Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes E-Book

Name: Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes E-Book | Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes E-Book
Brand: Elsevier
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Frank R. Noyes MD(Autor*in)

Elsevier (Verlag)

2. Auflage

Erschienen am 2. Februar 2016

1176 Seiten

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Beschreibung

Frank R. Noyes, MD - internationally-renowned knee surgeon and orthopaedic sports medicine specialist - presents this unparalleled resource on the diagnosis, management, and outcomes analysis for the full range of complex knee disorders. - Relies on Dr. Noyes' meticulous clinical studies and outcomes data from peer-reviewed publications as a scientifically valid foundation for patient care. - Features detailed post-operative rehabilitation programs and protocols so that you can apply proven techniques and ease your patients' progression from one phase to the next. - Presents step-by-step descriptions on soft tissue knee repair and reconstruction for anterior cruciate ligament reconstruction, meniscus repair, soft tissue transplants, osseous malalignments, articular cartilage restoration, posterior cruciate ligament reconstruction, and more to provide you with guidance for the management of any patient. - Contains today's most comprehensive and advanced coverage of ACL,PCL, posterolateral, unicompartmental knee replacement, return to sports after injury, along with 1500 new study references supporting treatment recommendations. - Features all-new content on unicompartmental and patellofemoral knee replacement, updated operative procedures for posterior cruciate ligament and posterolateral ligament deficiency, updated postoperative rehabilitation protocols, and new information on cartilage restoration procedures and meniscus transplantation. - Includes some of the most comprehensive and advanced discussions on arthrofibrosis, complex regional pain syndrome, tibial and femoral osteotomies, and posterolateral reconstructions available in modern published literature. - Covers gender disparities in ligament injuries for more effective analysis and management. - Includes access to 46 outstanding videos encompassing nearly 11 hours of surgery, live patient rounds, and live presentations. - Expert Consult eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, images, and references from the book on a variety of devices.

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Front Cover
IFC_Expert Consult page
Noyes' Knee Disorders
Copyright Page
Dedication
CONTRIBUTORS
PREFACE
PREFACE
FOREWORD TO THE FIRST EDITION
FOREWORD
References
FOREWORD
Table Of Contents
VIDEO CONTENTS
I Knee Anatomy
1 Medial and Anterior Knee Anatomy
Outline
Medial Anatomy of the Knee
Medial Layers of the Knee
Layer 1: Deep Fascia
Layer 2: Superficial Medial Collateral Ligament and Posterior Oblique Ligament
Semimembranosus.
Layer 3: Deep Medial Collateral Ligament and Knee Capsule
Anterior Anatomy of the Knee
Quadriceps Mechanism
Fascial Layers
Lateral
Medial
Prepatellar
Patella
Patellar Tendon
Infrapatellar Fat Pad
Superficial Neurovascular Structures
Conclusion
Video Content
References
2 Lateral and Posterior Knee Anatomy
Outline
Introduction
Iliotibial Band
Anterolateral Ligament
Fibular Collateral Ligament
Fabellofibular Ligament
Fabella
Popliteus Muscle-Tendon-Ligament Complex
Biceps Femoris
Fibular Head
Knee Capsule
Video Content
References
II Classification and Biomechanics
3 Scientific Basis for Examination and Classification of Knee Ligament Injuries
Outline
Classification System for Knee Ligament Injuries
Concept 1: Final Diagnosis of Knee Ligament Injuries Is Based on the Specific Anatomic Defect Derived From the Abnormal Motion Limit and Joint Subluxation
Concept 2: Ligaments Have Distinct Mechanical Functions to Provide Limits to Tibiofemoral Motions and the Types of Motions That Occur Between Opposing Cartilage Surfaces
Concept 3: Although There Are Six Degrees of Freedom, the Manual Stress Examinations Are Designed to Test Just One or Two Limits at a Time
Concept 4: Ultimately, the Clinical Examination Must Be Analyzed by a Six-DOF System to Detect Abnormalities
Concept 5: Together, the Ligaments and Joint Geometry Provide Two Limits (Opposite Directions) for Each Degree of Freedom
Concept 6: Rotatory Subluxations Are Characterized by the Separate Compartment Translations That Occur to the Medial and Lateral Tibial Plateaus During the Clinical Test
Robotic Studies
Concept 7: Damage to Each Ligament and Capsular Structure Is Diagnosed Using Tests in Which the Primary and Secondary Ligament Restraints Have Been Experimentally Determined
Ligamentous Restraints to AP Translation
Ligamentous and Capsular Restraints Resisting Medial and Lateral Joint Opening
Results
Medial Restraints
Lateral Restraints
Iliotibial Tract, Popliteus Tendon, Biceps Tendon
Location of Rotation Axes
Joint Motions During Clinical Examination
Conclusion
Function of Medial and Posteromedial Ligaments in ACL-Deficient Knees
Effect of Sectioning the MCL and PMC on Posterior Tibial Translation
Role of the POL
Variability among Clinicians during Clinical Knee Ligament Testing
Anteroposterior Displacement
Pivot Shift Testing
Medial-Lateral Joint Space Opening
Internal-External Tibial Rotation
Medial-Lateral Compartment Translations During External Tibial Rotation
Study Limitations and Conclusions
Definition of Terms for Knee Motions, Positions, and Ligament Injuries
