Ligamentum teres injury is associated with the articular damage pattern in patients with femoroacetabular impingement.

PURPOSE: The objective of this study was to investigate the association between ligamentum teres injury and the hip joint cartilage damage pattern in patients with femoroacetabular impingement. METHODS: We compared articular cartilage damage between ligamentum teres-intact and-ruptured hips. Data were collected for 77 consecutive patients with femoroacetabular impingement who underwent hip arthroscopy. The locations of the chondral lesions were recorded on anatomic articular maps using the geographic zone method. The patients were divided into 2 groups (ligamentum teres-intact and-injured groups), and the incidence and degree of cartilage injury were compared between the 2 groups by use of the Mann-Whitney U test. RESULTS: In patients with ligamentum teres injury, chondral damage extended to the middle-inferior area of the acetabulum (7.6% [grade 1] in ligamentum teres-intact group and 66.6% [grade 1, 12.1%; grade 2, 42.4%; grade 3, 12.1%] in ligamentum teres-injured group, P < .01) and the apex of the femoral head (anterior apex: 7.1% [grade 1, 3.8%; grade 2, 3.3%] in intact group and 42.4% [grade 1, 30.3%; grade 2, 12.1%] in injured group, P < .01; middle apex: 7.6% [grade 1, 3.8%; grade 2, 3.8%] in intact group and 63.5% [grade 1, 42.4%; grade 2, 18.1%; grade 3, 3.0%] in injured group, P = .04; posterior apex: 7.6% [grade 1, 3.8%; grade 2, 3.8%] in intact group and 42.4% [grade 1, 30.3%; grade 2, 12.1%] in injured group, P < .01). CONCLUSIONS: This study showed the association between ligamentum teres injury and articular cartilage damage in the inferior middle part of the acetabulum and the apex of the femoral head in patients treated for femoroacetabular impingement. LEVEL OF EVIDENCE: Level IV, case-control study.

Outcomes of knee arthrodesis following infected total knee arthroplasty: a retrospective analysis of 8 cases.

BACKGROUND: There is insufficient information regarding patient-based outcomes after knee arthrodesis following infected total knee arthroplasty (TKA). The purpose of this study was to analyze outcomes in patients who underwent knee arthrodesis following infected TKA using clinical and radiographic measurements including a patient-based outcome measuring system. METHODS: We evaluated 8 patients (mean age 72.9 years) who were followed for more than 3 years after arthrodesis. Clinical and radiographic evaluation was performed, including examination of the patient's function and use of supportive equipment for walking. The Japanese knee osteoarthritis measurement (JKOM) was used for measuring patient-based outcomes and health-related quality of life. RESULT: Knee fusion was achieved in 7 patients. The mean limb-length discrepancy was 5.4 cm. All patients could walk at least inside the house, and activity of daily living (ADL) independence was achieved by the patients with successful knee fusion, although walking aids, including a shoe lift causing little discomfort, were required. The results of JKOM for the patients with successful fusion were comparable to the data for patients who underwent TKA. CONCLUSIONS: When knee arthrodesis was performed for infected TKA cases, pain was reduced and ADL independence was established when knee fusion was achieved. This study demonstrated that information from subjective and functional evaluations of knee arthrodesis patients is useful in understanding postoperative activity and situations, and revealed the importance of supportive elements for walking.

Outcomes of knee arthrodesis following infected total knee arthroplasty: a retrospective analysis of 8 cases.

BACKGROUND: There is insufficient information regarding patient-based outcomes after knee arthrodesis following infected total knee arthroplasty (TKA). The purpose of this study was to analyze outcomes in patients who underwent knee arthrodesis following infected TKA using clinical and radiographic measurements including a patient-based outcome measuring system. METHODS: We evaluated 8 patients (mean age 72.9 years) who were followed for more than 3 years after arthrodesis. Clinical and radiographic evaluation was performed, including examination of the patient's function and use of supportive equipment for walking. The Japanese knee osteoarthritis measurement (JKOM) was used for measuring patient-based outcomes and health-related quality of life. RESULT: Knee fusion was achieved in 7 patients. The mean limb-length discrepancy was 5.4 cm. All patients could walk at least inside the house, and activity of daily living (ADL) independence was achieved by the patients with successful knee fusion, although walking aids, including a shoe lift causing little discomfort, were required. The results of JKOM for the patients with successful fusion were comparable to the data for patients who underwent TKA. CONCLUSIONS: When knee arthrodesis was performed for infected TKA cases, pain was reduced and ADL independence was established when knee fusion was achieved. This study demonstrated that information from subjective and functional evaluations of knee arthrodesis patients is useful in understanding postoperative activity and situations, and revealed the importance of supportive elements for walking.

