Bulletin of the Hospital for Joint Diseases Orthopaedic Institute最新文献

The results of posterior cruciate ligament (PCL) reconstruction with the patellar bone-tendon-bone graft performed in 21 patients between 1984 and 1989 were compared with the results of PCL reconstruction using the iliotibial band performed in 12 patients between 1980 and 1984. Much better results were obtained from the procedure using the patellar tendon. Four factors are considered to be responsible for the improvement: precise preoperative assessment of the pathomechanics of the posterior instability and simultaneous correction of collateral laxities if present; isometric placement of the PCL graft; use of a biomechanically sound graft and its secure fixation in the knee; and the concept of full extension of the knee to protect the graft from undue posterior stress during the early postoperative period.

Autoantibodies (antibodies to self-antigens) are a hallmark of rheumatic diseases. These antibodies are directed against nuclear or nonnuclear antigens and are regarded as marker antibodies for particular diseases.

Eighty-five knees of 85 patients who underwent anterior cruciate ligament reconstruction with autologous patellar and quadriceps tendon grafts were followed for 3-7 years. Hamstrings strength improved to normal. Quadriceps strength in men returned to the preoperative level, but not to normal strength. Quadriceps strength in women, at the final follow-up, was significantly less than it had been preoperatively. This weakness may be a consequence of impairment of the knee extensor mechanism resulting from harvesting the graft. Although favorable postoperative stability of the knee was obtained, we do not recommend this technique for ACL reconstruction because of the quadriceps weakness.

An unusual presentation of Klippel-Feil syndrome prompts a detailed description of this anomaly and a review of the literature. The patient, a six-year-old boy, had, in addition, multiple associated congenital anomalies that included Sprengel deformity, omovertebral bone, scoliosis, hypoplasia of the right thumb, plagiocephaly, choanal atresia, and Diamond-Blackfan anemia.

Eleven patients, 21-53 years of age, were treated for large tibial (9), femoral (1), or humeral (1) bone loss (4-16 cm) by the Ilizarov technique of external or internal bone transport. Bone defects were closed from within. Bone grafts were not used; instead, a free bone fragment was moved gradually internally by distraction to fill the defect. In cases of severe osteomyelitis, a large fragment (up to 16 cm) of affected bone was resected and the defect was filled by the same technique. Seven patients had external bone transport, three patients had internal bone transport, and one patient had combined external-internal bone transport. The duration of treatment was 5-28 months (mean, 12 months). Excellent results were achieved in eight patients, good results in two patients, and a fair result in one patient. Complications included two fractures of regenerated bone as a result of a second trauma, one 3-cm shortness of a limb, one development of foot equinus, and one incidence of transient peroneal nerve palsy.

Paget's disease is a chronic, progressive disturbance of bone metabolism of unknown etiology. The author describes the radiographic presentation of this disorder and discusses the various imaging modalities that are useful in the diagnosis of Paget's disease and its complications. A brief description of currently available treatment options is included in this review.