Video Content
References
4 Knee Ligament Function and Failure
Outline
Ligament Fiber Length-Tension Properties
How Ligament Fiber Microgeometry Determines Ligament Function and Failure
Importance of Femoral Attachment on Ligament Length-Tension Patterns
Ligament Fiber Length-Tension Patterns and Burmester Curves
Mechanical Properties of Ligaments
Effect of Strain Rate on Mechanical Properties
Analysis of Failure-Mode Mechanisms
Macroscopic Analysis
Microscopic Analysis
Effects of Immobilization and Disuse on Ligament Biomechanical Properties
Biomechanical Analysis: Human Ligament Grafts for Reconstruction
Strength of the ACL: Age-Related and Species-Related Changes
Comparison of Size Parameters
Comparison of Structural Parameters
Comparison of Material Properties
Age-Related Changes
Histologic Findings
Comparison of Ligament Structural Properties
Age-Related Changes
Gender-Related Anterior Cruciate Ligament Tensile Properties
Effect of Intraarticular Corticosteroids on Ligament Properties
Direct Steroid Injection Into Ligament
Intraarticular Steroid Injection
Effect of Vascularized and Nonvascularized ACL Grafts on Biomechanical Properties
Effect of Cellular Necrosis and Stress-Shielding on ACL Healing and Retention of Native ACL Fiber Microarchitecture
Allografts and Autografts: Biomechanical Properties after Implantation and Effect of Irradiation
Video Content
References
III Anterior Cruciate Ligament
5 Biology of Anterior Cruciate Ligament Graft Healing
Outline
Introduction
Native Tendon-Bone Insertion
Tendon-Bone Insertion After ACL Reconstruction
Challenges of Tendon-Bone Healing After ACL Reconstruction
Modulation of Tendon-Bone Healing
Technical Factors
Mechanical Factors
Biologic Factors
Modulation of the Inflammatory Response
Modulation of Bone Ingrowth
Stem Cells
Modulation of Vascularity
Modulation of Matrix Metalloproteinases
Modulation of Nitric Oxide
Effect of Hyperbaric Oxygen
Modulation of Other Biologic Mediators
Bone-to-Bone Healing in ACL Autograft Reconstruction
Intraarticular Graft Healing in ACL Autograft Reconstruction
Primary ACL Healing and Repair
Allograft Healing in ACL Reconstruction
Platelet-Rich Plasma as an Adjunct to Improved Healing
Conclusion
References
6 Human Movement and Anterior Cruciate Ligament Function:
Outline
Introduction
Joint Kinetics during Gait and the ACL-Deficient Knee
Definition of Intersegmental Moment
Interpretation of Intersegmental Moment
Flexion-Extension Moment and the ACL-Deficient Knee
Anatomy of the Extensor Mechanism and Quadriceps Inhibition
Flexion-Extension Moment and the ACL-Reconstructed Knee
Knee Kinematics During Walking and ACL Injury
Methods for Defining and Measuring Knee Kinematics During Walking
Anterior-Posterior Translation and Internal-External Rotation of the Knee During Normal Walking
Kinematic Changes After Anterior Cruciate Ligament Injury
Kinematics of the Anterior Cruciate Ligament-Reconstructed Knee
The Adduction Moment at the Knee and Anterior Cruciate Ligament Injury
Adduction Moment and Osteoarthritis at the Knee
Summary
References
7 Anterior Cruciate Ligament Primary Reconstruction
Outline
Indications
Contraindications
Clinical Biomechanics
Effect of Anterior Cruciate Ligament and Lateral Structures on Anterior Tibial Translation and Internal Tibial Rotation Limits
Division of Anterior Cruciate Ligament Into Anteromedial and Posterolateral Bundles
Tibial and Femoral Footprint Anatomy
Anterior Cruciate Ligament Function Defined by the Role of Anteromedial and Posterolateral Divisions
Our Robotic Studies on Anterior Cruciate Ligament Anteromedial Bundle and Posterolateral Bundle Function and Single Anterior Cruciate Ligament Graft Reconstruction
Clinical Measurement of Anterior Cruciate Ligament Graft Function During and After Anterior Cruciate Ligament Surgery
Recommended Tibial and Femoral Anterior Cruciate Ligament Graft Locations
Anterior Cruciate Ligament Graft Healing
Clinical Evaluation
Preoperative Planning
Intraoperative Evaluation
Operative Techniques
Graft Selection
Patient Setup and Positioning
Graft Harvest: Bone-Patellar Tendon-Bone Autograft
Graft Harvest: Quadriceps Tendon-Patellar Bone Autograft
Graft Harvest: Semitendinosus-Gracilis Autograft
Iliotibial Band Extraarticular Tenodesis
Anterior Cruciate Ligament Bone-Patellar Tendon-Bone Graft Anatomic Tibial and Femoral Technique
Placement of Tibial Tunnel
Placement of Femoral Tunnel
Graft Tunnel Passage, Conditioning, and Fixation
Techniques Using Other Grafts
Alternative Procedures
FlipCutter for Femoral Tunnel
All-Inside Anterior Cruciate Ligament Graft-Link Technique Using Second-Generation FlipCutter and TightRope Devices
Flexible Guide Pin and Drill for Femoral Tunnel
Management of Graft Malposition
Our Anterior Cruciate Ligament Reconstruction Clinical Studies
Type of Graft
Augmentation Procedures for Allografts (Iliotibial Band Extraarticular, Ligament Augmentation Device)
Secondary Sterilization Process Used for Allografts
Gender
Chronicity of Injury
Concomitant Operative Procedures
Preexisting Joint Arthritis and Prior Meniscectomy
Varus Osseous Malalignment
Rehabilitation Program
Insurance (Workers' Compensation)
Other Authors' Clinical Studies
Allografts Versus Autografts
Bone-Patellar Tendon-Bone Versus Semitendinosus-Gracilis Tendon Autograft
Effects of Age and Anterior Cruciate Ligament Graft Size
Single- Versus Double-Bundle Anterior Cruciate Ligament Reconstruction
Osteoarthritis Rates in Long-Term Studies
Prevention and Management of Complications
