Questions related to Knee Surgery
I am studying force transmission through the synovial layer of the knee and would like to dissolve the fat pad so that I can see the fibrous array. Does anyone know of a solution that allows one to do this?
particularly for patients after knee surgery, is there evidence to support whether it is best for rehabilitation and functional range of motion to elevate the affected lower extremity with or without support under the length of the lower extremity
Arthroscopic Partial Meniscectomy (APM) is one of the most popular orthopaedic procedures, but recent publications stated that non-operative treatments have similar results to arthroscopic surgery.
The Meniscus Consensus Project in which more than 80 physicians from 21 european countries have been involved was set up to try to standardize an uniform the treatment algorithm of degenerative meniscus lesions (DML).
In leg amputation the remained bone is rasped to make the edges smoother to avoid tissue injuries. but still there is an unusual structure underneath the skin.
Why don’t we use an implantable structure to avoid abnormal structure like sharp edges and damp the undue pressure and shocks underneath bones, the same way heel fat pad*(HFP) protects the underlying structures in the heel?
From my point of view, using such implants might also ease the use of prosthetic legs and decrease the possible pain in leg- prosthetic interfaces.
Are there any specific reasons not to use such implants during the leg amputation?
*The heel fat pad (HFP) is a highly specialized adipose-based structure that protects the rear foot and the lower extremities from the stress generated during the heel-strike and the initial support phase of locomotion. HFP cushioning efficiency is the result of its structure, shape and thickness.
I am currently comparing 3 different internal fixation techniques in mandibular osteotomy. My results are grouped into stresses in fixation and surrounding bone, and displacement of proximal segment under 6 different loading conditions.
What would be the best statistical test to compare the results between each fixations and how significantly different are they.
So far, I haven't come across any similar FEA studies carrying out any statistical analysis.
Appreciate any feedbacks given. Thank you!
I am looking for various ways to analyse medio-lateral control of the knee joint during single-leg landing following a hop. There are few methods suggested by Roos et al. (2014). I would appreciate hearing some suggestions, on this, from the members of ResearchGate.
Roos PE, Button K, Sparkes V, van Deursen RWM. Altered biomechanical strategies and medio-lateral control of the knee represent incomplete recovery of individuals with injury during single leg hop. Journal of Biomechanics. 2014;47(3):675-80.
Trying to measure procurvatum of the tibia in patients with blount disease, clinically using goniometer (not on the radiograph).
Whats your take on this modality of fixation? Is it rationale or just a fad?
I'm mostly interested in whether X-ray or MRI was used, whether operated or contralateral knee was measured and which parameters were considered.
I am trying to define the limit or threshold of the knee varus-valgus angle (rotational range) for normal subjects. please suggest good references for me.
It seems cadaveric studies, in vitro, are best.
Best regards: Tserenchimed.
Sometimes during the surgical procedure for TKR, one comes across hypertrophied synovium especially in suprapatellar pouch. I have only occasionally excised the synovium. Should it be excised as a routine or not, or what is the indication to remove it?
Does vascularised fibula achieve significantly better union rates than non vascularised fibula for segmental bone defect?
Traditionally the patella fracture with intact extensor apparatus has been treated by cylinder cast, long knee immobilizer brace as well as percutaneous lag screw.
But is there any evidence in the literature as to what is the best mode of treatment?
I'm trying to find some test to asses knee stability different to Star Excursion Balance Test. I'm interested in any test which can be proved with athletes who have been undergone to a ACL operation and can be performed at field.
Thanks so much
I am trying to design a new knee implant for a project. Are there some calculations which can be done to determine the thickness of the femoral and tibial components? I know that I can design and then test for deflection using FEA, but I am trying to find also some calculations which can be used to approximate the behavior of the femoral and tibial component when subjected to some stress.
Any information given, will be greatly appreciated.
I wonder why the jigs used to size the femur have varying degrees of external rotation angles 3-9 degrees attached to them when we know that we need cut at angle of 3 degree external rotation. How do we measure the external rotation with jigs when we have a lateral or medial posterior condyle wear?
