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Book Details
Abstract
Online and in print, Insall & Scott Surgery of the Knee, edited by W. Norman Scott, MD, and 11 section editors who are experts in their fields, is your complete, multimedia guide to the most effective approaches for diagnosis and management of the full range of knee disorders affecting patients of all ages. From anatomical and biomechanical foundations, to revision total knee replacement, this authoritative reference provides the most up-to-date and complete guidance on cutting-edge surgical procedures, the largest collection of knee videos in one knee textbook. Expanded coverage and rigorous updates—including 40 online-only chapters—keep you current with the latest advances in cartilage repair and regeneration, allograft and autografts, computer robotics in total knee arthroplasty, and other timely topics. This edition is the first book ever endorsed by The Knee Society. Access the full text - including a wealth of detailed intraoperative photographs, a robust video library, additional online-only chapters, a glossary of TKR designs, quarterly updates, and more - at www.expertconsult.com.
- Get all you need to know about the clinical and basic science aspects of the full range of knee surgeries as well as the latest relevant information, including imaging and biomechanics; soft tissue cartilage; ligament/meniscal repair and reconstructions; partial and total joint replacement; fractures; tumors; and the arthritic knee.
- Master the nuances of each new technique through step-by-step instructions and beautiful, detailed line drawings, intraoperative photographs, and surgical videos.
- See exactly how it’s done. Watch master surgeons perform Partial and Primary TKR, Revision TKR, Tumor Replacement, Fracture Treatment, and over 160 videos on the expertconsult.com.
- Find information quickly and easily thanks to a consistent, highly templated, and abundantly illustrated chapter format and streamlined text with many references and chapters appearing online only.
- Access the fully searchable contents of the book online at www.expertconsult.com, including 40 online-only chapters, a downloadable image library, expanded video collection, quarterly updates, and a glossary of TKR designs with images and text from various device manufacturers.
- Grasp and apply the latest knowledge with expanded coverage of cartilage repair and regeneration techniques, expanded ligament techniques in allograft and autografts, computer robotics in surgical prognostics, fitting and techniques in partial and total knee arthroplasty, and more.
- Consult with the best. Renowned knee surgeon and orthopaedic sports medicine authority Dr. W. Norman Scott leads an internationally diverse team of accomplished specialists—many new to this edition—who provide dependable guidance and share innovative approaches to reconstructive surgical techniques and complications management.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc_i | ||
| Insall & Scott Surgery of the Knee | i | ||
| Copyright page | iv | ||
| Section Editors | v | ||
| Dedication | vii | ||
| Contributors | ix | ||
| Foreword | xx | ||
| Preface to the Fifth Edition | xxi | ||
| Preface to the Fourth Edition | xxiii | ||
| Preface to the Third Edition | xxv | ||
| Preface to the Second Edition | xxvi | ||
| Preface to the First Edition | xxvii | ||
| Acknowledgments | xxix | ||
| Table of Contents | xxxi | ||
| Online Contents | xxxvii | ||
| 1 Basic Science | 1 | ||
| 1 Anatomy | 2 | ||
| Normal Skeletal Structures | 2 | ||
| Bone Physiology | 2 | ||
| Bony Architecture | 2 | ||
| Patella | 2 | ||
| Femur | 4 | ||
| Tibia | 7 | ||
| Tibiofibular Joint | 8 | ||
| Hyaline/Articular Cartilage | 8 | ||
| Menisci | 9 | ||
| Medial Meniscus | 16 | ||
| Lateral Meniscus | 16 | ||
| Capsule | 18 | ||
| Synovial Cavity | 19 | ||
| Bursae | 21 | ||
| Cruciate Ligaments | 21 | ||
| Anterior Cruciate Ligament | 22 | ||
| Posterior Cruciate Ligament | 26 | ||
| Anterior Aspect | 28 | ||
| Medial Aspect | 29 | ||
| Lateral Aspect | 32 | ||
| Posterior Aspect | 35 | ||
| Nerves | 37 | ||
| Blood Supply | 40 | ||
| Motion and Function | 43 | ||
| Action of the Muscles | 45 | ||
| Key References | 45 | ||
| References | 45.e1 | ||
| Chapter 2 | 46 | ||
| 2 Anatomic Aberrations | e1 | ||