Arthrofibrosis and Limitation of Knee Motion
Infection
Graft Contamination
Fluid Extravasation
Illustrative Cases
Video Content
References
8 Anterior Cruciate Ligament Revision Reconstruction
Outline
Indications
Contraindications
Clinical Evaluation
Preoperative Planning
Graft Selection
Operative Techniques
Patient Setup
Identification of Tibial Tunnel Problems in Revision Knees and Need for Staged Bone Grafting
Identification of Prior Femoral Tunnel in Revision Knees and Need for Staged Bone Grafting
Bone Grafting Procedure for Tibial and Femoral Enlarged Tunnels
Anterior Cruciate Ligament Bone-Patellar Tendon-Bone Graft Anatomic Tibial and Femoral Technique
Placement of Tibial Tunnel
Placement of Femoral Tunnel
Graft Tunnel Passage, Conditioning, and Fixation
Techniques Using Other Grafts
Alternative Procedures
Iliotibial Band Extraarticular Reconstruction
Anterolateral Ligament Reconstruction
Our Anterior Cruciate Ligament Revision Clinical Studies
Anterior Cruciate Ligament Revision Using Quadriceps Tendon-Patellar Bone Autografts
Anterior Cruciate Ligament Revision Using Bone-Patellar Tendon-Bone Autografts
Anterior Cruciate Ligament Revision Using Bone-Patellar Tendon-Bone Allografts
Prevalence of Nonanatomic Graft Placement in Failed Anterior Cruciate Ligament Reconstructions
Other Authors' Clinical Studies
Risk Factors for Failure of Anterior Cruciate Ligament Reconstruction
Bone-Patellar Tendon-Bone Autograft
Reharvested Bone-Patellar Tendon-Bone Autograft
Semitendinosus-Gracilis Autograft
Staged Bone Grafting
Quadriceps Tendon-Patellar Bone Autograft
Allografts
Conclusion
Video Content
Illustrative Cases
References
9 Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients
Outline
Introduction
Indications
Contraindications
Clinical Evaluation
History
Risk Factors for Injury
Notch volume.
Landing mechanics.
Physical Examination
Diagnostic Tests
Preoperative Planning
Skeletal Maturity
Associated Intraarticular Pathology
Intraoperative Evaluation
Operative Techniques and Clinical Outcomes
Primary Repair
Physeal-Sparing Techniques
Transepiphyseal Reconstruction
Partial Transphyseal Reconstruction
Transphyseal Reconstruction
Graft Selection
Recommendations
Injury Prevention
Neuromuscular Training
Video Content
References
10 Scientific Basis of Rehabilitation After Anterior Cruciate Ligament Autogenous Reconstruction
Outline
Introduction
Immediate Knee Motion, Early Weight Bearing, and Bracing
Lower-Extremity Muscle Atrophy and Weakness after Surgery
Options to Regain Muscle Strength
Patellofemoral Joint Protection
Control Effusion
Electrical Muscle Stimulation and Biofeedback
Open Versus Closed Kinetic Chain Exercises
Calculated ACL Forces, in Vivo ACL Strain
Anterior Tibial Translation
Muscle Activation Patterns
Eccentric Muscle Training
Motor Imagery
Restoration of Neuromuscular Function
Proprioception and Postural Stability
Advanced Neuromuscular Activities
Criteria to Begin Sports Training, Return to Full Activities
Published Criteria
Our Recommendations
Home-Based Versus Supervised Therapy
Reinjury Risk Factors
Psychological Factors That May Affect Outcomes
Video Content
References
11 Rehabilitation of Primary and Revision Anterior Cruciate Ligament Reconstruction
Outline
Clinical Concepts
Rehabilitation Protocol for Primary ACL B-PT-B Autogenous Reconstruction: Early Return to Strenuous Activities
Modalities
Postoperative Bracing
Range of Knee Motion
Patellar Mobilization
Weight Bearing
Flexibility
Strengthening
Balance, Proprioceptive, and Perturbation Training
Conditioning
Running and Agility Program
Plyometric Training
Return to Sports Activities
Rehabilitation Protocol with Delayed Parameters for Revision ACL Reconstruction, Allografts, and Complex Knees
Video Content
References
12 Neuromuscular Training After Anterior Cruciate Ligament Reconstruction
Outline
Introduction
Terminology
Effects of Injury on Proprioception
Clinical Implications
Motor Skill Development Stages
Neuromuscular Training Program
Postoperative Rehabilitation Program
Phase I: Acute Phase
Phase II: Dynamic Stability Drills
Phase III: Neuromuscular Control Drills
Phase IV: Functional Activities and Skill Training
Conclusion
Video Content
References
IV Gender Disparity in Anterior Cruciate Ligament Injuries
13 Risk Factors for Anterior Cruciate Ligament Injuries in the Female Athlete
Outline
Introduction
Genetics
Extrinsic: Footwear, Playing Surface, Climate Conditions
Anatomic
Geometry of the Intercondylar Notch and Anterior Cruciate Ligament
Tibial Plateau Geometry
Foot Pronation, Pelvic Tilt
Joint Laxity
Body Mass Index, Q-Angle
Hormonal
Neuromuscular/Biomechanics
Muscular Protection of the Knee: Lower Extremity, Hip, Core
Gender Differences in Lower Extremity Muscle Strength and Stiffness
Gender Differences in Strength, Lower Extremity Function and Alignment During Single-Leg Tasks
Gender Differences in Strength, Lower Extremity Function, and Alignment During Two-Legged Landings
Gender Differences in Strength, Lower Extremity Function, and Alignment During Running, Cutting, Stop-Jump Tasks
Fatigue
Conclusion
Video Content
References
14 Decreasing the Risk of Anterior Cruciate Ligament Injuries in Female Athletes
Outline
Scientific Rationale and Supporting Investigations for Sportsmetrics Neuromuscular Retraining Program
Sports Injury Test
Sportsmetrics Essential Components
Dynamic Warmup
Plyometrics/Jump Training
Strength Training
Flexibility
Sportsmetrics Training Program Options
Sportsmetrics Warmup for Injury Prevention and Performance
