Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Knee Joint ; abnormalities ; surgery ; Male ; Middle Aged

Popliteal pterygium syndrome is a rare congenital disorder that consists of popliteal webs and craniofacial, genitourinary and extremity anomalies. Only moderate successful surgical excision of the fibrotic band within the popliteal web has been reported because the nerves and vessels in the affected site are short and displaced into the web and they are attached to adjacent tissues. We performed hamstring tenotomy on the ischial tuberosity, tenotomy of the flexor hallucis longus and Z-lengthening of the Achilles tendon on the ankle in our patient, and this was followed by gradual correction using an Ilizarov external fixator. Full extension of the knee joint was achieved at the ninth postoperative week. However, some recurrence of flexion contracture was noted at two years follow-up. Gradual soft tissue lengthening with an Ilizarov external fixator can be one of the optimal procedures when excision of a fibrous band and Z-plasty are not possible due to severe adhesion of the nerves and vessels into a fibrotic band. However, a cautious approach is recommended when considering the high risk of recurrence.
Child ; Contracture/*congenital/*surgery ; External Fixators ; Humans ; *Ilizarov Technique ; Knee Joint/*abnormalities/*surgery ; Male ; Tenotomy

OBJECTIVETo investigate results of total knee arthroplasty using the long-stem tibial component combined with metallic wedge of knee prosthesis for the treatment of proximal defects.

METHODSFrom January 2011 to May 2013, 10 patients (11 knees) were treated with total knee arthroplasties using the long-stem tibial component with metallic tibial wedge of knee prosthesis. All the patients were female and the average age was 67 years old (ranged, 60 to 77 years old). All the patients were osteoarthritis. All the patients were classified as T2A style. The patients were evaluated according to knee score system (KSS).

RESULTSAll the patients were followed up for 12 months on average (ranged 3 to 29 months). The clinical outcome was assessed using KSS score, including knee pain score, knee stability score, knee range of motion score and knee walking score, knee stairs score. There were significantly differences at 6 weeks, 3 months, 6 months and 12 months between pre-and postoperative KSS score.

CONCLUSIONThe mechanical stability of tibial fixation in primary TKA is significantly increased by using the long-stem tibial component with metallic wedge of knee prosthesis, even in the presence of poor proximal bone.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Knee Prosthesis ; Male ; Osteoarthritis, Knee ; physiopathology ; surgery ; Range of Motion, Articular ; Tibia ; abnormalities ; physiopathology ; surgery

Adult ; Bone Plates ; Female ; Humans ; Internal Fixators ; Joint Deformities, Acquired ; surgery ; Knee Joint ; abnormalities ; Male ; Middle Aged ; Osteoarthritis ; surgery

OBJECTIVETo explore the application and efficacy of Ilizarov external fixator in the treatment of severe genuflex deformity in spastic cerebral palsy patients.

METHODSThe individualized Ilizarov external fixtor was designed to have two hinges posteriorly and one hinges anteriorly based on the tension-stress law. Distraction posteriorly and simutaneously compression anteriorly started 3 to 5 days after surgery. Extension on the flexion side was 2 mm every day. Check toe movement, wound and wire tension everyday. The deformity were corrected in 3 to 6 weeks. Then the fixator were kept in overextension of about 10 degrees for about 3 weeks before the Ilizarov external fixator were removed. The patients were encourged to start knee rehabilitation program and discharged. And a long leg brace was prescribed to wear while walking for 2 to 3 months.

RESULTSThe average genuflex deformity was (80.61 +/- 25.51) degrees preoperatively and (8.91 +/- 2.39) degrees postoperatively. The patients were followed up for 5 months, 21 of which got an excellent results, 4 joints had recurrence of the deformity with an average of (9.32 +/- 7.33) degrees.

CONCLUSIONThe proper use of Ilizarov technique in the treatment of severe genuflex deformity in spastic cerebral palsy patients could get satisfactory results with few complications.

Adolescent ; Adult ; Cerebral Palsy ; surgery ; External Fixators ; Female ; Humans ; Ilizarov Technique ; Knee Joint ; abnormalities ; Male

