Jesse C. DeLee

Acute posterolateral rotatory instability of the knee

Posterolateral rotatory instability of the knee, a poste rior rotational subluxation of the lateral tibial plateau in relation to the lateral femoral condyle, is an unusual condition. Twelve cases of acute posterolateral rotatory instability are presented with an average followup of 7.5 years after surgical repair. Clinical signs suggestive of this injury included posterolateral knee tenderness, and a contusion or abrasion over the anteromedial aspect of the tibia. Indications for operative repair in cluded a 2+ or greater varus instability of the knee at 30° flexion in association with a positive external rota tion recurvatum or posterolateral drawer test. At oper ation, the consistent finding was a tear in the arcuate ligament complex in all patients. Primary operative repair resulted in stable and func tional knees in 8 of 11 patients without evidence of degenerative joint disease at 7½ years postinjury. Roentgenographic evidence of degenerative joint dis ease was present in three patients, two of whom had some residual posterolateral laxity. Results were evaluated subjectively, objectively, and functionally. There were eight good, three fair, and no poor subjective results; eight good, two fair, and one poor objective results; and seven good, three fair and one poor functional results. The single objective and functional poor result had a deep infection postopera tively. Eight of the 11 patients participated in recreational sports following repair and no patients were limited in the activities of daily living.

Incidence of Injury in Texas Girls' High School Basketball

We studied the incidence of injury in girls varsity bas ketball to characterize injury demographics in high school athletics. We defined a reportable injury as one that occurred during organized practice or competition, resulted in either missed practice or game time, re quired physician consultation, or involved the head or face. We prospectively evaluated the athletes on team rosters during the 1993 to 1994 season from 100 ran domly selected Class 4A and 5A Texas public high schools that employed full-time certified athletic train ers. The 890 student athletes from 80 schools ranged in age from 14 to 18 years. Four hundred thirty-six injuries were reported for a rate of 0.49 per athlete per season. Injury risk, calculated on the basis of exposure time, was 0.4% per hour per athlete. Although game time accounted for only 12.5% of exposure time, it represented one half of the total injuries. Sprains and strains (56%) were the most common injuries, followed by contusions (15%) and dental injuries (14%). Injuries to the ankle (31 %) and knee (19%) were by far the most common. There were 34 severe injuries defined as requiring surgery or hospitalization, for a rate of 0.038 per athlete per season. Knee injuries were by far the most likely to require surgeries, and ACL injuries accounted for 69% of the severe knee injuries.

Anterior cruciate ligament reconstruction using bone-patellar tendon-bone allografts A biological and biomechanical evaluation in goats

Twenty-eight goats underwent ACL reconstruction with freeze-dried bone-patellar tendon-bone allografts in one knee, the opposite knee serving as a control. One group of 16 knees was evaluated, in groups of four, at 6, 12, 26, and 52 weeks by histologic and vascular injection techniques. The other group of 12 knees was evaluated in two groups of six at 26 and 52 weeks by morpholog ical and biomechanical techniques of analysis. Within the first 12 weeks these allografts were revas cularized ; in the first 26 weeks they had matured to resemble normal connective tissue. Graft stiffness was 29% of the control value and maximum force to failure was 43% of the control value. The results of this study indicated that freeze-dried bone-patellar tendon-bone allografts are biomechani cally and biologically similar to patellar tendon auto- grafts.

Incidence of injury in Texas high school football

This study was undertaken to determine the incidence of injury in high school football based on evaluation of 100 high schools in the State of Texas during a single football season (1989). Certified athletic trainers were the initial medical professionals providing on-site diag nosis and treatment of all injuries. An injury was defined as: 1) an incident causing an athlete to miss all or part of a single practice or game; 2) any incident treated by a physician; and 3) all head injuries reported to the athletic trainer. Data were collected that allowed cal culation of the time of exposure to injury per athlete in the sample. There was 75.5% participation in the study by the certified athletic trainers in the 100 schools. A total of 4399 athletes in varsity football programs participated in the study. There were 2228 injuries, as defined in the study, during the period of study, giving an inci dence of injury of 0.506 injury per athlete per year. Severe injuries—those requiring hospitalization—were found in 137 cases, for an incidence rate of 0.031 injury per athlete per year. The incidence of reportable defined injury was calculated to be 0.003 injury per hour of exposure per student athlete. The knee was found to be the most commonly injured anatomic site; the ankle ranked second.

