No abstract

Purpose The intra‐operative femorotibial joint gap and ligament balance, the predictors affecting these gaps and their balances, as well as the postoperative knee flexion, were examined. These factors were assessed radiographically after a posterior cruciate‐retaining total knee arthroplasty (TKA). The posterior condylar offset and posterior tibial slope have been reported as the most important intra‐operative factors affecting cruciate‐retaining‐type TKAs. The joint gap and balance have not been investigated in assessments of the posterior condylar offset and the posterior tibial slope. Methods The femorotibial gap and medial/lateral ligament balance were measured with an offset‐type tensor. The femorotibial gaps were measured at 0°, 45°, 90° and 135° of knee flexion, and various gap changes were calculated at 0°–90° and 0°–135°. Cruciate‐retaining‐type arthroplasties were performed in 98 knees with varus osteoarthritis. Results The 0°–90° femorotibial gap change was strongly affected by the posterior condylar offset value (postoperative posterior condylar offset subtracted by the preoperative posterior condylar offset). The 0°–135° femorotibial gap change was significantly correlated with the posterior tibial slope and the 135° medial/lateral ligament balance. The postoperative flexion angle was positively correlated with the preoperative flexion angle, γ angle and the posterior tibial slope. Multiple‐regression analysis demonstrated that the preoperative flexion angle, γ angle, posterior tibial slope and 90° medial/lateral ligament balance were significant independent factors for the postoperative knee flexion angle. The flexion angle change (postoperative flexion angle subtracted by the preoperative flexion angle) was also strongly correlated with the preoperative flexion angle, posterior tibial slope and 90° medial/lateral ligament balance. Conclusion The postoperative flexion angle is affected by multiple factors, especially in cruciate‐retaining‐type TKAs. However, it is important to pay attention not only to the posterior tibial slope, but also to the flexion medial/lateral ligament balance during surgery. A cruciate‐retaining‐type TKA has the potential to achieve both stability and a wide range of motion and to improve the patients’ activities of daily living.

We have experienced two cases of dislocation of the shoulder joint with ipsilateral humeral shaft fracture and reported long-term results over 10 years. Good clinical results were demonstrated in both cases.

therapeutic case series.

Introduction A cruciate ganglion is a relatively rare and, their reports are juvenile or adult patients. Clinically symptomatic posterior cruciate ligament (PCL) ganglion in a preschool child treated with sport restriction rather than surgery has never been reported. Case report We report the case of a ganglion cyst of the posterior cruciate ligament in a 5-year-old boy who complained of limping due to right knee pain and extension disturbances. The active range of his knee was −15°for extension and 145°for flexion with terminal pain. Magnetic resonance imaging (MRI) revealed proton density-height and T2WI with fat saturation-high signals in the PCL. Three months of sport activity restriction resolved his symptoms of pain and extension disturbances. Conclusion We report a very rare case of a ganglion of the PCL in a preschool child. If this disease is considered preoperatively, then it can be diagnosed based on characteristic MRI findings, and restricted sport activity could be implemented instead of arthroscopic treatment.