Orthopedic surgeons in India are using both slow eccentric and rapid eccentric (isolytic) stretches in rehabilitation following hip and knee surgery (see attachment). I am interested to discover the mechanisms associated with these methods, particularly relating to intra -and inter- muscular connective tissue structures.
Biomet (before its merger) was introducing a product called the Vanguard XP that preserved both the PCL and ACL. The product's indication was expected to be limited, which is why I believe the product has now been shelved after the merger.
My question then, to researchers and clinical practitioners, is how often is the ACL intact in patients with indications for total knee replacement?
Hi all! as a part of a study about the Ponseti procedure for the treatment of the congenital clubfoot I’m analyzing the correlation between two different scores (Pirani and Dimeglio) and the number of casts required to achieve the correction. I used Spearman rho (normality could not be assumed as the K-S test indicated the p-value of less than .05 for all the items) and found that both Pirani and Dimeglio are significantly associated to the number of casts, and almost collinear between them (Spearman’s rho = .875); but how to determine which is better in terms of predictability? May I use linear regression or what else? Thank you all for your suggestion
For those who prefer intra-medullar guiding, have you ever noticed post-operative complications (whatsoever)?
In some patients we observe an oblique joint line (i.e. in cases of a femoral valgus which is compensated by a tibial varus deformity) even though the overall alignment of the affected leg is straight. Does anybody know papers on the biomechanical influence of an oblique joint line in such patients ?
Currently several landmarks are used to identify the joint line level in revision knee arthroplasty. However, I wonder which one is a suitable method? Does anyone have an idea? Thank you for your contributions.
Why is the tibial and femoral component in the Knee implant made of different material? Why can't the femoral and tibial component be of completely Metal or Polyethylene? Does it have anything to do with lubrication?
Could you provide some reference for the same
What is the appropriate approach for management for a neglected patella fracture of over a year with the proximal fragment at the region of the mid thigh with weakness in the extensor mechanism.
I am trying to find out level of cartilage destroying enzymes which is associated with crepitus sound with pain.
Criteria of return to light activities (return to a sedentary job, straight-ahead running) uses commonly a timeline (12-16 weeks postoperatively)?
You use functional test to give your agreement to return to light activities? (Hop tests?)
I am starting work on tibia stress simulation after surgery. I found a validate model of femur. But where I can find an already validated model of tibia to start research on it?
Is there any defining factors (noted in the first week post op, i.e. analgesia, physiotherapy, swelling) that can predict a patient having ongoing knee stiffness and requiring a MUA post TKR? And therefore any prevention strategies?
We receive such patients who refuse replacement surgery and expect a 100% recovery by PT Rx in terms of pain, function, gait and even joint space and deformity. We try counseling but they keep on complaining.
Do you face such problems? What's your opinion?
All the available articles investigate acute tournament related traumatic injuries. I am looking for articles describing the wear and tear on the joints from years of karate training.
We get neglected cases of OA knee with badly stretched LCL. Weight bearing Xrays show even medial subluxation of tibia with posteromedial bone loss on tibia. The options at surgery include use of metallic wedges/ bone grafting to reconstruct the bone loss combined with intramedullary extension rods in tibia. The option of use of a larger tibial post to provide stability against subluxation is another option. What should be the algorithm of treating such cases?
In one of my recent surgeries on an obese female, the extension and flexion gaps (after the releases) were just sufficient enough for the largest insert (17.5) I had available. I was wondering what the options to tackle this situation would be if the gap was bigger.
I am a medical student of the University Medical Center of Freiburg, Department of Orthopedics and Trauma Surgery, Germany, working on my thesis concerning anterior cruciate ligament graft remodeling. I would like to know if any of you already measured the crimp length of the original patellar or semitendinosus tendon in light or electron microscopy? I would be very grateful for any help.
There are three main types of bone marrow stimulation in the literature; microfracture, abrasion chondroplasty, and drilling. Can anybody tell me why microfracture is overwhelmingly more popular than the other techniques? Does anybody have any references on the results of these different techniques? Or do you use other bone marrow stimulation techniques other than microfracture?