| Skeletal Abnormalities | e1 | ||
| Femur | e1 | ||
| Trochlear Dysplasia | e1 | ||
| Patella | e1 | ||
| Congenital Absence and Hypoplasia | e1 | ||
| Bipartite Patella | e1 | ||
| Ligament Abnormalities | e3 | ||
| Anterior Cruciate Ligament | e3 | ||
| Congenital Absence | e3 | ||
| Other Abnormalities | e3 | ||
| Posterior Cruciate Ligament | e3 | ||
| Meniscal Abnormalities | e3 | ||
| Anomalous Attachments | e3 | ||
| Hypoplasia and Congenital Absence | e3 | ||
| Discoid Meniscus | e3 | ||
| Medial | e4 | ||
| Lateral | e4 | ||
| Other Structural Meniscal Anomalies | e6 | ||
| Meniscofemoral Ligaments | e6 | ||
| Oblique Intermeniscal Ligaments | e7 | ||
| Muscle Abnormalities | e7 | ||
| Anomalous Attachments | e7 | ||
| Accessory or Hypertrophic Muscles | e7 | ||
| Hypoplasia | e8 | ||
| Arterial Anomalies | e8 | ||
| Persistent Sciatic Artery | e8 | ||
| Persistent Deep Popliteal Artery | e8 | ||
| Popliteal Artery Entrapment Syndrome | e9 | ||
| Nerve Abnormalities | e9 | ||
| Sensory Distribution Variations | e9 | ||
| Cysts | e9 | ||
| Ganglion Cysts | e9 | ||
| Meniscal Cysts | e9 | ||
| Popliteal Cysts | e11 | ||
| Plicae | e12 | ||
| Medial Patellar Plica | e12 | ||
| Suprapatellar Plica | e14 | ||
| Infrapatellar Plica | e14 | ||
| Summary | e14 | ||
| Key References | e15 | ||
| References | e15 | ||
| 3 Clinical Examination of the Knee | 47 | ||
| History | 47 | ||
| Observation and Inspection | 47 | ||
| Palpation | 47 | ||
| The Patellofemoral Joint | 47 | ||
| The Tibiofemoral Joint | 50 | ||
| Examination of the Ligaments and Associated Capsular Structures | 53 | ||
| Key References | 60 | ||
| References | 60.e1 | ||
| Chapter 4 | 61 | ||
| 4 Gene Therapy in the Treatment of Knee Disorders | e18 | ||
| Definition | e19 | ||
| Gene Selection | e19 | ||
| Vectors and Expression | e19 | ||
| Nonviral Vectors | e19 | ||
| Viral Vectors | e20 | ||
| Regulating Expression With the Use of Promoters | e21 | ||
| Methods of Delivery | e22 | ||
| In Vivo Gene Therapy | e22 | ||
| Ex Vivo Gene Therapy | e22 | ||
| Stem Cells and Ex Vivo Delivery Devices | e23 | ||
| Tissue Engineering | e23 | ||
| Considerations for Clinical Development | e24 | ||
| Achieving a Better Understanding of Intra-articular Gene Therapy | e24 | ||
| Translating New Understanding to Practice | e24 | ||
| Clinical Trials—Arthritis | e24 | ||
| Meniscus | e24 | ||
| Tendon | e25 | ||
| Ligament | e27 | ||
| Intra-articular Ligaments | e28 | ||
| Extra-articular Ligaments | e29 | ||
| Cartilage—Chondral and Osteochondral Defects | e29 | ||
| Osteoarthritis (OA) | e31 | ||
| Rheumatoid Arthritis (RA) | e34 | ||
| Conclusion and Future Directions | e39 | ||
| Acknowledgments. | e39 | ||
| Key References | e40 | ||
| References | e40 | ||
| 2 Imaging of the Knee | 63 | ||
| 5 Knee Imaging Techniques and Normal Anatomy | 64 | ||
| Radiography | 64 | ||
| Applications | 64 | ||
| Technique | 64 | ||
| Radiographic Views | 64 | ||
| Anteroposterior Radiograph | 64 | ||
| Lateral Radiograph | 64 | ||
| Axial View | 65 | ||
| Supplemental Views | 67 | ||
| Special Considerations and Anatomic Variants | 68 | ||
| Patellofemoral Alignment | 68 | ||
| Short- versus Long-standing Views | 70 | ||
| Arthrography | 71 | ||
| Safety | 71 | ||
| Computed Tomography | 71 | ||
| Applications | 71 | ||
| Technique | 71 | ||
| Image Interpretation | 73 | ||
| CT Arthrography | 73 | ||
| Artifacts/Special Considerations | 74 | ||
| Safety | 74 | ||
| Magnetic Resonance Imaging | 75 | ||
| Applications | 75 | ||
| Technique | 75 | ||
| Plane and Protocol Selection | 76 | ||
| Normal Anatomy | 76 | ||
| Ligaments | 76 | ||
| Menisci | 78 | ||
| Tendons | 80 | ||
| Cartilage | 81 | ||
| Ultrasound | 82 | ||
| Applications | 82 | ||
| Technique | 82 | ||
| Image Interpretation | 82 | ||
| Artifacts/Special Considerations | 82 | ||
| Safety | 83 | ||
| Nuclear Medicine | 83 | ||
| Applications | 83 | ||
| Technique | 83 | ||
| Technetium 99m-Methylene Diphosphonate (Tc-MDP) Scan | 83 | ||
| Labeled White Blood Cell Scan | 84 | ||
| Technetium-99m Sulfur Colloid Scan | 84 | ||
| Gallium-67 Citrate Scan | 85 | ||
| Safety | 85 | ||
| Key References | 85 | ||
| References | 85.e1 | ||
| Chapter 6 | 86 | ||
| 6 Imaging of Osseous Knee Trauma | e49 | ||
| Bone Contusions | e49 | ||
| Dislocations | e51 | ||