OBJECTIVE: To investigate the clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.
 METHODS: A total of 15 patients received total knee arthroplasty for correcting mild (10°-15°) to moderate (15°-30°) valgus knee between January 2011 and February 2014 in Xiangya Hospital of Central South University. We adopted a stable prosthesis surgery through patellar medial approach, osteophytes cleaning, conventional osteotomy, a selective soft tissue release and balance technical correcting of knee valgus deformity. Then conventional anticoagulation and symptomatic rehabilitation was utilized. Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) and inspecting the prosthesis position. FTA, visual analog scale (VAS) standard, and parallel knee scoring system (KSS) were used to evaluate the clinical effect.
 RESULTS: Fifteen patients were followed up for 14 to 36 (22.40±11.88) months. The hospitalization time was 7-13 (7.73±1.58) d; operative time was 58-110 (81.8±16.85) min, the dominant blood loss was 140-600 (337.30±143.65) mL. Two cases had knee extension hysteresis, and the knee activity recovered after exercise. Leg power lines were normal. Three postoperative cases suffered anterior knee pain. They were subjected to celecoxib analgesic treatment and the pain gradually eased after 3 months. One postoperative case showed incision discharge and swelling, which was healed after change of dressing. During follow-up, review of X-ray film does not show prosthesis loose, subsidence and other complications. The knee valgus angle (8.1±1.8)°, knee motion range (107.33±9.61)°, KSS knee score (74.7±14.5, 75.3±2.7) and pain score (2.5±0.9) were significantly better than the preoperative (P<0.05). The clinical and function KSS scores showed that the improvement rate was 80%. 
 CONCLUSION Total knee arthroplasty is an effective way to treat patients with knee osteoarthritis combined with mild to moderate valgus knee deformity. The correction of deformity and improvement of joint function can be achieved significantly. The clinical result is satisfactory and patients' quality of life is improved.
Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Blood Loss, Surgical ; Humans ; Knee Joint ; abnormalities ; Knee Prosthesis ; Operative Time ; Osteoarthritis, Knee ; surgery ; Osteophyte ; surgery ; Osteotomy ; Pain, Postoperative ; therapy ; Patella ; surgery ; Quality of Life ; Tibia ; Treatment Outcome

OBJECTIVETo find out the reasons of extensor weakness after total knee arthroplasty for severe flexion deformity knees, and the rehabilitation method.

METHODSFrom January 2001 to January 2004, 30 knees (20 cases) with severe flexion deformity were performed total knee arthroplasty with PS prosthesis, and the follow up were at least 6 months (6 to 40 months, average 18 months). All cases in this group were classified with the extensor force grade and were given certain exercises according to the grade. The HSS scores, extensor force, residual flexion deformity, satisfaction scores and rang of motion were recorded pre-operation and 3 days, 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months and then every year when follow up.

RESULTSAt the end point of the 6 months follow up, all items increased significantly, the average HSS score was 75.9 degrees, the average extensor force was 4.1, 8 knees among the group remained an average flexion deformity with 7.4 degrees, all patients were satisfied with the operation, and the average range of motion was 87.7 degrees.

CONCLUSIONSQuadriceps atrophy for disuse and the relative extensor mechanism excess are the main cause of extensor deficit, correct strength evaluation and individual exercise project are critical principle for successful rehabilitation.

Adolescent ; Adult ; Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Deformities, Acquired ; surgery ; Knee Joint ; abnormalities ; surgery ; Male ; Middle Aged ; Muscle Weakness ; etiology ; rehabilitation ; Postoperative Complications ; rehabilitation

PURPOSE: The aim of the study was to investigate and analyze bilateral incidence and morphology of complete discoid lateral meniscus (DLM) with possible relation to tears and symptoms in knee joints. MATERIALS AND METHODS: Thirty-eight consecutive patients with symptomatic or already-torn complete DLM on magnetic resonance imaging in a unilateral knee underwent diagnostic arthroscopy on both knee joints upon agreement. The presence and shape of complete DLM as well as presence and pattern of tear were recorded accordingly. RESULTS: In total, 89.5% (34 of 38 patients) showed bilateral complete DLM, and 84.2% yielded bilateralism with identical shape. Cape-slab was the most frequent shape, comprising 68.8% of patients with identically-shaped bilateral DLM overall. Tear patterns were more frequent, in the order of longitudinal, simple horizontal, radial, and degenerative; however, the morphological shape of complete DLM was not significantly related to tear incidence or pattern. Meniscus tears and knee symptoms occurred in the contralateral knee with incidences of 32.4% and 26.5% in patients with bilateral complete DLM, respectively. CONCLUSION: Based on these findings, more aggressive warning on the presence of discoid pathology and the need for evaluation on the contralateral knee should be considered during consultation with patients with symptomatic complete DLM in a unilateral knee in the outpatient clinic.
Adolescent ; Adult ; Arthroscopy/*methods ; Female ; Humans ; Incidence ; Knee Joint/*pathology ; Magnetic Resonance Imaging/methods ; Male ; Menisci, Tibial/*injuries/surgery ; Middle Aged ; Musculoskeletal Abnormalities/complications/diagnosis/epidemiology/*surgery ; Retrospective Studies ; Young Adult