Mervyn J. Cross

Long-term followup of posterior cruciate ligament rupture: A study of 116 cases

With adequate quadriceps exercises, the prognosis of a ruptured posterior cruciate ligament can be greatly improved. Of the 116 cases followed in this report, 55 were sports injuries while most of the remainder were traffic accidents. An excellent or good result was ob tained in 47 sports-injured patients, while only 5 in volved in road trauma obtained this result. Surgery was used to improve the eventual result and this was suc cessful in nine cases. Early repair is still the treatment of choice. Eighty percent of ruptures can have a good or excellent result with effective management.

Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities.

The functional anatomy of the anterior cruciate ligament was studied in 18 freshly amputated specimens. The cruciates were observed in the extremes of flexion and extension, and in midposition in simulated weight-bearing and nonweight-bearing conditions. Five femoral shafts were split longitudinally so that the femoral and tibial attachments of the ligament could be inspected. The findings indicated that (1) the anterior cruciate ligament is a secondary static stabilizer against rotatory in stabilities of the knee; (2) the anteromedial bundle contributes to anterolateral stability; (3) the intermediate bundle adds to straight and anteromedial stability; and (4) the posterolateral bundle assists in posterolateral stability. Specific bundles and functions of bundles must be considered in reconstruction, substitution, or replacement of the anterior cruciate ligament.

Participation in Sports After Total Knee Replacement

Return to regular sports activity was evaluated in a retrospective review of 160 patients who had undergone total knee replacement surgery by a single surgeon (208 knee replacements). Mean age of the patients was 68 years (range, 27 to 87) at surgery and 73 years (range, 33 to 91) at review at a mean follow-up of 5 years (range, 3 to 7). Seventy-nine patients regularly participated in sports, at least once per week, before surgery, and 51 patients regularly participated in sports after surgery. Only eight patients took up sports after surgery who were not regularly involved in sports in the year before surgery. Patients were more likely to return to low-impact activities such as bowls (29 of 32, or 91%) than to high-impact activities such as tennis (6 of 30, or 20% returned). Forty-three of 56 patients (77%) who had participated in regular exercise in the year before surgery returned to sports. Eighty patients did not participate in sports before surgery and 54 of these had coexisting disease that prevented sports. None of these patients returned to sports.

The intercondylar shelf and the anterior cruciate ligament

The anterior cruciate ligament is the only completely intraarticular knee ligament without capsular attachment, and this makes it impossible to examine its integrity directly. Therefore, the determination of injury to the anterior cruciate ligament relies upon the rapidity and character of clinical swelling, the mechanism of injury, and nonspecific tests of knee stability. The manner of contribution of the anterior cruciate ligament to knee stability and the interpretation of various tests of examination for anterior cruciate disruption are confusing.

Femoral nerve block in knee joint surgery

Assessment is made of the effectiveness of femoral nerve block, administered either before or after surgery, in supplementing postoperative analgesia for knee joint (anterior cruciate) reconstruction surgery. Femoral nerve block, performed before surgery, with Bupivacaine 0.5%, reduced intramuscular opiate ad ministration by 80% in the recovery room and 40% in the first 24 postoperative hours. An effective and rapidly performed technique for fem oral nerve block is described.

Surgical reconstruction of severe patellofemoral maltracking.

Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon advancement, and a tibial tubercle transfer. Along with being moved medially, the tubercle also is moved distally to correct patella alta and elevated anteriorly to reduce patellofemoral joint reaction forces. One hundred seven knees in 84 patients were reviewed. Fifty-five percent of patients had frank dislocation. The remaining patients had anterior knee pain and had abnormal patella tracking on examination. The mean followup was 5.6 years. Seventy-nine percent of patients had a good to excellent functional outcome and 84% of patients stated they would have the operation again. Two patients with marked generalized ligamentous laxity had recurrent dislocation of the patella.

Isolated rupture of the flexor hallucis longus tendon A case report

Partial and complete rupture of the flexor hallucis longus tendon has been well described in ballet dancers,2, 3, with the lesion developing at the proximal end of the tendon sheath behind the talus. Similarly, flexor hallucis tenosynovitis in young active males’ and in long distance athletes,4 has been well described. We are presenting a case where, following tenosynovitis in the foot of a long distance athlete, complete rupture of the flexor hallucis longus tendon occurred in the midfoot. It was unrelated to injury, abnormal anatomy, steroid injections, or identifiable systemic abnormalities. To our knowledge, such a case has not been previously described.

Acute repair of injury to the anterior cruciate ligament A long-term followup

We reviewed 30 patients at an average of 7.4 years after acute repair of the anterior cruciate ligament aug mented with a loop of iliotibial tract. A noncontact twisting had been the mechanism of injury in 18 of these patients, with 28 having been injured in sports. At followup, 25 patients had not experienced symptoms of instability and 23 were able to return to unrestricted athletic activity; only 5 had been unable or unwilling to return to sporting activity at all. There had been no swelling in 23 patients; however, 17 suffered from pain on exertion. The average Lysholm score was 93.2. Joint laxity was assessed and anteroposterior tibial translation quantified with a KT-1000 arthrometer. Eighteen patients had a normal or 1+ Lachman test and 27 had an absent or 1 + pivot shift. When compared with the results of a similar study performed on this group of patients at 2 years after surgery, there had been little subjective change in knee function. However, objectively there had been significant deterioration of the anteroposterior stability of the knees at 7 years, suggesting failure of the integrity of the repaired liga ment with time. An associated medial collateral ligament injury had a significant adverse effect both on the integrity of the anterior cruciate ligament repair and the incidence of postoperative stiffness.

The use of the Putti-Platt procedure in the treatment of recurrent anterior dislocation With special reference to the young athlete

This study presents the results of 107 shoulder recon structions by one surgeon, of which 59 were Putti-Platt procedures, and 48 were combined Putti-Platt/Bank hart procedures. The patients were predominately young males engaged in contact sports, particularly the Rugby football codes. There were nine redislocations noted in clinical records for the 107 Putti-Platt or com bined Putti-Platt procedures, but 8 noted on the 71 replies to a questionnaire. There was only one redislo cation in the absence of significant trauma. The average loss of external rotation was 20° in the 41 patients that were able to present for reexamination. Sixty-two of the 71 patients who answered questionnaires were able to play any sport without functional impairment. The Putti-Platt procedure provides excellent shoulder sta bility for active sportsmen without significant loss of performance.

Enhanced Fixation of Uncemented Knee Replacement with Hydroxyapatite

Early results with bioactive coatings on arthroplasty prostheses have been encouraging [1]. Most information to date however concerns total hip arthroplasty, with few reports regarding the knee. Although the published results of cemented knee arthroplasty are good [2-4], growing concerns with cement fixation have lead to an increasing trend for cementless fixation [4-7]. Simple press-fit total knee prostheses however have not demonstrated enough intrinsic stability, and ingrowth into porous coated implants is inconsistent, possibly because of inexact bone cuts.