| Lateral Patellar Dislocation | e51 | ||
| Femorotibial Knee Dislocation | e51 | ||
| Fractures | e52 | ||
| Distal Femoral Fractures | e53 | ||
| Tibial Plateau Fractures | e53 | ||
| Patellar Fractures | e56 | ||
| Fractures Involving the Physis | e56 | ||
| Avulsion Fractures | e56 | ||
| Stress Fractures | e60 | ||
| Osteochondral Injury | e61 | ||
| Imaging of Suspected Occult Fracture | e62 | ||
| Key References | e63 | ||
| References | e63 | ||
| 7 Internal Derangements: | 87 | ||
| Bursae | 87 | ||
| Bone Marrow Contusion Patterns | 87 | ||
| Anterior Cruciate Ligament | 88 | ||
| Posterior Cruciate Ligament | 94 | ||
| Medial Collateral Ligament | 96 | ||
| Lateral Collateral Ligament and Posterolateral Corner | 98 | ||
| Posteromedial Corner | 100 | ||
| Extensor Mechanism | 100 | ||
| Iliotibial Band | 103 | ||
| Multiligament Knee Injuries | 103 | ||
| Conclusion | 104 | ||
| Key References | 105 | ||
| References | 105.e1 | ||
| 8 Internal Derangements: | 106 | ||
| Meniscus | 106 | ||
| Anatomy | 106 | ||
| Function | 106 | ||
| Magnetic Resonance Imaging of the Meniscus | 106 | ||
| MRI Criteria for Meniscal Injuries | 108 | ||
| Errors in Interpretation | 109 | ||
| Other Meniscal Disorders | 112 | ||
| Types of Meniscal Tears | 113 | ||
| Meniscal Tear Stability | 115 | ||
| Postoperative Meniscus | 116 | ||
| Spontaneous Osteonecrosis of the Knee (SONK) | 117 | ||
| Cartilage | 117 | ||
| Cartilage and Osteochondral Injuries | 117 | ||
| MRI of Hyaline Cartilage | 118 | ||
| Osteochondral Lesions | 120 | ||
| Traumatic Osteochondral Lesions | 120 | ||
| Osteochondritis Dissecans | 120 | ||
| Recent Advances in MRI of Cartilage | 122 | ||
| Key References | 122 | ||
| References | 123.e1 | ||
| Chapter 9 | 124 | ||
| 9 Arthropathies, Osteonecrosis, and Bursitis | e65 | ||
| Arthropathies | e65 | ||
| Osteoarthritis | e65 | ||
| Inflammatory Arthropathies of the Knee | e66 | ||
| Crystal Deposition Diseases and Arthropathies | e70 | ||
| Synovial Proliferative and Tumor-like Disorders | e72 | ||
| Neuropathic Osteoarthropathy | e74 | ||
| Septic Arthritis | e75 | ||
| Osteonecrosis | e76 | ||
| Bursitis | e78 | ||
| Anterior | e78 | ||
| Posterior | e79 | ||
| Medial | e80 | ||
| Lateral | e81 | ||
| Key References | e82 | ||
| References | e82 | ||
| 10 Imaging of Total Knee Arthroplasty | 125 | ||
| Imaging | 125 | ||
| Radiographs | 125 | ||
| Preoperative Radiographs | 125 | ||
| Postoperative Radiographs | 125 | ||
| Normal Postoperative Radiographic Appearances | 125 | ||
| Alignment | 125 | ||
| AP and Lateral Knee Radiographs. | 125 | ||
| Standing Radiographs | 125 | ||
| Axial Alignment. | 125 | ||
| The Mechanical Axis. | 125 | ||
| The Joint Line. | 125 | ||
| Radiolucent Lines. | 126 | ||
| Stress Shielding. | 126 | ||
| Patellofemoral Joint. | 126 | ||
| Imaging Techniques. | 126 | ||
| Patellar Height. | 127 | ||
| Patellar Tilt. | 128 | ||
| Asymmetry of Patellar Component Placement. | 128 | ||
| Overstuffing. | 128 | ||
| Computed Tomography | 128 | ||
| Scout View | 128 | ||
| Rotational Alignment of Components | 128 | ||
| MRI | 129 | ||
| Complications | 129 | ||
| Disorders of the Patella and Extensor Mechanism | 129 | ||
| Polyethylene Liner Wear | 130 | ||
| Loosening, Particle Disease, and Osteolysis | 130 | ||
| Loosening | 130 | ||
| Granulomas | 131 | ||
| Metal Synovitis | 133 | ||
| Periprosthetic and Component Fractures | 133 | ||
| Unicompartmental Complications | 133 | ||
| Infection | 134 | ||
| Radiographs | 134 | ||
| CT and MRI | 134 | ||
| Radionuclide Imaging | 134 | ||
| Bone Scintigraphy | 134 | ||
| Sequential Bone/Gallium Imaging | 135 | ||
| Labeled Leukocyte Imaging | 137 | ||
| 18F-Fluorodeoxyglucose Positron Emission Tomography | 138 | ||
| Summary | 139 | ||
| Key References | 139 | ||
| References | 139.e1 | ||
| Chapter 11 | 140 | ||
| 11 Tumor and Tumor-like Conditions | e85 | ||
| Radiographs | e85 | ||
| CT/MRI | e86 | ||
| Nuclear Medicine | e87 | ||
| Bone Island | e88 | ||
| Osteosarcoma | e88 | ||
| Osteochondroma | e90 | ||
| Enchondroma | e91 | ||
| Chondrosarcoma | e91 | ||
| Juxtacortical Chondroma | e92 | ||
| Chondroblastoma | e92 | ||
| Chondromyxoid Fibroma | e92 | ||
| Giant Cell Tumor | e93 | ||
| Nonossifying Fibroma | e94 | ||
| Fibrous Dysplasia | e95 | ||
| Osteoid Osteoma | e96 | ||
| Osteoblastoma | e96 | ||
