
Mervyn J CrossNorth Sydney Orthopaedic And Sports Medicine Centre · knee surgery
Mervyn J Cross
MBBS FRACS MD
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98
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Introduction
Education
January 1959 - December 1964
Publications
Publications (98)
This chapter reviews the principles of cementless fixation of joint replacements, encompassing the anatomic considerations, implant material selection, design aspects and the clinical outcomes. Particular attention is given to working with the degenerate anatomy typically found and the means of enhancing secure, long-term fixation of the implant an...
PurposeThe objective of this study was to compare patellar height and patella alta between a control cohort and patients with patellar tendinopathy by the sagittal patellar flexion angle (SPFA) measurement.Methods
Magnetic resonance imaging (MRI) scans of the knee were obtained from a sports imaging facility and screened to select patients with ant...
Patellofemoral anatomical dysplasia is associated with patellofemoral instability and pain. The closure of the knee physis occurs at the same age as the peak incidence of patellofemoral dislocation. This study determined the effect on the patellofemoral anatomical development in a rabbit epiphysiodesis model. Twenty‐four skeletally immature New Zea...
Background
Patellar tendinopathy is an overuse condition affecting athletes, often with a high morbidity if left untreated. High-level evidence fails to support the use of surgery. A tibial tubercle osteotomy (TTO) has been suggested as a surgical option to improve patient outcomes. Our aim was to explore whether a distalising TTO will alter the pa...
Being around on the dawn of the ‘Big Bang’ of Orthopaedic Sports Medicine in 1970, I have witnessed great milestones and advances. I have also witnessed many preventable failures. My biggest worry is that there is a tendency to follow fads, such as the gross failures of intra-articular artificial ligaments, lateral release as the cure of patella in...
Background:
patellar tendinopathy is an overuse condition most commonly affecting jumping athletes. Surgery is reserved for refractory cases; however, it lacks high level clinical evidence and basic science to support its use. The purpose of this study was to determine the biomechanical and histological response of surgical excision on patellar te...
Patella tendinopathy condition is often resistant to conservative treatment. We report a case of patella tendinopathy treated by distalisation of the tibial tubercle with excellent long-term result.
Background: Patella tendinopathy is an overuse condition. Pathogenesis and identification of intrinsic risk factors have largely eluded the orthopaedic world. The cranial cruciate ligament (CrCL) in dogs is the equivalent to the human anterior cruciate ligament (ACL). We report the effect of two canine proximal tibial osteotomy procedures in the ve...
The article describes a case in which a popliteal cyst was identified presenting as a mass on the anterior aspect of the
right tibia. This occurred as a result of polyethylene wear debris from previous total knee arthroplasty. Although alternative
diagnoses for an anterior tibial mass are more likely, a popliteal cyst must be considered, particular...
Background:
In orthopedic and sports medicine literature there is minimal information regarding accurate diagnosis and the treatment options for tenosynovitis of the distal semimembranosus tendon. After reviewing the literature, the authors question both the etiology and treatment of this condition. Previous descriptions have associated the condit...
39 elite athletes were examined at 10 years following Bone Patella Bone reconstruction employing a novel "block and tackle" tibial fixation system and an interference apical femoral fixation screw. there was only one failure at 10 years and most returned to their same standard with ten representing at an international level
This chapter reviews the principles of cementless fixation of joint replacements. This encompasses the anatomic considerations, material selection for the implant, design aspects and the clinical outcomes. Particular attention is given to working with the degenerate anatomy typically found and the means of enhancing secure, long-term fixation of th...
The Lachman test is a commonly used clinical test for evaluating anterior cruciate ligament (ACL) integrity. When performing the Lachman test we have noted an additional, previously unreported finding, which helps to discriminate between the intact and ruptured ACL. This observation, which we have named the lift-off sign, can be explained using the...
Reporting of long-term outcome of anterior cruciate ligament (ACL) reconstruction with the patellar tendon (bone-patellar tendon-bone [BTB]) autograft is limited. There are concerns that degenerative joint disease is common in the long term, which may be associated with the procedure itself.
(1) ACL reconstruction with BTB provides good long-term o...
The patient population that will place the highest demand on the structural integrity and function of an ACL graft, whilst at the same time have the lowest tolerance for any donor site morbidity is the professional sportsman. The graft most appropriate for this group, regardless of technical difficulties, should therefore be considered the gold sta...
The treatment of knee arthrosis in the young active patient poses a management dilemma for the orthopedic surgeon. This problem is further complicated when arthrosis is accompanied by symptomatic knee instability as a result of anterior cruciate ligament rupture. This article gives an overview of the physiological role of the anterior cruciate liga...
