Donald B. Kettelkamp

Factors Effecting Late Results After Meniscectomy

Meniscectomy has frequently been performed on the assumption that the absence of a meniscus has little effect on joint function. Statistical analysis of data obtained from the histories, physical examinations, and roentgenographic and electrogoniometric studies of ninety-nine patients with a mean follow-up of 17.5 years after meniscectomy revealed a high incidence of poor results, degenerative arthritis, ligamentous laxity, and decreased stance-phase flexion. A meniscus should be removed only when it is definitely abnormal.

An Electrogoniometric Study of Knee Motion in Normal Gait

We have presented the results of an electrogoniometric method of measuring the three planes of knee motion while walking. The results were comparable to those obtained by photometric methods using skeletal pins or skin markers. The electrogoniometric method has the great advantage that it can be used in clinical studies. Knee motion in men and women differed only in the amount of flexion during stance phase. Less flexion occurred in women. Motion in the right and left knees was the same in men as a group but may differ in individuals. The timing of events in the gait cycle differed between individuals but a similar sequence or pattern of motion occurred in all normal knees.

Spontaneous rupture of the posterior tibial tendon.

The diagnostic features in four cases of spontaneous rupture of the posterior tibial tendon were pain distal and posterior to the medial malleolus, loss of stability of the foot, and the absence of posterior tibial function. The functional results were fair following surgical repair of the ruptured tendon. The contributory role of antecedent non-specific tenosynovitis was documented in three cases.

Traumatic dislocation of the long-finger extensor tendon. A clinical, anatomical, and biomechanical study

Five cases of traumatic dislocation of the extensor tendon of the long finger are presented. The anatomical defect consists of loss of continuity between the radial intrinsic muscles and the extensor tendon. The extensor tendon of the long finger sits on top of the proximal portion of the transverse fibers where it is maintained by a relatively poor fibrous attachment. The force tending to displace the normally situated extensor ulnarward is greatest in full extension, decreases during the first 60 degrees of flexion, and subsequently increases as flexion increases from 60 to 90 degrees. The force required to prevent further ulnar dislocation is large once the tendon is displaced. Simple primary repair is usually satisfactory for traumatic dislocation of the extensor tendon.

Development of a knee scoring scale.

Two knee scoring scales have been tested against post-osteotomy knees for degeneration arthritis and post-arthroplasty knees (McIntosh Operation) and were found to be acceptable for both conditions. Scoring Scale I was slightly better than Scale II. This scale should be tested on other types of knee reconstruction. Modifications in this scale may be needed in the future in an effort to produce as near perfect an objective knee function scoring method as is possible.

Analysis of patterns of knee motion walking for four types of total knee implants.

The pattern of normal knee joint motion was compared with the pattern of knees after arthroplasty operations with: (a) variable axis, (b) geometric, (c) Herbert and (d) Shiers implants. The pattern of motion during walking was not implant-specific. Considerable variation in the transverse and coronal planes occurs in normal and postimplant knees. The magnitude of stance phase flexion did vary between the implants studied. Loosening and breakage are most closely related to design constraints in the coronal and transverse planes where there is considerable variation from patient to patient.

Evaluation of the Steindler flexorplasty.

The Steindler flexorplasty was evaluated in fifteen patients to determine the maximum strength of the flexorplasty. Nine of the fifteen patients were able to lift one pound or more to 110 degrees of flexion. The flexion contracture present was correlated to the strength of the flexorplasty. The greatest strength occurred in patients with a flexion contracture of 30 degrees or more. A flexion contracture of 30 degrees or more was common when the triceps was of less than a strength rating of 3. There was no correlation between pronation contracture and strength. There was no pronation contracture when the strength of the supinator was 4 or 5. Arthrodesis of a flail shoulder improves the effectiveness of the flexorplasty.

Biomechanics and knee replacement arthroplasty.

Biomechanics and Knee Replacement Arthroplasty Donald Kettelkamp;Richard Nasca; Clinical Orthopaedics and Related Research

Radioactive albumin, red blood cells, and sodium as indicators of tissue damage after frostbite☆

Determination of tissue damage soon after frostbite would permit an evaluation of treatment. We reported a preliminary study using 131I-RISA to determine tissue loss soon after frostbite. We now present further studies with 131I-RISA, 51Cr-tagged red blood cells and 24NaCl. Each isotope was evaluated in a separate group of New Zealand rabbits under the same test conditions. We have reported the freezing and counting methods. We graded tissue damage as tissue loss and no loss by dissection after 3 weeks. Tissue damage could be predicted with 85% accuracy with 131I-RISA. Values for no tissue loss differed significantly from tissue loss at the .05 level. We could not predict tissue loss with 51Cr-tagged red blood cells or 24NaCl. Mean counts of 51Cr and 24Na were increased in paws with tissue loss but the groups with and without tissue loss were not different at the .05 level. The findings with 51Cr-tagged red blood cells are compatible with an increased blood flow and capillary stasis soon after frostbite as suggested by others. The increased 24Na probably parallels the swelling of the paw without a predictable relationship to tissue damage. 131I-RISA permits prediction of tissue loss soon after frostbite. We believe 131I-RISA provides an index of capillary damage and that the severity of capillary damage correlates with the ultimate fate of the part.

Recertification in orthopedics

Will the recertification process always remain the same or is there room for change? Almost certainly the process will change with experience and newer technology, particularly as it relates to clinical policies, outcome studies, and increased computerization of patient data. Even the addition of the practice-based oral exam in 1989 represented a change. The American Board of Orthopaedic Surgery will continue to study and review the experience and methods of other boards with recertification and will continue the dialogue with orthopedic surgeons. Change is, after all, a constant.