| Aneurysmal Bone Cyst | e97 | ||
| Other Cysts | e97 | ||
| Ewing’s Sarcoma | e98 | ||
| Langerhans’ Cell Histiocytosis | e98 | ||
| Cortical Desmoid | e99 | ||
| Metastases | e99 | ||
| Lymphoproliferative/Hematologic Diseases | e99 | ||
| Osseous Malignant Fibrous Histiocytoma/Fibrosarcoma | e100 | ||
| Soft Tissue Sarcoma | e101 | ||
| Neurogenic Tumors | e102 | ||
| Key References | e103 | ||
| References | e103 | ||
| 3 Biomechanics | 141 | ||
| Chapter 12 | 142 | ||
| 12 Three-Dimensional Morphology of the Knee | e106 | ||
| Materials and Methods | e106 | ||
| Data Acquisition | e106 | ||
| Atlas Creation and Validation | e106 | ||
| Morphologic Shape Analysis | e107 | ||
| Automated Measurements | e107 | ||
| Distal Femoral Measurements | e108 | ||
| Distal Femur Curvature Mapping | e109 | ||
| Tibial Measurements | e110 | ||
| Results | e110 | ||
| Femur | e110 | ||
| Tibia | e111 | ||
| Discussion | e111 | ||
| Key References | e113 | ||
| References | e113 | ||
| 13 Fluoroscopic Analysis of Total Knee Replacement | e115 | ||
| Principles of Fluoroscopy | e115 | ||
| Radiographic Image Prediction | e115 | ||
| Modeling Methods | e115 | ||
| Clinical Applications of Fluoroscopy | e116 | ||
| Anteroposterior Translation | e117 | ||
| Stance Phase of Gait | e117 | ||
| Deep Knee Bend | e118 | ||
| Axial Femorotibial Rotation | e120 | ||
| Stance Phase of Gait | e120 | ||
| Deep Knee Bend | e121 | ||
| Femoral Condylar Lift-Off | e122 | ||
| Range of Motion | e122 | ||
| Clinical Significance | e123 | ||
| Anteroposterior Translation | e123 | ||
| Axial Femorotibial Rotation | e124 | ||
| Femoral Condylar Lift-Off | e124 | ||
| Range of Motion | e125 | ||
| Summary | e127 | ||
| Key References | e127 | ||
| References | e127 | ||
| 14 Biomechanics and Vibroarthrography of the Patellofemoral Joint | e129 | ||
| Biomechanical Functions of the Patella | e129 | ||
| Quadriceps Mechanism Moment Arms | e129 | ||
| What Is a Moment Arm? | e129 | ||
| Literature Data Discrepancy | e131 | ||
| Moment Arms in Natural, Patellectomy, and Total Knee Arthroplasty Knees | e131 | ||
| Patellofemoral Kinematics, Tracking, and Contact | e133 | ||
| Unambiguous Description | e133 | ||
| Patellar Kinematics | e133 | ||
| Patellar Shift | e133 | ||
| Patellar Flexion | e135 | ||
| Patellar Rotation | e135 | ||
| Patellar Tilt | e135 | ||
| Patellofemoral Contact | e137 | ||
| Extensor Mechanism Forces and Patellofemoral Stresses | e138 | ||
| Vibroarthrography of the Patellofemoral Joint | e141 | ||
| Historical Background | e141 | ||
| Current Research | e141 | ||
| Clinical Significance | e144 | ||
| Key References | e144 | ||
| References | e145 | ||
| Chapter 15 | 143 | ||
| 15 Contact Mechanics of the Human Knee | e148 | ||
| Methods for Studying Knee Contact Mechanics | e148 | ||
| Normal Knee Motion | e149 | ||
| Normal Knee Forces | e149 | ||
| Comparison of Total Knee Arthroplasty and Normal Knee Motion and Forces | e150 | ||
| Comparison of Total Knee Arthroplasty Contact Kinetics | e152 | ||
| Conclusion | e153 | ||
| Key References | e153 | ||
| References | e153 | ||
| 16 In Vivo Mechanics and Vibration of the Knee Joint | e155 | ||
| Knee Kinematics: Mobile or Fixed, Retaining or Sacrificing? | e155 | ||
| Knee Kinetics: What Have We Found? | e157 | ||
| Telemetry | e157 | ||
| Mathematical Modeling | e158 | ||
| Knee Vibration Data: The Future of Diagnosis? | e158 | ||
| Key References | e160 | ||
| References | e160 | ||
| 17 Does Strain in the Patella Change After TKA? A Finite Element Investigation of Natural and Implanted Patellae | e162 | ||
| Materials and Methods | e162 | ||
| Results | e164 | ||
| Discussion | e165 | ||
| Acknowledgments. | e167 | ||
| Key References | e167 | ||
| References | e168 | ||
| Chapter 18 | 144 | ||
| 18 Simulation Testing of Knee Implants | e169 | ||
| Introduction to Wear Simulation | e169 | ||
| Effect of Input Kinematics on Bearing Wear | e170 | ||
| Influence of Bearing Design on In Vitro Wear Performance of Knee Replacements | e170 | ||
| Comparison of Mobile and Fixed Bearings | e170 | ||
| Effect of Conformity of the Contact | e171 | ||
| Unicompartmental Knee Replacements | e171 | ||
| Wear Performance of New Materials | e171 | ||
| Comparison of Standard Ultra– High-Molecular-Weight Polyethylene With Cross-Linked Materials | e171 | ||
