Donald B. Slocum

Rotatory instability of the knee. Its pathogenesis and a clinical test to demonstrate its presence.

Rotatory instability of the knee permitting abnormal external rotation of the tibia on the femur is the result of forced abduction of the flexed knee and external rotation of the tibia. The basic lesion present in all patients is a tear of the medial capsular ligament. Occasionally, this may be present as an Isolated lesion but, more commonly, there are associated lesions of the tibial collateral and anterior cruciate ligaments. A test for rotatory instability of the knee, based on the modification of the test for the anterior drawer sign, has been presented. The essential feature of this test is the demonstration of a lateral shift of the longitudinal axis of rotation In the horizontal plane following rupture of the medial capsular ligament. It is stressed that rupture of the anterior cruciate ligament need not be present when the test is positive for rotatory instability, although it is most markedly positive when the anterior cruciate ligament is torn.

Pes Anserinus Transplantation: A SURGICAL PROCEDURE FOR CONTROL OF ROTATORY INSTABILITY OF THE KNEE

A surgical method to control rotatory instability of the knee has been described. Complications in the postoperative period are relatively few. Late results indicate substantial improvement in the majority of cases.

Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study.

Proximal tibial valgus osteotomy was performed for unicompartmental osteoarthritis in forty-five patients (fifty-one knees). The average age of the patients was forty-one years (range, twenty-three to fifty years), and the average length of follow-up was ten years. At follow-up, 70 per cent (thirty-six knees) were rated as good or excellent and 30 per cent (fifteen knees) were rated as fair or poor. There was no clear correlation between the quality of the result and the radiographic evidence of the severity of the arthritis preoperatively, the age of the patient at osteotomy, or the length of follow-up. There was a correlation between an improved result and an increased angle of correction after osteotomy, but the values were not statistically significant. The most important factor influencing the quality of results was the over-all level of disease in the knee as reflected in the preoperative knee score. Deficiency of the anterior cruciate ligament at the time of the osteotomy did not prevent a good result. We believe that proximal tibial osteotomy for unicompartmental arthritis of the knee is a good and effective procedure for patients who are less than fifty years old and who have an active life-style, and that lasting results can be achieved if the procedure is done early in the course of the disease.

Reconstruction procedures for anterior cruciate ligament insufficiency: A computer analysis of clinical results

A pre- and postoperative study of 205 patients who had surgical reconstruction of the anterior cruciate lig ament (ACL) of the knee was evaluated with the use of a prototype computer program. An average followup of 4.1 years revealed a 27% improvement in subjective complaints and a 8% improvement in objective findings. The anterior drawer test was improved 25% and sub luxation of the lateral tibial plateau (ALRI) was improved 118% correlating highly (P < 0.001) with a good result. Seventy-four percent of patients had undergone medial meniscectomy, 58% lateral meniscectomy, and 41% had both menisci removed at followup after reconstruc tion. Ninety-two percent of the 121 patients responding to a final subjective complaint evaluation felt that their knee was significantly improved (average 6.1 years after reconstruction). The computer demonstrated a wide variation in the results of reconstruction within the intraarticular, extraarticular, and combined groups. The addition of associated procedures to the main recon structive procedure significantly affected the results. This study reveals improvement of subjective com plaints and objective findings after reconstructing the anterior cruciate ligament and proposes the use of computer analysis for specific evaluation of different procedures.

High Tibial Osteotomy

High Tibial Osteotomy is a valuable tool for young active patients with osteoarthritis that is isolated to a single compartment. Recently, more surgeons have migrated to the use of the medial opening wedge technique in the hope that some of the complications associated with the lateral closing wedge can be avoided. This article describes the preoperative evaluation, surgical procedure, postoperative rehabilitation, and its potential pitfalls. Our goal is to provide a concise easy-to-read manual for the procedure.

Wedge recession for treatment of recurrent luxation of the patella: a preliminary report.

Wedge recession is a method which utilizes the geometry of similar triangles to recess an articular wedge into the underlying bone. This concept has been applied to congenital luxating patellae in the dog. A trochlear wedge recession deepens the femoral trochlea and provides stability to the patella. Preliminary trials of the procedure in dogs produced excellent results.