Sportsmetrics Soccer, Sportsmetrics Basketball, Sportsmetrics Volleyball, Sportsmetrics Tennis
Sportsmetrics Return to Play
Strategies for Implementation of Neuromuscular Training
Widespread Implementation of Neuromuscular Training
Problems Encountered and Suggested Solutions
Acknowledgments
Video Content
References
V Posterior Cruciate and Posterolateral Ligament Struct
15 Function of the Posterior Cruciate Ligament and Posterolateral Ligament Structures
Outline
Introduction
Effect of Sectioning the PCL and PLSs on the Limits of Knee Motion
Effect on Limits of Extension
Effect on Anteroposterior Translation Limits
Effect on Internal-External Tibial Rotation Limits
Effect on Adduction-Abduction Rotation Limits
Role of the Posterior Oblique Ligament
Function and Role of the PMTL
Application to Surgical Reconstruction
Posterior Subluxation of the Medial and Lateral Tibiofemoral Compartments
Posterior Tibial Translation
External Tibial Rotation
Effect of Physiologic Laxity
Effect of PCL and Posterolateral Reconstruction on Restoring Normal Knee Motion Limits
Isolated Posterior Cruciate Ligament Reconstructions
Combined Posterior Cruciate Ligament-Posterolateral Reconstructions
Clinical Effects of Posterior Tibial Subluxation of the PCL-Deficient Knee
Meniscofemoral Ligaments
Popliteomeniscal Fascicle Attachments
PCL Fiber Function: Scientific Basis for Placement of PCL Grafts at Tibiofemoral Locations
Cyclic Fatigue Testing of One- and Two-Strand PCL Graft Constructs
References
16 Posterior Cruciate Ligament Injuries
Outline
Indications
Contraindications
Posterior Cruciate Ligament Anatomy
Vascular Anatomy and Variations
Clinical Evaluation
Physical Examination
Diagnostic Clinical Tests
Radiographic Assessment
Preoperative Planning
Acute Ruptures of the Posterior Cruciate Ligament
Posterior Cruciate Ligament and Multiligament Injuries
Chronic Ruptures of the Posterior Cruciate Ligament
Intraoperative Evalution
Operative Techniques
Selection of Tibial Attachment Techniques: Arthroscopic All-Inside Versus Open Tibial Inlay Approach
Selection of Posterior Cruciate Ligament Femoral Attachment Technique: Two-Tunnel Versus Single-Tunnel Options
Selection of Single-Strand Versus Two-Strand Posterior Cruciate Ligament Graft Constructs
Selection of Posterior Cruciate Ligament Grafts Based on Biomechanical Properties
Preparation of Quadriceps Tendon-Patellar Bone Autograft
Preparation of Achilles Tendon-Bone Allograft
Surgical Technique for Anteromedial Approach and Outside-in Femoral Tunnels
Recommendations for Surgeons on Selecting a Posterior Cruciate Ligament Operative Technique
Posterior Cruciate Ligament All-Inside Technique: One- and Two-Strand Graft Reconstructions Using Quadriceps Tendon-Patellar Bone Autograft (Preferred Technique for Athletic Patients)
Patient Positioning and Setup
Tibial Tunnel Preparation
Tibial Tunnel Drilling
Femoral Graft Technique
Technique for Femoral Placement of One or Two Tunnels and Graft Passage
Graft Tensioning and Fixation
Femoral Placement of a Single Tunnel: Outside-In Technique
Alternative Posterior Cruciate Ligament All-Inside Techniques
Femoral Placement of Rectangular (Oval) Tunnel for Bone Plug
Posterior Cruciate Ligament Arthroscopic-Assisted Open Tibial Inlay Technique
Patient Positioning and Setup
Identification of the Femoral Posterior Cruciate Ligament Attachment: Vastus Medialis Obliquus Approach
Posteromedial Approach
Identification of Posterior Tibial Posterior Cruciate Ligament Attachment
Graft Conditioning, Tensioning, and Fixation
Posterior Cruciate Ligament Avulsion Fractures
Posterior Cruciate Ligament Augmentation Approaches and Techniques
Our Clinical Studies
Posterior Cruciate Ligament Two-Strand Quadriceps Tendon-Patellar Bone Autograft Tibial Inlay
Posterior Cruciate Ligament Two-Strand Quadriceps Tendon-Patellar Bone Autograft Tibial Tunnel
Causes of Failure of Posterior Cruciate Ligament Reconstructions
Posterior Cruciate Ligament Revision Two-Strand Quadriceps Tendon-Patellar Bone Autograft Reconstruction
Posterior Cruciate Ligament Single-Strand Allograft Reconstruction
Results From Other Clinical Studies
Isolated Posterior Cruciate Ligament Single-Strand Reconstruction
Posterior Cruciate Ligament Single-Strand Versus Two-Strand Reconstruction
Posterior Cruciate Ligament Reconstruction With Associated Ligament Instabilities
Posterior Cruciate Ligament Augmentation, Preservation of Remnant
Posterior Cruciate Ligament Revision Reconstruction
Conclusions
Illustrative Cases
Video Content
References
17 Posterolateral Ligament Injuries
Outline
Indications
Contraindications
Clinical Evaluation
Classification and Treatment of Partial to Complete PL Injuries
Preoperative Planning: Timing of Surgery
Acute Injuries
Chronic Injuries
Cruciate Graft Reconstruction
Intraoperative Evaluation
Operative Treatment of Acute PL Ruptures
Operative Setup and Patient Positioning
Identification of Ligament and Soft Tissue Rupture Pattern
Common Peroneal Nerve Identification
Surgical Repair and Reconstruction of Acute Injuries
Surgical Approach and Order of Repair
Operative Treatment of Chronic Posterolateral Ruptures
Overview of Operative Options
Anatomic Reconstruction of the Fibular Collateral Ligament and Popliteus Muscle-Tendon-Ligament Unit
Patient Positioning and Surgical Approach
Peroneal Nerve Dissection and Visualization
Fibular Collateral Ligament Bone-Patellar Tendon-Bone Reconstruction
Graft choices for fibular collateral ligament reconstruction.
