Persistent Joint Laxity and Congenital Dislocation of the Hip

Carter, Cedric; Wilkinson, John

doi:10.1302/0301-620x.46b1.40

Cited by 514 publications

(234 citation statements)

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“…We recorded the Q-angle (pathological when > 19° for women and when > 16° for men; Woodland and Francis 1992), generalized ligamentous laxity (> 3/5 positive; Carter and Wilkinson 1964), bilateral femoral neck antetorsion (trochanter prominence test; Ruwe et al 1992) and outward rotation of the tibia, ankle and foot (forced thighfoot angle; Stuberg et al 1991).…”

Section: Methodsmentioning

confidence: 99%

Operative treatment of primary patellar dislocation does not improve medium-term outcome

et al. 2005

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BackgroundThe best treatment for primary patellar dislocation has been the subject of debate. Surgery has been recommended for all patients or for special subgroups to improve outcome. We have previously reported similar 2-year results after closed or open treatment. This report concerns 127 patients who were re-evaluated by questionnaire at least 5 years after the primary onset.Patients and methods At baseline, the patients were randomized regarding closed treatment (57) or individually adjusted proximal realignment operation (70). All patients were re-evaluated after a mean follow-up of 7 (6-9) years.Results The outcomes were similar: the patient's own overall opinion was excellent or good after closed treatment in 81% of cases and after operative treatment in 67%. Mean Kujala and Hughston VAS knee scores were 90 and 94, respectively, after closed treatment and 88 and 89 after operative treatment. The proportions of stable patellae were 30% and 36% for closed treatment and operative treatment, respectively. In a multivariate risk analysis, there was a correlation between a Kujala score of less than 90 and female sex (OR: 3.5; 95% CI: 1.4-9.0), loose bodies on radiographs (4.1; 1.2-15), and also an initial history of contralateral patellar instability (3.6; 0.9-15). There were 2 risk factors for recurrent instability: initial contralateral instability (4.9; 0.9-28) and young age (0.9; 0.8-1.0/year). Girls with open tibial apophysis had the worst prognosis for instability (88%; 95% CI: 77-98).Interpretation We do not recommend proximal realignment surgery for treatment of primary dislocation of the patella.

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Section: Methodsmentioning

confidence: 99%

Operative treatment of primary patellar dislocation does not improve medium-term outcome

et al. 2005

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“…We recorded thigh circumferences 10 cm above the patella, range of knee motion, patellofemoral crepitus and apprehension sign, the surgical scar and prepatellar sensibility. The patient's generalized joint laxity was analyzed by 5 tests (Carter and Wilkinson 1964): apposition of the thumb to forearm, and hyperextension of the fingers, elbows, knees and feet. Laxity was diagnosed if more than 3 of these tests were positive.…”

Section: Methodsmentioning

confidence: 99%

Operative versus closed treatment of primary dislocation of the patella Similar 2-year results in 125 randomized patients

Nikku

Nietosvaara

Kallio

et al. 1997

Acta Orthopaedica Scandinavica

192

115

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“…Immediately postnatal this requires that the joint is abducted and the developing articular surfaces must be held close together by the capsule and ligaments (Carr et al 1993). In DDH, the acetabulum is too shallow and the head of the femur is too flat, and in addition, there may be generalised joint laxity (Wilkinson, 1963 ;Carter & Wilkinson, 1964). It is thought that the laxity of the capsule is a major contributory factor (Carr et al 1993).…”

Section: Concluding Commentsmentioning

confidence: 99%

The hip joint: the fibrillar collagens associated with development and ageing in the rabbit

Bland

Ashhurst

2001

Journal of Anatomy

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The fibrillar collagens associated with the articular cartilages, joint capsule and ligamentum teres of the rabbit hip joint were characterised from the 17 d fetus to the 2-y-old adult by immunohistochemical methods. Initially the putative articular cartilage contains types I, III and V collagens, but when cavitation is complete in the 25 d fetus, type II collagen appears. In the 17 d fetus, the cells of the chondrogenous layers express type I collagen mRNA, but not that of type II collagen. Types III and V collagens are present throughout life, particularly pericellularly. Type I collagen is lost. In all respects, the articular cartilage of the hip joint is similar to that of the knee. The joint capsule contains types I, III and V collagens. In the fetus the ligamentum teres contains types I and V collagens and the cells express type I collagen mRNA ; type III collagen is confined mainly to its surface and insertions. After birth, the same distribution remains, but there is more type III collagen in the ligament, proper. The attachment to the cartilage of the head of the femur is marked only by fibres of type I collagen traversing the cartilage ; the attachment cannot be distinguished in preparations localising types III and V collagens. The attachment to the bone at the lip of the acetabulum is via fibres of types I and V collagens and little type III is present. The ligament is covered by a sheath of types III and V collagens. Type II collagen was not located in any part of the ligamentum teres. The distribution of collagens in the ligamentum teres is similar to that in the collateral ligaments of the knee. Its insertions are unusual because no fibrocartilage was detected.

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Persistent Joint Laxity and Congenital Dislocation of the Hip

Cited by 514 publications

References 10 publications

Operative treatment of primary patellar dislocation does not improve medium-term outcome

Operative treatment of primary patellar dislocation does not improve medium-term outcome

Operative versus closed treatment of primary dislocation of the patella Similar 2-year results in 125 randomized patients

The hip joint: the fibrillar collagens associated with development and ageing in the rabbit

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