The Diagnosis and Treatment of Medial Subluxation of the Patella After Lateral Retinacular Release

Five patients with medial subluxation of the patella oc curring after isolated lateral retinacular release were treated between July 1985 and July 1989. The diag nosis was made by clinical examination. The patients complained of pain, swelling, and giving way after the lateral release. All five patients had increased medial passive patellar mobility, a positive gravity subluxation test, and a positive medial apprehension test. All pa tients failed conservative treatment. The patients were treated by reconstruction of the lateral retinaculum using sensory epidural anesthesia. At an average fol lowup of 3.3 years, four of the five patients had no symp toms of instability and the medial patellar mobility and gravity subluxation tests were negative. There were three excellent and two good results using the grading system of Merchant and Mercer.

Neurologic and vascular injuries associated with knee ligament injuries.

Background Multiple ligament knee injuries are commonly associated with neurovascular complications such as popliteal artery, common peroneal nerve, and tibial nerve injuries. Hypothesis While the importance of identifying these complications in association with bicruciate and triligamentous injuries has been well established, it is important to recognize that any biligamentous and some single ligament knee injuries present with neurological and vascular complications as well. Study Design Literature review. Conclusion Popliteal artery injuries require immediate intervention to help prevent limb loss. Peroneal and tibial nerve injuries can be a significant cause of morbidity and, therefore, require an understanding of their natural history, anatomy, and pathophysiologic implications to maximize functionality. Clinical Relevance This review explores the types, mechanisms, and classifications of common neurovascular complications of knee ligament injuries, discusses their diagnosis, and reviews the therapeutic options available to optimize patient outcomes.

Acute straight lateral instability of the knee

Although ligamentous injuries of the knee joint repre sent a common orthopaedic problem, damage to the lateral supporting structures is a relatively rare occur rence. 1, 2,5,6,18,25,28,29,30,33

The reaction of nerve tissue to various suture materials: A study in rabbits

Adult, male white New Zealand rabbits were used to compare two new synthetic suture materials, polyglycolic acid (Dexon) and polypropylene (Prolene), with wire, plain catgut, and silk. The purpose of the study was simply to determine the reaction of nerve tissue to each of the five different materials. No attempt was made to measure functional results. The nerves were examined grossly and microscopically in an effort to evaluate which suture incited the least host reaction. Although no difference was noted in the initial cellular response, Prolene was shown to incite the least fibrolastic response. Silk evoked the most marked fibroblastic response.

Tibial Tunnel Widening After Hamstring Tendon Anterior Cruciate Ligament Reconstruction The Effect of Supplemental Aperture Fixation With Autogenous Bone Cores

Background Tibial tunnel widening is a common phenomenon seen with hamstring anterior cruciate ligament reconstruction. Concern exists that increased tunnel widening can lead to delayed graft incorporation, graft laxity, or difficulties in revision surgery. Hypothesis Supplemental aperture fixation with autogenous bone cores or bioabsorbable interference screws will decrease tibial tunnel widening in hamstring anterior cruciate ligament reconstruction. Study Design Cohort study; Level of evidence, 3. Methods One hundred twenty-nine patients were divided into 3 groups based on type of aperture fixation: none, bioabsorbable interference screws, and autogenous bone cores. Tibial tunnel diameters were measured on plain radiographs at a minimum of 3 months postoperatively based on the timeline of tibial tunnel widening suggested by Simonian et al, and tunnel widening was quantified by the increase in tunnel diameters relative to initial reamer size. Results Means for tunnel widening based on both anteroposterior and lateral maximum tunnel width measures were significantly different between the 3 groups (P < .05, 1-way analysis of variances); however, compared with the means for the group receiving no aperture supplementation, the means for the group receiving bioabsorbable interference screws were more than 0.8 mm wider, representing a significant increase (P < .05, Bonferroni-adjusted t tests), while the means for the group receiving autogenous bone cores were less than 0.6 mm wider than the group without aperture supplementation and not significantly different (P > .25, Bonferroni-adjusted t tests). Conclusion Tibial tunnel aperture supplementation does not appear to decrease tunnel widening in hamstring anterior cruciate ligament reconstruction and may actually increase the amount of tibial tunnel widening.

Salter-Harris type III fractures of the medial distal femoral physis--a fracture pattern related to the closure of the growth plate: report of 3 cases and discussion of pathogenesis.

Salter-Harris type III fractures of the medial femoral condyle in adolescents are uncommon injuries. They are caused by a valgus force to the knee and have been reported secondary to sports injuries and motor vehicle accidents. These fractures can be minimally displaced and may require stress radiographs or MRI for diagnosis. They start at the medial physis and exit into the joint near the intercondylar notch. This pattern of fracture may be caused by the sequence of closure of the distal femoral physis and is therefore similar to the juvenile Tillaux fracture of the distal tibia. The purpose of this paper is to report on 3 teenage athletes with Salter-Harris III distal femur fractures and propose a mechanism of injury related to the sequence of closure of the distal femoral physis in the adolescent patient.