Placement of fibular and femoral tunnels.
Bone-patellar tendon-bone graft placement.
Graft Replacement of Popliteus Muscle-Tendon-Ligament Unit: Acute or Chronic Cases
Posterolateral Capsule Reconstruction for Severe Varus Recurvatum
Femoral-Fibular Reconstruction
Proximal Advancement of the Posterolateral Structures
Our Clinical Studies
Anatomic Posterolateral Reconstruction
Femoral-Fibular Allograft Reconstruction
Proximal Advancement of Posterolateral Structures
Causes of Failure of Posterolateral Operative Procedures
Other Operative Techniques and Results
Illustrative Cases
Video Content
References
18 Rehabilitation of Posterior Cruciate Ligament and Posterolateral Reconstructive Procedures
Outline
Clinical Concepts
PCL Clinical Biomechanics
Protocol for Partial or Acute Isolated PCL Ruptures
PCL Reconstruction Rehabilitation Protocol
Immediate Postoperative Management
Modalities
Brace Support
Range of Knee Motion
Weight Bearing
Patellar Mobilization
Flexibility
Strengthening
Balance, Proprioceptive, and Perturbation Training
Conditioning
Running and Agility Program
Plyometric Training
Return to Sports Activities
Posterolateral Reconstruction Rehabilitation Protocol
Video Content
References
VI Medial Collateral Ligament
19 Medial and Posteromedial Ligament Injuries
Outline
Indications
Contraindications
Clinical Biomechanics
Classification of Ligament Injury and Instability
Clinical Evaluation
History and Physical Examination
Diagnostic Clinical Tests
Radiographs and Imaging Studies
Conservative Versus Operative Treatment: Rules and Planning
Acute Medial and Posteromedial Ligament Ruptures
Acute Medial Ligament Ruptures With Knee Dislocation
Chronic Medial and Posteromedial Ruptures
Intraoperative Evaluation
Selection of Grafts for Medial Ligament Reconstruction
Operative Treatment
Acute Medial and Posteromedial Ligament Repairs
Chronic Medial and Posteromedial Ligament Repairs
Complications
Our Clinical Study
Results From Other Clinical Studies
Illustrative Case
Acute Combined ACL, PCL, SMCL, POL Ligament Disruption With Staged Medial Ligament Reconstruction
Video Content
References
20 Rehabilitation of Medial Ligament Injuries
Outline
Clinical Concepts
Conservative Treatment of Medial Ligament Injuries
Third-Degree Injuries: Weeks 1 to 3
Third-Degree Injuries: Weeks 4 to 6
Third-Degree Injuries: Weeks 7 to 9
Third-Degree Injuries: Weeks 10 to 12
Concomitant Cruciate Ligament Injuries
Postoperative Rehabilitation of Medial Ligament Repairs/Reconstructions
Modalities
Postoperative Bracing
Weight Bearing
Range of Knee Motion
Patellar Mobilization
Flexibility
Strengthening
Balance, Proprioceptive, and Perturbation Training
Conditioning
Running and Agility Program
Plyometric Training
Return to Sports
Video Content
References
VII Dislocated Knees and Multiple Ligament Injuries
21 Classification of Knee Dislocations
Outline
Introduction
Definition of Knee Dislocation
Position Classification System
Energy of Injury Classification System
Anatomic Classification System
Conclusion
References
22 Management of Acute Knee Dislocation Before Surgical Intervention
Outline
Introduction
Evaluation
Classification
Vascular Injuries
Neurologic Injuries
Ligamentous Injuries
Reduction and Immobilization
Imaging
Emergent Surgery
Definitive Management
References
VIII Meniscus
23 Meniscus Tears:
Outline
Introduction
Indications
Candidates
Meniscus Tear Classification
Contraindications
Clinical Biomechanics
Meniscus Function
Meniscus Suture Repair Biomechanics
Meniscus Repair Healing
Clinical Evaluation
Preoperative Planning
Intraoperative Evaluation
Operative Technique
Patient Preparation
Exposure for Medial Meniscus Repair
Exposure for Lateral Meniscus Repair
Patient Positioning and Equipment for Inside-Out Suture Repair
Suture Repair Techniques
Single and Double Longitudinal Tears
Radial Tears
Lateral Radial Tears Associated With a Cyst
Horizontal Tears
Meniscus Attachment Root Tears
Flap Tears
Repair of the Lateral Meniscus Popliteomeniscal Fascicles and Attachments
Techniques to Stimulate Healing of Meniscus Repairs
Our Clinical Studies
Arthroscopic Evaluation of 79 Meniscus Repairs in the R/R and R/W Zones
Outcome of 198 Meniscus Repairs in the R/W Zone
Outcome of 30 Meniscus Repairs in the R/W Zone in Patients 40 Years of Age and Older
Outcome of 71 Meniscus Repairs in the R/W Zone in Patients 20 Years of Age or Younger
Long-Term Outcome of 29 Meniscus Repairs in the R/W Zone in Patients 20 Years of Age or Younger
Results of Meniscus Repairs from Other Clinical Studies
Illustrative Cases
Video Content
References
24 Meniscus Transplantation
Outline
Indications
Contraindications
Clinical Biomechanics
Chondroprotective Effects
Knee Joint Contact Mechanics After Meniscus Transplantation
Effect of Fixation and Location of Meniscus Transplants
Clinical Evaluation
Preoperative Planning
Tissue Bank and Sterilization Issues
Meniscus Sizing Issues
Intraoperative Evaluation
Operative Technique: Lateral Meniscus Transplant
Operative Technique: Medial Meniscus Transplant
Medial Meniscus Central Bone Bridge Technique
Medial Meniscus Two-Tunnel Technique
Our Clinical Studies
Clinical Outcomes: Initial Studies
Magnetic Resonance Imaging Analysis: Meniscus Transplant Characteristics
Clinical Outcomes: Long-Term Study