We reviewed 32 knees in 26 patients who had previously undergone arthroscopic debridement for symptomatic osteochondritis dissecans (OCD) of the knee. The patients were followed up at a minimum of 11 years following surgery and were evaluated clinically using the American Knee Society Clinical Rating Score. Additional evaluation was performed using...
We carried out a prospective study of 118 hydroxyapatite-coated, cementless total knee replacements in patients who were ≤ 55 years of age and who had primary (92; 78%) or post-traumatic (26; 22%) osteoarthritis. The mean period of follow-up was 7.9 years (5 to 12.5). The Knee Society clinical scores improved from a pre-operative mean of 98 (0 to 1...
Eleven infected total knee arthroplasties underwent revision using an articulating spacer comprising a total condylar component and meniscal polyethylene insert cemented in place using antibiotic-loaded cement. Only 1 case required subsequent rerevision for infection, 2 were revised for pain, 6 remain in situ, and 2 patients have died with their sp...
INTRODUCTION In the adult population, equinus deformity is frequently accompanied by an underlying etiology, such as a neurologic disorder, trauma, poliomy-elitis, muscular anomaly, diabetes, or vascular malformation. 1-4,6-12,14 Often these patients present secondar y to the aesthetics of an altered gait, difficulty with ambulation, problems with...
In a series of 1304 patients (1867 knees), the results of simultaneous and staged bilateral total knee arthroplasty were compared with each other and with unilateral total knee arthroplasty. The bilateral procedures had a significantly higher rate of complications than unilateral procedures, almost entirely because of thromboembolic problems. Howev...
Stiffness is an uncommon but potentially debilitating complication following total knee replacement (TKR). The treatment of this condition remains difficult and controversial. We present the results of 13 patients who underwent open arthrolysis for stiffness. The mean time between TKR and arthrolysis was 14 months. The mean follow-up was 7.2 years...
We prospectively reviewed 1000 consecutive patients who underwent a cementless, hydroxyapatite-coated, stemless, total knee replacement over a period of nine years. Regular post-operative clinical follow-up was performed using the Knee Society score. The mean pre-operative score was 96, improving to 182 and 180 at five and ten years, respectively....
To increase awareness of the presence of ganglion cysts of the anterior cruciate ligament and to consider this diagnosis in any knee that has lost range of motion (ROM) in the absence of osteoarthritis.
Case series.
We present a series of 15 cases recorded over a period of 5 years illustrating the clinical presentation and additional pathology seen...
We have carried out a prospective study comparing the results at five years in patients older than 75 years of age undergoing hydroxyapatite-coated, cementless total knee replacement (TKR) with those who were younger. The Knee Society clinical rating scores were recorded before and after operation. Of 559 patients undergoing TKR, 135 were in the el...
Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon a...
Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral mal-tracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon...
Infection is a potentially disastrous complication of total knee replacement (TKR). Retention of the prosthesis has been associated with high rates of persistent infection. Our study shows that in selected situations, arthroscopic debridement may allow retention of the prosthesis and eradication of the infection. However, the prosthesis must be sta...
A prospective study of the clinical outcome in patients with a hydroxyapatite coated, uncemented total knee replacement was performed. 1000 primary total knee replacements were implanted in 692 patients for, in the vast majority, osteoarthrosis. Mean follow-up was 75 (range 40-115) months. Knee scores were significantly (p<0.001) improved postopera...
The increasing trend for uncemented joint prostheses has led to some concerns regarding fixation and the search for methods that may enhance it. Of the currently available bioactive ceramics, Hy- droxyapatite (HA) remains the one with the most clinical use. We report early results of an unce- mented total knee arthroplasty demonstrating excellent f...
A prospective study of early clinical and radiologic outcome of the Motus (Osteo, Selzach, Switzerland) meniscal bearing total knee arthroplasty was performed. We reviewed the first 75 consecutive prostheses in 62 patients, implanted over a 4-year period. The mean follow-up was 2.5 years. Average preoperative knee score was 97 out of 200 (Knee Soci...
We have investigated the ability to kneel after total knee replacement. We asked 75 patients (100 knees) at least six months after routine uncemented primary total knee replacement, to comment on and to demonstrate their ability to kneel. Differences between the perceived and actual ability to kneel were noted. In 32 knees patients stated that they...
We have investigated the ability to kneel after total knee replacement. We asked 75 patients (100 knees) at least six months after routine uncemented primary total knee replacement, to comment on and to demonstrate their ability to kneel. Differences between the perceived and actual ability to kneel were noted. In 32 knees patients stated that they...
Patellar fracture is a rare but specific complication of anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. When this complication occurs, early internal fixation is recommended and need not compromise the outcome. We report 2 cases of displaced transverse patellar fracture occurring after reconstruction but which...