Some experts say that up to 7 mm full thickness of longitudnal tears, and any length of partial thickness for longitudnal tears reaching to only one surface (femoral or tibial) can be left untouched.
I have always been wary about leaving them behind because I feel they are the trigger points for future extensions.
The extension ROM after TKR has been reported as a negative value, i.e. - 3.2 or -2 in some articles and in some other articles it has been reported as a positive value, i.e. 3.56 , 3.58 . What should we interpret? The authors have not mentioned anything.
I'm currently seeing a patient who is 40 years old and has symptomatic arthritis of the prox tibiofibular joint. The patient is a healthy, active, long-distance runner. Knee and ankle joints are OK. Imaging includes MRI of tibiofibular joint showing typical signs of OA including effusion and some edema in the surrounding soft tissues. No indication of infection of tumor.
Which therapeutic approach do you recommend?
Anterior Cruciate Ligament (ACL) tears of the knee is a very common injury where it can be used different types of grafts to reconstruct a torn ACL such as: BTB (Bone- Patellar Tendon-Bone) autograft, hamstrings autograft, quadriceps tendon (QT) autograft or allografts to reconstruct the torn ligament. But which is your criteria to decide the ideal graft for you patient?
Presentation ACL Reconstruction Options
During the anterior cruciate ligament reconstruction, my hanstring graft (STG) has fell on the floor accidently twice. I did not have option of the allograft. I only had the options of either harvesting the same side BTB or contralateral hamstring or using the same graft after cleansing it. I exercised the last option of washing the graft with 500 ml saline, soaking it in cidex for 30 minutes and again washing it with saline. I was fortunate enough that in both the patients there was no infection. Both the patients have completed 2 years and 5 years follow up and the KT assessment as well as functional assessment is good.
But is it the right way to go in this situation or we should always harvest another new graft?
Can the patient walk immediately putting weight on the limb? Should the patient use a knee brace articulated and how? Can the patient immediately articulate the knee? When may the patient resumes sport? etc ...
Recently, a new randomized controlled clinical trial comparing partial menistectomy and sham surgery in patients without relevant osteoarthritis of the affected knee has been published (Sihvonen et al., NEJM 2013: http://www.nejm.org/doi/full/10.1056/NEJMoa1305189).
In summary, clinical outcome at 12 months in the "partial menistectomy" group was no better when compared to sham surgery, while significant improvement from baseline was found in both groups.
What is your interpretation of the results of this study ? What conclusion can be drawn by this study ? Do you think the study has significant limitations ? What do you consider the reason for improvement in the sham arm of the surgery ?
Varisation osteotomy is an established treatment for younger patient with arthritis of knee due to valgus malalignment. Since the majority of those deformities is located on the femur, supracondylar varisation osteotomy is indicated in the majority of the cases. Nevertheless, in some case in tibial deformities osteotomy of the proximal tibia can be performed. Is there an indication for double osteotomies in patients with a mixed type (femoral and tibial) deformity?
Recently the Anterolateral ligament has been suggested as an important anatomical structure for rotational stability of the knee? What is your opinion on the relevance of this structure?
Functional assessment of patients undergoing ACL reconstruction: you use Cincinnati Knee Rating system, IKDC or SANE (single assessment numeric evaluation), or other?
Limited range of motion is frequently observed following intra- or periarticular fractures of the knee. What do you consider special about this entity in comparison to other types of arthrofibrosis? What are your criteria to indicate revision surgery and how do you address arthrofibrosis? What time point following fracture treatment is best to perform revision surgery?
For a dynamic, ever changing human knee environment Is it more important to get the knee to feel right during surgery or more important to work on post-operative rehabilitation?
Does anybody have the experience of observing cartilage regeneration by itself directly or indirectly (for example, by radiography)?
Do you have a specific diagnostic algorithm? Please specify what to do and when. What kind of imaging modalities do you include?