Meniscus Transplant Extrusion
Results From Other Clinical Studies
Conclusion
Illustrative Cases
Video Content
References
25 Rehabilitation of Meniscus Repair and Transplantation Procedures
Outline
Clinical Concepts
Immediate Postoperative Management
Brace and Crutch Support
Range of Knee Motion and Flexibility
Balance, Proprioception, and Neuromuscular Training
Strengthening
Conditioning
Running Program
Plyometric Training
Return to Sports Activities
Video Content
References
IX Lower Extremity Osseous Malalignment
26 Tibial and Femoral Osteotomy for Varus and Valgus Knee Syndromes
Outline
Indications
Contraindications
Lower Limb Alignment: Primary, Double, and Triple Varus Knees
Gait Analysis
Clinical Evaluation
Subjective and Functional Outcome
Physical Examination
Diagnostic Clinical Tests
Tibiofemoral Rotation Test (Dial Test)
Radiographic Assessment
Preoperative Planning
Calculations to Determine Angular Correction
Calculations to Determine Tibial Slope and Clinical Indications to Change Tibial Slope
Timing of Procedures
Cruciate Graft Options
Opening Versus Closing Wedge Osteotomy
Opening Wedge Osteotomy: Preservation of Tibial Slope
Final Recommendations to Obtain Correct Coronal and Slope Alignment
Intraoperative Evaluation
Operative Technique: Opening Wedge Tibial Osteotomy
Step 1: Initial Operating Room Preparations
Step 2: Knee Arthroscopy
Step 3: Anterior Iliac Crest Bone Graft Harvest (Opening Wedge =15 mm)
Step 4: Initial Anteromedial Tibial Approach
Step 5: Proximal Osteotomy and Placement of Tibial Guide Pins
Step 6: Opening Wedge Technique and Measurement of Gaps to Confirm Tibial Slope
Step 7: Intraoperative Verification of Desired Limb Alignment Correction
Step 8: Placement of Bone Graft and Internal Fixation
Management of the Superficial Medial Collateral Ligament
Operative Technique: Closing Wedge Tibial Osteotomy
Step 1: Initial Operating Room Preparation and Arthroscopy
Step 2: Initial Anterolateral Tibial Approach
Step 3: Fibular Osteotomy
Step 4: Proximal Osteotomy: Removal of Tibial Wedge
Step 5: Fluoroscopic Verification of the Weight-Bearing Line for Corrected Alignment
Role of Computerized Navigation for High Tibial Osteotomy
Opening Wedge Distal Femoral Osteotomy
Our Clinical Studies
Closing Wedge High Tibial Osteotomy in Anterior Cruciate Ligament-Deficient Varus-Angulated Knees
The Treatment of Double and Triple Varus Knees: Closing Wedge High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Posterolateral Reconstruction
Opening Wedge High Tibial Osteotomy: An Operative Technique and Rehabilitation Program to Decrease Complications and Promote Early Union and Function
Results From Other Clinical Studies
High Tibial Osteotomy Survival Rates
High Tibial Osteotomy Opening Versus Closing Wedge Osteotomy
High Tibial Osteotomy and Associated Cartilage Restorative Procedures
Effect of High Tibial Osteotomy on Long-Term Knee Symptoms and Function
High Tibial Osteotomy Versus Unicompartmental Knee Replacement
Opening Wedge Distal Femoral Osteotomy
Prevention and Management of Complications
Bony Instability, "Teeter Effect"
Inadequate or Loss of Axial Correction
Delayed Union or Nonunion
Tibial Plateau Fracture
Arterial Injury
Peroneal Nerve Injury or Palsy
Arthrofibrosis and Patella Infera
Iliac Crest Harvest Site Pain
Deep Vein Thrombosis
Illustrative Cases
Video Content
References
27 Valgus Malalignment
Outline
Introduction
Indications
Contraindications
Clinical Biomechanics
Clinical Evaluation
History and Physical Examination
Radiographic Evaluation
Preoperative Planning
Operative Technique
Our Clinical Outcomes
Clinical Outcomes From Other Authors
Complications
Summary
Acknowledgment
References
28 Rehabilitation After Tibial and Femoral Osteotomy
Outline
Clinical Concepts
Postoperative Rehabilitation Protocol
Modalities
Postoperative Bracing and Weight Bearing
Range of Knee Motion
Patellar Mobilization
Flexibility
Strengthening
Balance, Proprioceptive, and Perturbation Training
Conditioning and Return to Activities
Video Content
References
29 Correction of Hyperextension Gait Abnormalities
Outline
Introduction and Diagnosis
Abnormal Knee Hyperextension Patterns
Gait Retraining Program for Abnormal Knee Hyperextension
Clinical Investigation
Methods and Materials
Analysis of Gait Mechanics before Retraining
Analysis of Gait Mechanics after Retraining
Effect of Retraining on Patient Symptoms
Summary
Illustrative Cases
Video Content
References
30 Unicompartmental Knee Replacement for Varus or Valgus Malalignment
Outline
Indications
Contraindications
Implant Design
Robotic Technology
Clinical Examination
Surgical Technique
Postoperative Management
Complications and Factors Leading to Failure
Clinical Studies
Medial Unicompartmental Knee Arthroplasty
Unicompartmental Knee Arthroplasty versus High Tibial Osteotomy
Unicompartmental Knee Arthroplasty versus Total Knee Arthroplasty
Lateral Unicompartmental Knee Arthroplasty
Illustrative Cases
Video Content
References
X Articular Cartilage Procedures and Rehabilitation of the Arthritic Knee
31 Knee Articular Cartilage Restoration Procedures
Outline
Indications
Contraindications
Clinical Biomechanics
Clinical Evaluation
History
Physical Examination
Diagnostic Tests
Preoperative Planning