| Studies of New Materials | e172 | ||
| Summary | e172 | ||
| Key References | e173 | ||
| References | e173 | ||
| 19 Knee Wear | e175 | ||
| Wear and Damage | e175 | ||
| Components of Wear | e175 | ||
| Scratching and Pitting | e175 | ||
| Fatigue Failure | e175 | ||
| Adhesive and Abrasive Wear | e177 | ||
| Quantifying Wear | e177 | ||
| Factors Involved in Knee Wear | e179 | ||
| Conformity | e179 | ||
| Cement | e180 | ||
| Tibial Tray | e181 | ||
| Cast, Machined, and Grit-Blasted Trays | e181 | ||
| Polished Trays | e182 | ||
| Mobile-Bearing Knees | e182 | ||
| Highly Cross-Linked Polyethylene in Knees | e185 | ||
| Summary | e186 | ||
| Acknowledgments. | e187 | ||
| Key References | e187 | ||
| References | e188 | ||
| 4 Sports Medicine: Articular Cartilage and Meniscus | 145 | ||
| 20 Articular Cartilage: | 146 | ||
| Biology and Structure | 146 | ||
| Chondrocytes | 146 | ||
| Extracellular Matrix | 146 | ||
| Tissue Fluid | 147 | ||
| Macromolecules | 147 | ||
| Collagens | 147 | ||
| Proteoglycans | 147 | ||
| Noncollagenous Proteins and Glycoproteins | 149 | ||
| Regions Surrounding the Chondrocyte | 149 | ||
| Pericellular Matrix | 149 | ||
| Territorial Matrix | 149 | ||
| Interterritorial Matrix | 149 | ||
| Zones | 149 | ||
| Superficial Zone | 149 | ||
| Transitional Zone | 150 | ||
| Deep (Radial) Zone | 150 | ||
| Calcified Cartilage Zone | 150 | ||
| Biomechanics | 150 | ||
| Healing Response | 150 | ||
| Cell and Matrix Damage | 151 | ||
| Cartilage Disruption | 151 | ||
| Cartilage and Subchondral Bone Disruption | 151 | ||
| Future Directions | 152 | ||
| Key References | 152 | ||
| References | 152.e1 | ||
| 21 Articular Cartilage Injury and Adult OCD: | 153 | ||
| Presentation | 153 | ||
| Imaging | 153 | ||
| Etiology, Natural History, and Prognosis | 154 | ||
| Nonoperaive Treatment | 155 | ||
| Surgical Treatment | 155 | ||
| Positioning, Examination Under Anesthesia, and Diagnostic Arthroscopy | 156 | ||
| Loose Body Removal | 156 | ||
| Reparative Procedures | 156 | ||
| Drilling | 156 | ||
| Arthroscopic or Open Reduction and Internal Fixation | 157 | ||
| Summary of Author’s Preferred Reparative Treatment Method | 159 | ||
| Restorative Procedures | 159 | ||
| Marrow Stimulation (Microfracture) | 159 | ||
| Osteochondral Autograft Transplantation | 160 | ||
| Autologous Chondrocyte Implantation | 160 | ||
| Osteochondral Allograft | 161 | ||
| Conclusions | 161 | ||
| Key References | 161 | ||
| References | 162.e1 | ||
| 22 International Experience With Autologous Chondrocyte Implantation With Periosteum (Autologous Chondrocyte Implantation), Including Scaffold Guided Techniques and Tissue Engineered Matrix Support | 163 | ||
| Historical Background of Autologous Chondrocyte Implantation (Transplantation) | 163 | ||
| Indications for Autologous Chondrocyte Implantation | 164 | ||
| Clinical Evaluation | 165 | ||
| Background Factors to Consider | 165 | ||
| Arthroscopic Evaluation—Cartilage Retrieval | 165 | ||
| Cell Culturing | 166 | ||
| Surgical Procedure—Chondrocyte Implantation | 166 | ||
| Chondral Lesions | 166 | ||
| Excision and Débridement of the Lesion | 166 | ||
| Harvesting of the Periosteal Flap | 167 | ||
| Suturing of the Periosteal Flap | 167 | ||
| Osteochondral Lesions (Osteochondritis Dissecans) | 167 | ||
| The Concept of Optimal Environmental Conditions for the Short- and Long-Term Survival of Repair Tissue | 168 | ||
| Postoperative Treatment | 169 | ||
| Results of Autologous Chondrocyte Implantation: Long-Term Swedish Experience | 171 | ||
| Isolated Injury to the Femoral Condyle | 171 | ||
| Femoral Condyle Lesions With ACL Reconstruction | 171 | ||
| Osteochondritis Dissecans of the Femoral Condyle | 171 | ||
| Arthroscopic Assessment and Biopsies | 172 | ||
| Indentation Test of Repair Tissue | 172 | ||
| Immunohistochemical Analysis | 172 | ||
| Complications | 172 | ||
| Evaluation With dGEMRIC | 172 | ||
| Long-Term Durability | 172 | ||
| Cartilage Registry Report | 173 | ||
| Complications | 173 | ||
| Tissue Engineered Matrix Support (TEMS) Using Membranes, Carriers, Scaffolds, and Gels in Autologous Chondrocyte Implantation | 173 | ||
| Tissue Engineered Matrix Support (TEMS) | 173 | ||
| What Is the Optimal Scaffold? | 174 | ||
| Matrix-Induced Autologous Chondrocyte Implantation (MACI) | 174 | ||
