Patellar complications following total knee arthroplasty: a review of the current literature.

Total knee arthroplasty is a common operation for treating patients with end-stage knee osteoarthritis and generally has a good outcome. There are several complications that may necessitate revision of the implants. Patella-related complications are difficult to treat, and their consequences impact the longevity of the implanted joint and functional outcomes. In this review, we explore the current literature on patellar complications in total knee arthroplasty and identify risk factors as well as strategies that can help in preventing these complications. We present pertinent findings relating to patellar complications. They can be classified into bony or soft tissue complications and include bone loss, aseptic loosening, periprosthetic fractures, patella fracture, patellar clunk syndrome, patellofemoral instability, extensor mechanism complications, maltracking, patella baja and malrotation. We conclude that patellar complications in total knee arthroplasty are common and have significant implications for the functional outcome of total knee arthroplasty. A high index of suspicion should be maintained in order to avoid them. Implant malpositioning and other forms of intraoperative technical error are the main cause of these complications, and therefore, primary prevention is crucial. When dealing with these established problems, a clear plan of action should be formulated in advance to allow appropriate management as well as anticipation of adverse outcomes.

Injuries in extreme sports.

Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports.

Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction.

PURPOSE: To present a 5-year comparison of the functional outcomes of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction with those of isolated ACL reconstruction. METHODS: All patients were reviewed clinically and completed knee function questionnaires prospectively, by use of the International Knee Documentation Committee (IKDC) 2000, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scoring systems, preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent combined ACL-PLC reconstruction were identified and reviewed. These patients had intact lateral collateral ligaments. A comparison group was created from a group of patients who underwent isolated ACL reconstruction. The ACL group was selected to have the same profile with regard to age, sex, and meniscal procedure. RESULTS: There were 25 patients in the ACL-PLC group and 100 in the ACL group. All patients underwent restoration of their PLC function as shown on dial testing. The preoperative values for all KOOS measures and the Lysholm score were significantly lower in the ACL-PLC group than in the ACL group (P < .001). The IKDC score was not significantly different. All knee scores showed a significant improvement in both groups postoperatively at 1, 2, and 5 years (P < .001). At 5 years, the KOOS symptoms subscore (P < .001), KOOS pain subscore (P < .001), KOOS sports subscore (P < .001), KOOS quality-of-life subscore (P < .05), KOOS activities-of-daily living subscore (P < .001), aggregate score for all KOOS parameters (P < .001), and Lysholm score (P < .001) were significantly lower in the ACL-PLC group than in the ACL group. At 5 years, the IKDC scores were not significantly different. All patients in the ACL-PLC group resumed preinjury employment, and 23 of 25 had resumed sports. CONCLUSIONS: Combined ACL-PLC injuries have greater morbidity than isolated ACL injuries. However, return to work and sporting activity is possible in most cases after combined ACL-PLC reconstruction. The KOOS for sport outcomes suggests that sports were resumed at lower functional levels. LEVEL OF EVIDENCE: Level III, case-control study.