Intraoperative Evaluation and Operative Technique
Clinical Outcomes
References
32 Osteochondral Grafts
Outline
Introduction
Indications
Autografts
Allografts
Contraindications
Clinical Evaluation
Preoperative Planning
Intraoperative Planning
Autografting
Allografting
Operative Technique
Autografting
Allografting
Dowel Allograft
Shell Allograft
Postoperative Management
Our Clinical Outcomes
Clinical Outcomes from Other Authors
Autografts
Allografts
Complications
Acknowledgment
References
33 Rehabilitation After Articular Cartilage Procedures
Outline
Introduction
Principles of Articular Cartilage Rehabilitation
Individualization
Create a Healing Environment
Biomechanics of the Knee
Reduce Pain and Effusion
Restore Soft Tissue Balance
Restore Muscle Function
Enhance Proprioception and Neuromuscular Control
Control the Application of Loads
Team Communication
Rehabilitation Philosophy
Rehabilitation after Articular Cartilage Repair Procedures
Phase I: Early Protection Phase
Phase II: Transition Phase
Phase III: Remodeling Phase
Phase IV: Maturation Phase
Specific Postoperative Guidelines
Debridement and Chondroplasty
Microfracture
Osteochondral Autograft Transplantation Procedure
Autologous Chondrocyte Implantation Procedure
Conclusion
Video Content
References
34 Aquatic Therapy for the Arthritic Knee
Outline
Introduction
Scientific Foundation
Aqua Physics
Buoyancy
Hydrostatic Pressure
Viscosity and Hydrodynamics: Using Speed and Surface Area
Clinical Research
Applications
Mobility
Muscle Performance
Exercise Using Buoyancy
Exercise Using Viscosity
Balance, Stabilization, and Gait
Cardiopulmonary
Transition to Land
Summary
References
XI Patellofemoral Disorders
35 Operative Options for Extensor Mechanism Malalignment and Patellar Dislocation
Outline
Indications
Contraindications
Biomechanics of Medial and Lateral Patellofemoral Restraints
Preoperative Planning
Surgical Techniques
Lateral Retinacular Release
Proximal Realignment
Medial Patellofemoral Ligament Reconstruction
Distal Realignment
Lateral Patellofemoral (Iliopatellar Tract) Reconstruction
Patella Alta Correction
Trochleoplasty
Iliotibial Band Z-Plasty Release for Contracture
Postoperative Management
Complications
Clinical Studies
Medial Patellofemoral Ligament Reconstruction
Outcomes of Procedures for Patellofemoral Articular Cartilage Lesions
Autologous Chondrocyte Implantation
Osteochondral Autograft Transfer
Our Studies of Procedures for Patellofemoral Articular Cartilage Lesions
Outcomes of Trochleoplasty Procedures
Illustrative Case
Video Content
References
36 Patellofemoral Disorders
Outline
Introduction
What is Rotational Malalignment?
Anterior Knee Pain, Patellar Instability, and Patellar Chondropathy
How Does Long Bone Torsion Affect the Patellofemoral Joint?
Biomechanic Evidence Relating Limb Torsion with Patellofemoral Instability and Pain
Clinical Evidence Relating Limb Torsion to Patellofemoral Instability and Pain
Femoral and Tibial Torsion Measurements Lack Standards
Indications
Surgical Strategy
Surgical Technique
Complications
Results of Torsional Realignment
Conclusions
References
37 Unicompartmental Patellofemoral Replacement
Outline
Indications
Contraindications
Implant Design
Clinical Examination
Preoperative Planning
Surgical Technique
Incision
Registration
Implantation of Trochlear Component
Patellar Resection and Component Placement
Final Cement Technique
Surgical Decision Making for Special Problems
Correction of Trochlear Dysplasia
Correction of Increased Tibial Tubercle-Trochlear Groove Distance
Valgus-Aligned Lower Extremity with Excessive Body Mass Index
Prior Lateral Dislocations, Insufficient Medial Patellofemoral Ligament
Excessive Medial Soft Tissue Tightening (Medial Patellofemoral Ligament and Medial Retinaculum)
Lateral Retinacular Release
Infrapatellar Contracture
Patella Alta
Postoperative Management
Complications and Factors Leading to Failure
Clinical Studies
Illustrative Cases
Video Content
References
XII Postoperative Complications
38 Prevention and Treatment of Knee Arthrofibrosis
Outline
Introduction
Terminology and Classification Systems
Risk Factors after Knee Ligament Reconstruction
Severity of the Injury
Preoperative Issues
Technical Factors at Surgery
Postoperative Course and Rehabilitation
Other Risk Factors
Pathophysiology and Experimental Prevention Studies
Prevention
Preoperative
Intraoperative
Postoperative
Diagnosis and Clinical Presentation
Conservative Managment of Limitation of Knee Extension
Conservative Management of Limitation of Knee Flexion
Role of Oral Corticosteroids
Gentle Manipulation Under Anesthesia
Operative Management of Severe Restriction of Knee Motion
Arthroscopic Soft Tissue Releases
Open Z-Plasty, Medial-Lateral Retinacular Tissues
Posterior Medial-Lateral Capsulotomy
Inpatient Physical Therapy Program
Extended Epidural for Pain Management
Developmental Patella Infera
Our Clinical Studies
Other Authors' Clinical Studies
Illustrative Cases
Video Content
References
39 Knee Pain of Neural Origin
Outline
Introduction
Peripheral Nerve Anatomy Related to the Knee
Innervation of the Human Knee Joint
Innervation of the Proximal Tibiofibular Joint
Common Peroneal Nerve
Deep Peroneal Nerve
Superficial Peroneal Nerve
Proximal Tibial Nerve
Lateral Femoral Cutaneous Nerve