| Collagen-Covered Autologous Chondrocyte Implantation (CACI) (Chondro-Gide, Restore, Maci) | 174 | ||
| Three-Dimensional Scaffolds for Autologous Chondrocyte Implantation | 175 | ||
| Hyaluronic Acid Scaffolds (Hyalograft C) | 175 | ||
| Suggested Classification of ACI Techniques | 175 | ||
| International Experience With Autologous Chondrocyte Implantation | 176 | ||
| Future Indications | 176 | ||
| Other Joints | 176 | ||
| Summary | 176 | ||
| Key References | 177 | ||
| References | 177.e1 | ||
| 23 Osteochondral Autograft Plug Transfer | 178 | ||
| Indications | 178 | ||
| Technical Considerations | 179 | ||
| Topography | 179 | ||
| Contact Pressures | 179 | ||
| Fill Pattern | 181 | ||
| Depth of Insertion | 181 | ||
| Graft Insertion | 182 | ||
| Graft Harvest | 182 | ||
| Pearls and Pitfalls | 182 | ||
| Postoperative Regimen | 182 | ||
| Results | 183 | ||
| Gross Morphology and Histology | 183 | ||
| Imaging | 190 | ||
| Future Directions | 192 | ||
| Summary | 192 | ||
| Key References | 193 | ||
| References | 194.e1 | ||
| 24 Osteochondral Allograft Transplantation | 195 | ||
| Basic Science | 195 | ||
| Indications | 196 | ||
| Procurement, Screening, and Storage | 196 | ||
| Preoperative Planning | 197 | ||
| Surgical Technique | 198 | ||
| Press-Fit Plug Allograft Technique | 199 | ||
| Shell Allograft Technique | 201 | ||
| Postoperative Management | 201 | ||
| Results | 202 | ||
| Complications | 204 | ||
| Conclusions and Recommendations | 205 | ||
| Key References | 205 | ||
| References | 206.e1 | ||
| 25 Débridement and Microfracture for Full-Thickness Articular Cartilage Defects | 207 | ||
| Background | 207 | ||
| Indications for Microfracture | 207 | ||
| Contraindications for Microfracture | 207 | ||
| Preoperative Planning | 208 | ||
| Surgical Technique | 208 | ||
| Postoperative Management | 210 | ||
| Rehabilitation | 210 | ||
| Rehabilitation Protocol for Patients With Lesions on the Femoral Condyle or Tibial Plateau | 210 | ||
| Rehabilitation Protocol for Patients with Patellofemoral Lesions | 211 | ||
| Potential Complications from Microfracture | 211 | ||
| Patient Outcomes | 211 | ||
| Database Management | 211 | ||
| Outcome Measures | 212 | ||
| Lysholm Score | 212 | ||
| Tegner Activity Scale | 212 | ||
| Western Ontario and McMaster University Osteoarthritis Index | 212 | ||
| Patient Satisfaction | 212 | ||
| Results of Microfracture | 212 | ||
| Summary | 213 | ||
| References | 213.e1 | ||
| Key References | 213 | ||
| 26 Articular Cartilage Repair With Bioscaffolds | 214 | ||
| Part I: Scientific Basis for Design Considerations of Bioscaffolds | 214 | ||
| Scaffold Requirements | 214 | ||
| Basic Science | 215 | ||
| Physical Characteristics | 215 | ||
| Mechanical Strength | 215 | ||
| Structure | 215 | ||
| Biologic Characteristics | 216 | ||
| Biocompatibility | 216 | ||
| Degradation | 216 | ||
| Bioactivity | 216 | ||
| Summary of Desired Scaffold Attributes | 216 | ||
| Part II: Scaffolds in Development | 216 | ||
| Scaffolds Without Cells at Time of Implantation (Host Cell Source) | 217 | ||
| Autologous Matrix-Induced Chondrogenesis | 217 | ||
| 5 Sports Medicine: Ligament Injuries | 317 | ||
| 37 Classification of Knee Ligament Injuries | 318 | ||
| Relationship of Capsular and Ligamentous Structures | 318 | ||
| Medial Structures | 318 | ||
| Lateral Structures | 321 | ||
| Anterior Cruciate Ligament | 321 | ||
| Posterior Cruciate Ligament | 321 | ||
| Kinematics | 324 | ||
| Position | 324 | ||
| Motion | 325 | ||
| Laxity | 326 | ||
| Classification of Ligament Injuries | 326 | ||
| Sprain | 326 | ||
| Instability | 326 | ||
| Rotatory Instability | 326 | ||
| Anteromedial Rotatory Instability | 326 | ||
| Anterolateral Rotatory Instability | 327 | ||
| Posterolateral Rotatory Instability | 327 | ||
| Posteromedial Rotatory Instability | 327 | ||
| Combined Anteromedial and Anterolateral Rotatory Instability | 328 | ||
| Combined Anterolateral and Posterolateral Rotatory Instability | 328 | ||
| Combined Anteromedial and Posteromedial Rotatory Instability | 328 | ||
| Straight Instability | 328 | ||
| Straight Medial Instability | 328 | ||
| Straight Lateral Instability | 328 | ||
| Straight Posterior Instability | 328 | ||
| Straight Anterior Instability | 328 | ||
| Noyes and Grood Rotatory Instability Model | 328 | ||
