessed by the method of Harner. RESULTSAll patients reported their willingness to undergo the surgery again. The average pre-operative Tegner score improved from 7.17 (4-10) to 6.45 (2-10; p = 0.0001). The average post-operative Lysholm score was 87 points (47-100). At final follow-up, the full range of motion was recorded in 39 patients (74%), while the remaining patients exhibited only insignificant restriction of knee motion in comparison with the pre-operative status. The results of the Lachman test were negative in 38 patients (71.7%) while the pivot shift test was negative in 52 patients (98.1%). In the one-leg hop test, 44 patients (83%) were able to jump on the treated leg for a distance longer than 90% of the distance done on the healthy leg. The GnRB test at a force of 134n showed an anterior shift of the proximal tibia by 2.2 mm (0.1-9.3) on the average. The tibial tunnel was placed in zone B in 48 patients (90.6%) and the femoral tunnel was most often located to zone D (n = 47; 88.7%). DISCUSSIOnThe choice of tissue for ACL reconstruction is still being discussed. In some centres an ATM tendon allograft is used only in revision surgery while, in other centres, it is also employed in primary procedures. Recent studies on ACL surgery suggest that outcomes are relatively independent of the material used for reconstruction. In view of evidence-based medicine, more well-conducted multicentre clinical trials are needed to optimise indications for allograft ACL reconstruction. COnCLUSIOnSThe ACL reconstruction using an ATM tendon allograft showed good clinical outcome at a minimum follow-up of 21 months. The method can be recommended not only for revision ACL reconstruction but also in primary reconstructions particularly in elderly patients. The present-day technology of producing allografts maintains tissue biomechanical characteristics and reduces risks for transmission of infection to a minimum.

“…Kontrola předozadního sklonu tibiálního plató má význam při provádění osteotomie u varózních kolen s přítomností anteroposteriorní instability. U poškození předního zkříženého vazu je preferováno zmenšení posteriorního sklonu tibiálního plató a u poškození zadního zkříženého vazu je naopak žádoucí zvětšení jeho sklonu (10). Úhlově stabilní implantáty umožňují stabilní fixaci a s propracovanou operační technikou zajišťují dokonalou stabilitu osteotomie a umožňují rozevření osteotomie na vnitřní straně až o 2,5 cm (14,17,21).…”

Section: úVodunclassified

The Effect of Releasing the Medial Stabilisers of the Knee on the Magnitude of Correction in Opening-Wedge High-Tibial Valgus Osteotomy. Anatomy Study on Cadavers

Okál¹,

Hart²,

Komzák³

2012

PURPOSE OF THE STUDYWhen a larger opening of high-tibial osteotomy is necessary to achieve good correction of the lower extremity axis, partial release of the attachments of the medial stabilisers of the knee may be required. The aim of the study was to ascertain, in cadaver specimens, the effect of loosening the medial knee stabilisers on the magnitude of correction in medial opening-wedge high-tibial valgus osteotomy. MATERIAL AND METHODSThirty-eight knees obtained from cadavers of Caucasian race were dissected. Medial opening-wedge high-tibial valgus osteotomy was performed using a dynamic distractor, constructed by us, with a dynamometer to ensure constant force action. Using a kinematic navigation system, the lower leg axis was studied at opening-wedge osteotomy under constant forces of 100 N and 150 N. The change in its angulation was recorded after each step in releasing the medial stabilisers whose structures were gradually made loose, under constant action of the given force, in the following order: superficial portion of the medial collateral ligament, tendons of the gracilis, semitendinosus and sartorius muscles. RESULTSThe results were statistically analysed using descriptive statistical methods and the two-sample paired t-test with the level of statistical significance set at p < 0.05. Loosening of the medial stabilisers one by one under a constant load led to a statistically significant change in alignment. The most significant change in angulation, both in clinical and statistical terms, was that of 3.4° occurring after the superficial portion of the medial collateral ligament was made loose under a constant force of 100 N applied to osteotomy. Thus, this loosening contributed by 62% to an overall change of 5.5° in the lower extremity mechanical axis, as compared with the condition not allowing for loosening of the stabilisers. Under a load of 150 N applied to osteotomy, loosening of the medial collateral ligament resulted in a change by 4.1°, which accounted for 56% of an overall change of 7.3° that occurred after all stabilisers were released. On distraction of the osteotomy using a higher force, an increase in a stabilising effect of the pes anserinus was apparent. DISCUSSIONThe evolution of angle-stable implants has advanced options for reliable fixation of high-tibial corrective osteotomy which involves cutting out a wedge and forcing it open on the medial side. These implants provide stable fixation even when a large correction of the limb mechanical axis is required, and allow for rehabilitation with early weight-bearing. As with a large correction the force needed to make the wedge open is increasing, it is necessary to consider loosening of the medial stabilisers of the knee. According to our knowledge, no study on the effect of individual medial stabilising structures of the knee on the force required to open high-tibial osteotomy with the wedge opened medially has been published. CONCLUSIONSThe process of correcting lower extremity alignment by high-tibial opening-wedge valgus osteotomy ...