No abstract

Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.

Endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft affords and maintains good self-reported assessments and clinical ligament evaluation up to 13 years. Radiographic degenerative changes were seen in three quarters of patients. Almost half developed loss of extension, suggesting onset of early osteoarthritis. Patients who had undergone meniscectomy at the time of reconstruction had increased clinical ligament laxity over time and greater odds of graft rupture, possibly reflecting the effect of prolonged increased strain on the graft. Continued follow-up is required to resolve concerns regarding integrity of the patellar tendon graft beyond 13 years, particularly in the absence of meniscal tissue.

No abstract

In the past three decades, the incidence of overuse injury has risen because of greater participation in recreational and competitive sporting activities. 1 Excessive repetitive overload of tendo Achillis is regarded as the main pathological stimulus which leads to tendinopathy. 2 In a recent study, however, 31% of 58 patients with this condition did not participate in vigorous physical activity. 3 In this article, we have concentrated on tendinopathy of the main body of tendo Achillis. We have not dealt with Haglund's condition, insertional tendinopathy, or with lesions of the myotendinous junction. Anatomy. The gastrocnemius muscle merges with the soleus to form tendo Achillis. 4 It has a round upper part and is relatively flat in its distal 4 cm. Its fibres spiral through 90°, increasing the release of stored energy during locomotion.

The results suggest that pre-operative education is a safe and effective method of reducing length of stay for knee arthroplasty patients.

Medial patellofemoral ligament (MPFL) disruption may alter patellofemoral joint (PFJ) kinematics and contact mechanics, potentially causing pain and joint degeneration. In this controlled laboratory study, we investigated the hypothesis that MPFL transection would change patellar tracking and PFJ contact pressures and increase the distance between the attachment points of the MPFL. Eight fresh frozen dissected cadaveric knees were mounted in a rig with the quadriceps and ITB loaded to 205 N. An optical tracking system measured joint kinematics, and pressure sensitive film between the patella and trochlea measured PFJ contact pressures. Length patterns of the distance between the femoral and patellar attachments of the MPFL were measured using a suture led to a linear displacement transducer. Measurements were repeated with the MPFL intact and following MPFL transection. A significant increase in the distance between the patellar and femoral MPFL attachment points was noted following transection (p < 0.05). MPFL transection resulted in significantly increased lateral translation and lateral tilt of the patella in early flexion (p < 0.05). Peak and mean medial PFJ contact pressures were significantly reduced and peak lateral contact pressures significantly elevated in early knee flexion following MPFL transection (p < 0.05). MPFL transection resulted in significant alterations to PFJ tracking and contact pressures, which may affect articular cartilage health. The medial patellofemoral ligament (MPFL) is the most important patellofemoral joint (PFJ) stabilizer from 0 to 30˚of knee flexion, contributing 50-60% of the passive resistance to patellar lateral translation.1-4 Patellar dislocation as a consequence of trochlear dysplasia and patella alta were previously highlighted in the literature.5-7 Given its anatomic position, lateral patellar dislocation will almost always damage the MPFL. 8Rupture of the MPFL occurs in 95-100% and injury in 100% of patients suffering patellar dislocation.9-11 PFJ dislocation is linked to the development of abnormal contact stress and joint degeneration. 12,13 This, alongside reports of recurrent instability rates >50% with non-operative management, 14 have perhaps contributed to the recent increase in primary management with operative MPFL repair. 15,16 Given the high levels of patient dissatisfaction following patellar dislocation, the associated incidence of MPFL rupture, and the link to joint degeneration, we hypothesized that MPFL transection would allow the patella to track more laterally than normal, and that this would lead to elevated articular contact pressure on the lateral facet of the PFJ. MATERIALS AND METHODS Specimen PreparationFive male and three female right-sided, fresh-frozen cadaveric knees of mean age 73.5 years (range: 46-88) were obtained from a tissue bank, following approval from a local Research Ethics Committee. Each specimen was cut to 20 cm of femur and 15 cm of tibia, with no deformity apparent on visual inspection. Specimens were stored at À2...

This provides guidance to surgeons as to the threshold at which MPFL reconstruction may satisfactorily restore patellofemoral mechanics, beyond which more invasive surgery such as TT transfer may be indicated.