| Determination of Knee Ligament Instability | 329 | ||
| Ligament Injury Tests | 330 | ||
| Valgus Stress Test | 330 | ||
| Varus Stress Test | 330 | ||
| Anterior Drawer Test | 330 | ||
| Lachman Test | 331 | ||
| Pivot-Shift Test | 331 | ||
| Posterior Drawer Test | 332 | ||
| Quadriceps Active Test | 333 | ||
| Reverse Pivot-Shift Test | 333 | ||
| Ligament Testing Devices Used in Classification | 333 | ||
| Knee Ligament Rating Systems | 334 | ||
| Key References | 338 | ||
| References | 338.e1 | ||
| 38 Sports Knee Rating Systems and Related Statistics | 339 | ||
| Selecting the Most Appropriate Self-Report Outcome Instrument | 339 | ||
| General Outcome and Quality of Life Scales | 339 | ||
| Medical Outcomes 36-Item Short Form Health Survey | 339 | ||
| Global Rating of Change | 339 | ||
| Visual Analogue Scale | 340 | ||
| Tegner Activity Scale | 341 | ||
| Knee-Specific Outcomes Scales | 341 | ||
| International Knee Documentation Committee Subjective Knee Form | 341 | ||
| Western Ontario and McMaster Universities Osteoarthritis Index | 341 | ||
| Knee Injury and Osteoarthritis Outcome Score | 342 | ||
| Kujala Anterior Knee Pain Scale | 342 | ||
| Other Common Scales | 342 | ||
| Common Statistical Concepts in Outcomes Research | 343 | ||
| Prevalence and Incidence | 343 | ||
| Relative Risk and Odds Ratio | 343 | ||
| Reliability, Validity, Accuracy, and Precision | 344 | ||
| Sensitivity, Specificity, and Likelihood Ratios | 344 | ||
| Hypothesis Testing Using Outcomes Data | 344 | ||
| Parametric and Nonparametric Inferential Statistics | 345 | ||
| Statistical Tests for Comparing Two Groups | 345 | ||
| Statistical Tests for Comparing More Than Two Groups | 346 | ||
| Post Hoc Tests | 346 | ||
| Statistical Tests for Categorical Data | 346 | ||
| Statistical Tests for Describing Relationships | 346 | ||
| Probability Values and Statistical Error | 346 | ||
| Minimal Clinically Important Difference | 346 | ||
| Key References | 347 | ||
| References | 347.e1 | ||
| 39 Medial Ligamentous Injuries of the Knee: | 348 | ||
| Introduction | 348 | ||
| Anatomy and Biomechanics | 348 | ||
| Diagnosis | 348 | ||
| Imaging | 349 | ||
| Treatment | 351 | ||
| Brace Wear | 351 | ||
| Isolated MCL Injury | 351 | ||
| Combined Injuries | 352 | ||
| ACL/MCL | 352 | ||
| ACL/PCL/MCL | 352 | ||
| Reconstruction Techniques | 353 | ||
| Authors’ Preferred Treatment | 353 | ||
| Surgical Technique | 353 | ||
| Key References | 355 | ||
| References | 355.e1 | ||
| 40 Fibular Collateral Ligament and the Posterolateral Corner | 356 | ||
| Anatomy | 356 | ||
| Fibular Collateral Ligament | 356 | ||
| Popliteus Tendon | 356 | ||
| Popliteofibular Ligament | 356 | ||
| Lateral Gastrocnemius Tendon and Fabellofibular Ligament | 356 | ||
| Biceps Femoris Tendon: Long and Short Heads | 356 | ||
| Iliotibial Band | 358 | ||
| Lateral Capsular Thickenings | 358 | ||
| Clinically Relevant Biomechanics of the Posterolateral Knee | 358 | ||
| Varus Stress | 358 | ||
| External Tibial Rotation | 358 | ||
| Internal Tibial Rotation | 358 | ||
| Anterior Tibial Translation | 358 | ||
| Posterior Tibial Translation | 358 | ||
| Injuries to the Fibular Collateral Ligament and Posterolateral Corner | 359 | ||
| Mechanism of Injury | 359 | ||
| History and Physical Examination | 359 | ||
| Varus Stress Test | 359 | ||
| Dial Test | 359 | ||
| External Rotation Recurvatum Test | 360 | ||
| Posterolateral Drawer Test | 360 | ||
| Reverse Pivot Shift | 360 | ||
| Imaging | 360 | ||
| Plain Radiographs | 360 | ||
| Magnetic Resonance Imaging | 361 | ||
| Diagnostic Arthroscopy | 361 | ||
| Treatment | 361 | ||
| Repair | 362 | ||
| Reconstruction | 363 | ||
| Preferred Techniques | 363 | ||
| Fibular Collateral Ligament Reconstruction | 363 | ||
| Posterolateral Corner Reconstruction | 364 | ||
| Postoperative Management | 367 | ||
| Results | 367 | ||
| Chronic Posterolateral Corner Injuries | 368 | ||
| Preferred Technique: Medial Tibial Opening Wedge Osteotomy for Chronic Posterolateral Corner Injury With Varus Malalignment | 368 | ||
| Postoperative Management | 369 | ||
| Results | 369 | ||
| Complications | 369 | ||
| Key References | 370 | ||
| References | 370.e1 | ||
| 41 Anterior Cruciate Ligament Injuries and Reconstruction: | 371 | ||
| History of Anterior Cruciate Ligament Reconstruction | 371 | ||