Saphenous Nerve
Clinical Evaluation of Knee Pain of Neural Origin
Indications for Partial Knee Denervation
Preoperative Planning
Operative Techniques
Lateral Denervation of the Knee Joint
Medial Denervation of the Knee Joint
Resection of the Infrapatellar Branch of the Saphenous Nerve
Resection of the Medial Cutaneous Nerve of the Thigh
Neurolysis of the Common Peroneal Nerve
Denervation of the Proximal Tibiofibular Joint
Neurolysis of the Superficial Peroneal Nerve
Neurolysis of the Proximal Tibial Nerve
Neurolysis of the Lateral Femoral Cutaneous Nerve
Neurolysis of the Saphenous Nerve in Hunter's Canal
Our Clinical Studies
Other Authors' Clinical Studies
Reflex Sympathetic Dystrophy of the Knee
Video Content
References
40 Diagnosis and Treatment of Complex Regional Pain Syndrome
Outline
Introduction
Anatomy
Nervous System: Review of Basic Concepts
Neurons
Ganglions
Synapses
Sympathetic Nervous System
Parasympathetic Nervous System
Nerves Around the Knee and Lower Limb
Etiology, Pathophysiology
Etiology: Known and Speculated Risk Factors
Autonomic Dysfunction
Neurogenic Inflammation
Central Sensitization
Central Nervous System Alterations, Cortical Reorganization
Limb Ischemia/Hypoxia
Psychological Factors
Autoimmune Disorder
Diagnosis
Differential Diagnosis
Clinical Presentation
Disproportionate Pain to Inciting Event
Vasomotor Abnormalities
Sudomotor/Edema Abnormalities
Sensory Abnormalities
Motor Abnormalities
Trophic Changes
Psychological Issues
Stages and Natural History of Complex Regional Pain Syndrome
Objective Tests
Radiographs
Magnetic Resonance Imaging
Triple-Phase Bone Scintigraphy
Diagnostic Blocks
Vasomotor Measurement
Sudomotor Measurement
Treatment
Occupational and Physical Therapy
Psychotherapy
Medications
Corticosteroids and Nonsteroidal Antiinflammatories
Free Radical Scavengers
Calcitonin, Bisphosphonates
Anticonvulsants and Calcium Channel Blockers
Alpha-Adrenergic Antagonists
Topical Lidocaine and Capsaicin
Antidepressants
Opioids
Pharmacotherapy for Movement Disorders
Interventions
N-Methyl-D-Aspartate Receptor Antagonists: Intravenous Ketamine
Intravenous Immunoglobulin and Tumor Necrosis Factor-a Inhibitors
Sympathetic Block
Epidural Infusion
Surgical Sympathectomy
Neurostimulation
Surgery
Conclusions
Illustrative Case Reports
References
XIII Knee Rating Outcome Instruments
41 Cincinnati Knee Rating System
Outline
Introduction
Measurement of Psychometric Properties of Outcome Instruments
Components of the CKRS
Rating of Symptoms
Rating of Patient Perception of the Knee Condition
Rating of Sports and Daily Activities
Rating of Occupational Activities
Patient History
Knee Examination
Objective Testing
Operative Procedures and Articular Cartilage Surfaces
Postoperative Complications
Overall Rating Assessment
Reliability, Validity, and Responsiveness Testing: Our Study
Assessment of the CKRS by Independent Institutions
Modified CKRS Scales
Appendix A: Sports Activity and Function Form, Symptom Rating Form, Occupational Rating Form
Appendix B: Final Rating Form
References
42 International Knee Documentation Committee Rating System
Outline
Introduction
History of the IKDC
Components of the IKDC Knee Scoring System
2000 International Knee Documentation Committee Subjective Knee Evaluation Form
2000 International Knee Documentation Committee Knee Examination Form
International Knee Documentation Committee Demographic Form
International Knee Documentation Committee Current Health Assessment Form
2000 International Knee Documentation Committee Knee History and Surgical Documentation Forms
Comparison of IKDC Outcomes with Those of Other Knee Rating Systems
Our Comments
References
43 Rating of Athletic and Daily Functional Activities
Outline
Introduction
Sports Activity Scales
Tegner Activity Scale
Hospital for Special Surgery Sports Scale
Seto Sports Participation Survey
Straub and Hunter's Sports Performance Index
Daniel Sports Activity Rating
Marx Sports Activity Scale
Activities of Daily Living Scales
Lysholm Knee Score
Activities of Daily Living Scale of the Knee Outcome Survey
Global Outcome Instruments
Western Ontario and McMaster Universities Osteoarthritis Index
Knee Injury and Osteoarthritis Outcome Score
Lower Extremity Functional Scale
American Academy of Orthopaedic Surgeons Lower Limb Outcomes Questionnaire
Visual Analogue Scales for Quality of Life and Subjective Knee Symptoms
References
44 Articular Cartilage Rating Systems
Outline
Introduction
Commonly Used Articular Cartilage Rating Systems
Outerbridge
Cincinnati Knee Rating System
International Cartilage Repair Society
Reliability and Validation Studies of Cartilage Rating Systems
Conclusion
References
45 Knee Arthroplasty and Patellofemoral Rating Systems
Outline
Total Knee Arthroplasty Outcome Instruments
Introduction
University of California Los Angeles Activity-Level Rating Score
American Knee Society Scoring System
Oxford Knee Score
High-Activity Arthroplasty Score
Patellofemoral Outcome Instruments
Introduction
Functional Index Questionnaire
Anterior Knee Pain Scale (Kujala Scale)
Samsung Medical Center Patellofemoral Scoring System
Saltzman Patellofemoral Score
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
Z
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