We report a study of 636 patients requiring knee surgery, all of whom underwent detailed preoperative assessment. Fifty-eight patients had a clinical sign of a lump on the joint line when the knee was examined at 45 degrees of flexion, which has been thought to indicate a meniscal cyst. Of these 58 patients, however, only 30 patients had a meniscal...
The post-operative blood loss following an uncemented total knee replacement is substantial and can be affected by the vacuum pressure in the suction drains. One hundred and nine patients undergoing 122 uncemented total knee replacements were monitored to ascertain the influence of high or low vacuum drains on blood loss. Low volume drains produced...
Hamstring injuries are common and have a significant impact on athletic performance. Hamstring tightness is a contributing factor in pathological conditions of the knee and spine in nonathletic individuals. This article discusses the anatomy, physiology, and pathology of hamstring injuries and related conditions. We also identify the injury pattern...
T hirty cruciate ligaments were retrieved from either cadavers or limbs which had been amputated. Each specimen was sectioned and stained to demonstrate the presence of collagen, nerves and vessels. All 30 specimens contained an interconnecting band of collagen fibres between the anterior and posterior cruciate ligaments. Vascular structures were p...
Thirty cruciate ligaments were retrieved from either cadavers or limbs which had been amputated. Each specimen was sectioned and stained to demonstrate the presence of collagen, nerves and vessels.
All 30 specimens contained an interconnecting band of collagen fibres between the anterior and posterior cruciate ligaments. Vascular structures were pr...
Complete rupture of the hamstring tendons in the adult is a rare injury. This report discusses complete rupture of the hamstring tendons in nine patients treated by late operative repair. All patients were referred from outside centers for a second opinion after failed nonoperative treatment. The diagnosis was made quite easily on clinical grounds...
Rupture of the tendons of both peroneus longus and peroneus brevis results in considerable disability. We have performed transfer of flexor digitorum longus (FDL) to peroneus brevis in two patients with lateral instability of the hindfoot due to chronic transverse tears of both tendons for which end-to-end repair was not possible. Both patients had...
Rupture of the tendons of both peroneus longus and peroneus brevis results in considerable disability. We have performed transfer of flexor digitorum longus (FDL) to peroneus brevis in two patients with lateral instability of the hindfoot due to chronic transverse tears of both tendons for which end-to-end repair was not possible. Both patients had...
Return to regular sports activity was evaluated in a retrospective review of 160 patients who had undergone total knee replacement surgery by a single surgeon (208 knee replacements). Mean age of the patients was 68 years (range, 27 to 87) at surgery and 73 years (range, 33 to 91) at review at a mean follow-up of 5 years (range, 3 to 7). Seventy-ni...
Great confusion has existed for many years over the terminology for describing knee instability. This confusion is enhanced when some doctors describe knee instability in clinical terminology while others attempt to describe it in biomechanical terms. It is the purpose of this article to clarify many of the misconceptions about the definitions, und...
Five cases of anterior cruciate ligament reconstruction, performed for symptomatic episodes of giving way or during surgery for associated injury, were carried out in preepiphyseal closure adolescents (ages 12-15 years), utilising a strip of iliotibial band placed over the top of the lateral femoral condyle in a MacIntosh type repair, and avoiding...
We report four patients with a mean age of 17 years (14 to 22) with external rotation injuries of the knee in slight flexion. Radiographs showed a small fragment in the area of the lateral femoral condyle. At operation, the fragment, consisting of the femoral insertion of the popliteus, was anatomically reduced and fixed. At a mean follow-up of 35...
We reviewed 30 patients at an average of 7.4 years after acute repair of the anterior cruciate ligament aug mented with a loop of iliotibial tract. A noncontact twisting had been the mechanism of injury in 18 of these patients, with 28 having been injured in sports. At followup, 25 patients had not experienced symptoms of instability and 23 were ab...
This book is part of the Institute of Mathematics and its Applications Conference Series and is a collection of practical and theoretical contributions from representatives of all areas of mathematical modeling. The topics include the development of models of microstructural changes, the development of algorithm and codes as simulation tools, and t...
Apparent regeneration of the tendons of the semitendinosus and gracilis muscles after their use for anterior cruciate ligament reconstruction was noted during routine follow-up of 225 patients. From this group, four patients were selected for thorough examination, including magnetic resonance imaging, electromyographic studies, strength testing, an...
We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and internal fixation with return to full function, allowing in one case, athletic performances of Olympic standard. We also report one patient with an acute apophyseal...
We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and internal fixation with return to full function, allowing in one case, athletic performances of Olympic standard. We also report one patient with an acute apophyseal...