Topographical histology of the posterolateral corner of the knee, with special reference to laminar configurations around the popliteus tendon: a study of elderly Japanese and late-stage fetuses.

We investigated the histology of laminar configurations at the posterolateral corners of 40 knees (18 late-stage fetuses, 22 elderly persons). In the fetuses, the deeply located popliteal fascia and the superficially located inferior geniculate vascular sheath were evident in a space between the popliteus tendon (PT) and the biceps femoris and gastrocnemius. Along, and deep to, the popliteal fascia, the popliteus muscle parenchyma developed into both the PT and another dense connective tissue mass. The PT attached to the fibula (i.e., the fetal popliteofibular ligament) and to the base of the lateral meniscus (i.e., the fetal popliteomeniscal fasciculus). This laminar configuration was essentially maintained in the elderly. The fetal dense connective tissue of the popliteus origin seemed to correspond to the adult arcuate ligament. However, because a connective tissue complex (including the PT and the arcuate and popliteofibular ligaments) was often well developed, the complex involved the inferior geniculate vascular sheath and popliteal fascia. A spectrum of variations was found in how thickly the complex developed. Thus, clear separation of the PT from the surrounding tissues often became difficult. Notably, the connective tissue complex could be peeled in different manners, depending on the site and the individual. Therefore, macroscopic variation in the posterolateral corner, including the apparent absence of some ligaments, seemed to be related to the thickness and number of layers developed by the connective tissue complex, possibly due to an adaptation to the individual's mechanical environment during growth and aging.

Lateral ligament injury of the ankle and associated articular cartilage degeneration in the talocrural joint: anatomic study using elderly cadavers.

We investigated degenerative changes (DCs) of the articular cartilage using 33 cadaveric talocrural joints with anterior talofibular ligament injuries. The control group (93 normal ankles) were age- and sex-matched with the injury group. The injured ligament carried unusual wavy collagen bundles with hyalinization (or elongation) or rupture with scar. In both groups, we found talar-side dominance of DCs, multifocus occurrence, and a high incidence of mirror-image DCs in the medial parts of the joint. However, the mirror-image lesion was multiple or large (or both) in the injury group in contrast to its restricted nature in the control. Thus, the averaged numbers of affected areas or sectors in the injury group were almost twice as large as in the controls. A significantly high incidence of DCs, especially of the mirror-image lesion, was found in the lateral malleolar facet in the injury group. Although initial DC lesions might be at a medial site in the joint, as hypothesized in the control group, the lateral ligament injury seemed to increase the dominance of DCs on the lateral site. Consequently, early evaluation and treatment for lateral ligament insufficiency is more necessary in elderly patients than in younger patients to avoid widespread development of osteoarthritis.

Does the fabella contribute to the reinforcement of the posterolateral corner of the knee by inducing the development of associated ligaments?

The fabellofibular (FF) and arcuate ligaments are closely colocated at the posterolateral corner of the knee. However, a bony fabella is often absent in Japanese subjects. We investigated these structures morphometrically using 212 knees. A thick FF ligament was found in 38.1% (40/105) of knees with a hard fabella. When identified histologically, a bony fabella accompanied a thick FF in 82.8% (24/29). Conversely, a thin or indefinite FF ligament and an elastic-textured fabella co-existed in 77.9% (60/70) of knees. There were no strong correlations between the morphology of the fabella and the arcuate ligament. Thus, a hard or bony fabella seemed to relate to thickening of the FF ligament. In contrast, the thicknesses of the FF and arcuate ligaments were negatively correlated. When the FF ligament was more than 5 mm thick, indicating that it was as strong as the lateral collateral ligament, no arcuate ligament could be identified. Conversely, a thin or indefinite FF ligament often accompanied a well-developed arcuate ligament (61.9%, 96/155). Our observations suggest that these ligaments act in a complementary manner to stabilize the posterolateral corner. A possible common function is fixation of the popliteal tendon on the joint capsule and lateral meniscus, rather than direct stabilization against rotation stress.