We performed a randomised, prospective study of 80 mobile-bearing total knee arthroplasties (80 knees) in order to measure the effects of varus-valgus laxity and balance on the range of movement (ROM) one year after operation. Forty knees had a posterior-cruciate-ligament (PCL)-retaining prosthesis and the other 40 a PCL-sacrificing prosthesis. In the balanced group (69 knees) in which the difference between varus and valgus was less than 2 degrees, the mean ROM improved significantly from 107.6 degrees to 117.7 degrees (p < 0.0001). By contrast, in the 11 knees which were unbalanced and in which the difference between varus and valgus laxity exceeded 2 degrees, the ROM decreased from a mean of 121.0 degrees to 112.7 degrees (p = 0.0061). We conclude that coronal laxity, especially balanced laxity, is important for achieving an improved ROM in mobile-bearing total knee arthroplasty.

Arthroscopic treatment for posterior ankle bony impingement syndrome was minimally invasive and suitable for athletes who desire an early return to sports activity.

BackgroundStudies of medial and lateral femoral posterior condylar offset have disagreed on whether posterior condylar offset affects maximum knee flexion angle after TKA.Questions/purposesWe asked whether posterior condylar offset was correlated with knee flexion angle 1 year after surgery in (1) a PCL-retaining meniscal-bearing TKA implant, or in (2) a PCL-substituting mobile-bearing TKA implant.MethodsKnee flexion angle was examined preoperatively and 12 months postoperatively in 170 patients who underwent primary TKAs to clarify the effect of PCL-retaining (85 knees) and PCL-substituting (85 knees) prostheses on knee flexion angle. A quasirandomized design was used; patients were assigned to receive one or the other implant using chart numbers. A quantitative three-dimensional technique with CT was used to examine individual changes in medial and lateral posterior condylar offsets.ResultsIn PCL-retaining meniscal-bearing knees, there were no significant correlations between posterior condylar offset and knee flexion at 1 year. In these knees, the mean (± SD) postoperative differences in medial and lateral posterior condylar offsets were 0.0 ± 3.6 mm and 3.8 ± 3.6 mm, respectively. The postoperative change in maximum knee flexion angle was −5° ± 15°. In PCL-substituting rotating-platform knees, similarly, there were no significant correlations between posterior condylar offset and knee flexion 1 year after surgery. In these knees, the mean postoperative differences in medial and lateral posterior condylar offsets were −0.5 ± 3.3 mm and 3.3 ± 4.2 mm, respectively. The postoperative change in maximum knee flexion angle was −2° ± 18°.ConclusionsDifferences in individual posterior condylar offset with current PCL-retaining or PCL-substituting prostheses did not correlate with changes in knee flexion 1 year after TKA. We should recognize that correctly identifying which condyle affects the results of the TKA may be difficult with conventional radiographic techniques.Level of EvidenceLevel II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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BackgroundIn upper limb surgery, the pneumatic tourniquet is an essential tool to provide a clean, bloodless surgical field, improving visualization of anatomical structures and preventing iatrogenic failure. Optimal inflation pressure to accomplish these objects without injuring normal tissue and inducing complications is not yet established. Use of the minimum tourniquet pressure necessary to produce a bloodless surgical field is preferable in order to prevent injury to normal tissue. Various methods have been implemented in an effort to lower effective cuff pressure. The purpose of this study is to report clinical experience with a new tourniquet system in which pressure is synchronized with systolic blood pressure (SBP) using a vital information monitor.MethodsWe routinely used the tourniquet system in 120 consecutive upper limb surgeries performed under general anaesthesia in our operating room instead of our clinic. Cuff pressure was automatically regulated to additional 100 mmHg based on the SBP and was renewed every 2.5 minutes intervals.ResultsAn excellent bloodless field was obtained in 119 cases, with the exception of one case of a 44-year-old woman who underwent internal screw fixation of metacarpal fracture. No complications, such as compartment syndrome, deep vein disorder, skin disorder, paresis, or nerve damage, occurred during or after surgery.ConclusionsThis new tourniquet system, synchronized with SBP, can be varied to correspond with sharp rises or drops in SBP to supply adequate pressure. The system reduces labor needed to deflate and re-inflate to achieve different pressures. It also seemed to contribute to the safety in upper limb surgery, in spite of rare unexpected oozing mid-surgery, by reducing tissue pressure.

This study showed the effects of retention of the PCL and the degree of its functional recovery on postoperative ROM for the two prostheses.

A preoperative quantitative evaluation of soft tissues is helpful for planning total knee arthroplasty, in addition to the conventional clinical examinations involved in moving the knee manually. We evaluated preoperative coronal laxity with osteoarthritis in patients undergoing total knee arthroplasty by applying a force of 150 N with an arthrometer. We examined a consecutive series of 120 knees in 102 patients. The median laxity was 0°in abduction and 8°in adduction. The femorotibial angle on non-weight-bearing standard anteroposterior radiographs was 180°and correlated with both abduction (r=−0.244, p=0.007) and adduction (r=0.205, p=0.025) laxity. The results of a regression analysis suggested that the femorotibial angle is helpful for estimating both laxities. Considering the many reports on how to obtain well-balanced soft tissues, stress radiographs might help to improve the preoperative planning for gaining the optimal laxity deemed appropriate by surgeons.Résumé Une analyse avec évaluation quantitative préop-ératoire des tissus mous est nécessaire dans la planification d'une prothèse totale de genou, ceci en plus des examens cliniques conventionnels, notamment en ce qui concerne l'évaluation de la mobilité. Nous avons évalué, en préopératoire, les laxités ainsi que les stades de l'arthrose chez les patients qui ont bénéficié d'une prothèse totale du genou. Ces résultats ont été réalisés à l'arthromètre. Nous avons réalisé une série consécutive de 120 genoux chez 102 patients. La laxité moyenne était de 0°en abduction et de 8°en adduction. L'angle fémoro tibial, sans appui, sur les radiographies de face et de profil était de 180°et a été corrélé avec la laxité en abduction (r=−0.244, p=0.007) et en adduction (r=0.205, p= 0.025). Les résultats nous montrent que l'angle fémoro tibial est utile pour estimer les laxités. Si l'on considère les différentes études et la meilleure manière d'obtenir une bonne balance ligamentaire, les radiographies en stress permettent d'optimiser le planning opératoire et d'avoir une bonne idée des laxités.

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