A series of 68 knees were reviewed retrospectively at an average of 56 months following surgical treatment for patellar dislocation and subluxation. Fifty-three knees in 48 patients were assessed both subjectively by questionnaire and objectively by examination, and 15 knees were evaluated by questionnaire only. All cases were treated by a proximal...
A group of experts met to discuss a case from the North Sydney Orthopaedic and Sports Medicine Centre. This case conference is part of a series featuring a variety of sports medicine topics.
The sidestep cutting manoeuvre is a common mecha nism of noncontact or isolated ACL ruptures in athletes. We analyzed the amount and direction of tibial rotation that occurred at the knee joint with a triaxial electro goniometer on 11 male subjects who performed the sidestep cutting manoeuvre. The mean total tibial ro tation was 19.84 ± 5.63° and t...
Forty-seven patients had primary repair and extraarticular augmentation with a lateral loop of the iliotibial tract for acute rupture of the ACL. (All of these patients had anterolateral rotatory instability (ALRI) preoperatively as diagnosed by a positive jerk test.) Of these 47 patients, 36 were available for follow-up evaluation. Followup ranged...
Presentation on the use of the Dynamic Cruciate Tester for diagnosis of ACL rupture and the assessment longitudinally of reconstructive surgery
Presentation of a new method and device for assessment of anterior cruciate ligament laxity and the assessment of reconstructive procedures
This study presents the results of 107 shoulder reconstructions by one surgeon, of which 59 were Putti-Platt procedures, and 48 were combined Putti-Platt/Bankhart procedures. The patients were predominately young males engaged in contact sports, particularly the Rugby football codes. There were nine redislocations noted in clinical records for the...
Assessment is made of the effectiveness of femoral nerve block, administered either before or after surgery, in supplementing postoperative analgesia for knee joint (anterior cruciate) reconstruction surgery.
Femoral nerve block, performed before surgery, with Bupivacaine 0.5%, reduced intramuscular opiate ad ministration by 80% in the recovery roo...
With adequate quadriceps exercises, the prognosis of a ruptured posterior cruciate ligament can be greatly improved. Of the 116 cases followed in this report, 55 were sports injuries while most of the remainder were traffic accidents. An excellent or good result was obtained in 47 sports-injured patients, while only 5 involved in road trauma obtain...
The painful knee is discussed in the context of being the presenting symptom and a structured approach to diagnosis is offered. Mechanism of the pain is defined and related to the common clinical conditions. Diagnosis is essential to management and is possible in most instances with the aid of arthrography and arthroscopy.
The role of muscle receptors in proprioception has been demonstrated in a variety of ways (for review see McCloskey, 1978) but is still doubted by some. One simple but critical experiment has produced conflicting results: when a tendon of a conscious subject is exposed at operation under local anaesthesia, and pulled so as to stretch its muscle whi...
A series of 636 consecutive knee arthrotomies was subjected to a prospective study, including the incidence, clinical presentation, and operative findings of meniscal cysts and associated pathological conditions. The clinical differential diagnosis was studied in detail, and from this, the importance of a specific clinical sign indicating a torn la...
The functional anatomy of tha anterior cruciate ligament was studied in 18 freshly amputated specimens. The cruciates were observed in the extremes of flexion and extension, and in midposition in simulated weight-bearing and nonweight-bearing conditions. Five femoral shafts were split longitudinally so that the femoral and tibial attachments of the...
Based on the clinical and operative findings in sixty-eight knees with acute tears of the medial compartment and cruciate ligaments, a standardized terminology and classification of knee ligament instability is presented. With an intact posterior cruciate ligament, anteromedial, anterolateral, or posterolateral rotatory instability may occur, but n...
Lateral instability of the knee is less frequent but more disabling than medial instability of a comparable amount. At the same time the diagnostic tests for lateral instability are more subtle and more frequently misinterpreted. Posterolateral rotatory subluxation is demonstrated by an apparently positive posterior drawer test with the tibia in ne...
An analysis of 1004 X-rays has demonstrated that the medial patella facet is significantly smaller in patients with patellofemoral instability. There is no such significant difference in the width of the whole patella. Therefore the longitudinal ridge separating the smaller medial facet from the larger lateral facet must be closer to the medial pat...
The acutely injured knee can be evaluated clinically. Only those cases of acute severe ligamentous instability indicate surgical repair within the first week following injury. The apparent meniscus injury and patella subluxation deserve conservative treatment and follow up until there is definite objective evidence of disorders sufficient to indica...
The semimembranosus muscle medially and the biceps femoris muscle laterally, both supply expansions into the capsular areas of their respective posteromedial and posterolateral corners. The gastrocnemii also have capsular expansions as they attach to the femoral insertions. It is by an intricate understanding of the mechanism of the musculo ligamen...