Selection of patients for through-the-knee amputation.

Forty-six adult patients had a through-the-knee amputation (disarticulation of the knee) in a four-year period. Thirty-four of the patients had peripheral vascular insufficiency and were judged to lack the potential for using a prosthesis functionally, although the evaluation indicated that they had the potential for healing of the wound at the below-the-knee level of amputation. At a minimum follow-up of one year, the amputation wound had healed in thirty of these patients, and no joint contracture had developed. Two patients died in the first postoperative month, and two had failure to heal and needed revision to an above-the-knee amputation. The remaining twelve patients who had a through-the-knee amputation were judged to be potentially able to use a prosthesis functionally, but they did not have the capacity for wound-healing at the below-the-knee level. Therefore, in these patients, a through-the-knee amputation was performed as an alternative to an above-the-knee amputation. The amputation wound healed in eight of these patients, but four (33 per cent) had failure to heal and needed subsequent revision to an above-the-knee amputation. All twelve patients were able to use a prosthesis. The through-the-knee amputation provides good muscular balance and has a low risk for the late development of joint contracture. The residual limb (stump) provides an excellent surface area for sitting balance and a lever-arm for transfer. In a patient who has the potential to use a prosthesis functionally, the residual limb allows direct load-transfer (end weight-bearing).(ABSTRACT TRUNCATED AT 250 WORDS)

Force displacement characteristics of the posterior cruciate ligament.

The percent force changes in the posterior cruciate ligament were calculated using a previously validated computerized knee model after the femoral insertion sites were varied 2.5 and 5.0 mm in an anterior, posterior distal, anterior distal, and posterior distal direction. The tibial insertion sites were also varied 2.5 and 5.0 mm in the medial, lateral, proximal, and distal directions. Percent force changes were measured over a range of 0 degree to 90 degrees. These insertion sites simulated potential surgical placement errors. Results of this study demonstrated that the greatest percent force changes in the posterior cruciate ligament were at full extension. The greatest absolute percent force change between 0 degree and 90 degrees of flexion was with a femoral insertion of the posterior cruciate ligament placed 5 mm anterior to its normal attachment site, which resulted in a 39% change in the posterior cruciate ligament force. Distal femoral site attachment had the least effect (10% at 5.0 mm). Alterations at the tibial attachment site were less sensitive than on the femur; the greatest absolute percent force changes occurred with medial and lateral attachment sites (14% and 15%, respectively, at 5.0 mm). A minimal amount of percent force changes were seen between 45 degrees and 75 degrees of knee flexion in all positions tested for both tibial and femoral attachment sites. This model suggests that, like the anterior cruciate ligament, the force in the posterior cruciate ligament is also sensitive to attachment site position. As in anterior cruciate ligament studies, the femoral attachment site was found to be more sensitive.(ABSTRACT TRUNCATED AT 250 WORDS)

Idiopathic chondrolysis of the hip.

Fourteen patients (16 hips) with idiopathic chondrolysis of the hip were retrospectively studied at the Shriners Hospital from 1973 to 1986. Follow up averaged 84 months (range 13-180 months). All 14 patients were female. All but one were premenstrual. Each patient presented with an insidious onset of pain in the hip, thigh, or knee and radiographic symmetrical joint space narrowing. Three of the 16 hips required fusions, and only five regained a full range of motion. Partial restoration of the joint space occurred in eight hips. Essential treatment consists of unloading the hip joint while maintaining motion.

The influence of distal clavicle resection and rotator cuff repair on the effectiveness of anterior acromioplasty.

Anterior acromioplasty, described by Neer in 1972, is generally accepted as the procedure of choice for symptomatic subacromial impingement. Subsequent authors have written little about the prolonged length of postoperative rehabilitation, residual strength deficits, and the effect of the addition of a distal clavicle resection and/or rotator cuff repair. The authors reviewed 50 patients with late Neer Stage II and Stage III impingement lesions who were treated with anterior acromioplasty. In addition to the acromioplasty, 13 shoulders had a distal clavicle resection, nine had a rotator cuff repair, and ten had a distal clavicle resection and rotator cuff repair. The average patient age was 53 years (range, 36-70 years), and the average duration of symptoms was 43 months. Overall, 92% of the patients were graded as good or excellent on the basis of pain relief, strength, range of motion, and ability to resume full activity. Prolonged rehabilitation was noted in all groups, averaging 8.5 months; however, patients with a distal clavicle resection and rotator cuff repair required a 25% longer rehabilitation before full activity was obtained. A residual strength deficit was also noted in 70% of the patients requiring cuff repairs versus 50% in the patients with intact cuffs. Pain relief was equally obtained in all groups.