| Predisposing Factors and Associated Injuries | 371 | ||
| Indications for Reconstruction | 372 | ||
| Timing of Surgery | 373 | ||
| Surgical Technique | 373 | ||
| Diagnostic Arthroscopy | 373 | ||
| Graft Harvesting | 373 | ||
| Graft Preparation | 374 | ||
| Notchplasty | 374 | ||
| Tunnel Placement | 375 | ||
| Graft Passage | 376 | ||
| Graft Fixation | 377 | ||
| Postoperative Management | 379 | ||
| Complications | 379 | ||
| Intra-Operative Complications | 379 | ||
| Postoperative Complications | 380 | ||
| Outcomes | 381 | ||
| Anterior Cruciate Ligament Reconstruction and Development of Arthrosis | 382 | ||
| Graft Choice | 383 | ||
| New Directions | 383 | ||
| Conclusion | 384 | ||
| Acknowledgment. | 384 | ||
| Key References | 384 | ||
| References | 384.e1 | ||
| 42 Bone-Patellar Tendon-Bone Autograft Anterior Cruciate Ligament Reconstruction | 385 | ||
| Advantages of and Contraindications to Bone-Patellar Tendon-Bone Autograft Procedures | 385 | ||
| Advantages | 385 | ||
| Contraindications | 385 | ||
| Surgical Technique | 385 | ||
| Patient Positioning | 385 | ||
| Diagnostic Arthroscopy | 385 | ||
| Graft Procurement | 385 | ||
| Graft Preparation | 387 | ||
| Notch Preparation and Consideration of Notchplasty | 387 | ||
| Tunnel Preparation | 388 | ||
| Tibial Tunnel | 388 | ||
| Femoral Tunnel | 388 | ||
| Transtibial Technique | 388 | ||
| Accessory Medial Portal Technique | 389 | ||
| Two-Incision Technique | 389 | ||
| Graft Passage | 390 | ||
| Graft Fixation | 390 | ||
| Closure | 391 | ||
| Pearls and Pitfalls | 391 | ||
| Pearls | 391 | ||
| Pitfalls | 392 | ||
| Postoperative Management and Rehabilitation | 392 | ||
| Key References | 392 | ||
| References | 392.e1 | ||
| 43 Anterior Cruciate Ligament Reconstruction With Hamstring Tendons | 393 | ||
| Surgical Technique | 396 | ||
| Timing of Surgery | 396 | ||
| Preoperative Considerations | 396 | ||
| Positioning and Examination | 396 | ||
| Hamstring Tendon Harvest and Graft Preparation | 396 | ||
| Arthroscopy and Notch Preparation | 397 | ||
| Tunnel Placement | 398 | ||
| Femoral Tunnel | 398 | ||
| Tibial Tunnel | 398 | ||
| Passage of the Graft | 399 | ||
| Femoral Fixation | 399 | ||
| Graft Tensioning and Tibial Fixation | 399 | ||
| Closure | 399 | ||
| Postoperative Management | 399 | ||
| Common Complications and Their Treatment | 401 | ||
| Summary | 401 | ||
| Key References | 402 | ||
| References | 402.e1 | ||
| 44 Anterior Cruciate Ligament Reconstruction With Central Quadriceps Free Tendon Graft | 403 | ||
| Technique | 403 | ||
| Double-Bundle Reconstruction Using Quadriceps Free Tendon | 403 | ||
| Rehabilitation | 405 | ||
| Key References | 405 | ||
| 45 Allograft Anterior Cruciate Ligament Reconstruction | 406 | ||
| Allograft Considerations | 406 | ||
| Graft Options | 406 | ||
| Graft Procurement and Sterilization | 406 | ||
| Infection | 407 | ||
| Graft Biology | 407 | ||
| Results of Allograft Anterior Cruciate Ligament Reconstruction | 408 | ||
| Operative Considerations | 409 | ||
| Choice of Surgical Technique | 409 | ||
| Patient Evaluation | 409 | ||
| Graft Selection | 410 | ||
| Anesthesia | 410 | ||
| Examination Under Anesthesia | 410 | ||
| Positioning and Setup | 410 | ||
| Arthroscopic Evaluation | 410 | ||
| Procedure | 411 | ||
| Graft Preparation | 411 | ||
| Notch Preparation | 411 | ||
| Tunnel Site Selection | 412 | ||
| Tibial Tunnel | 412 | ||
| Femoral Tunnel | 412 | ||
| Graft Passage | 414 | ||
| Graft Fixation | 414 | ||
| Postoperative Management | 414 | ||
| Key References | 415 | ||
| References | 415.e1 | ||
| 46 Double-Bundle Anterior Cruciate Ligament Reconstruction | 416 | ||
| Anatomy and Biomechanics | 416 | ||
| Preoperative Considerations | 416 | ||
| Patient Evaluation | 416 | ||
| Imaging | 417 | ||
| Indications and Contraindications | 417 | ||
| Technique | 417 | ||
| Setup | 417 | ||
| Graft Selection and Preparation | 418 | ||
| Portal Establishment | 418 | ||
| Defining the Rupture Pattern and Anterior Cruciate Ligament Footprints | 418 | ||
| Tunnel Placement | 419 | ||
| Graft Passage and Fixation | 420 | ||
| Postoperative Rehabilitation | 421 | ||
| Potential Pitfalls and Recommendations | 421 | ||
| Results | 421 | ||
| Conclusion | 421 | ||
| Key References | 421 | ||
| References | 422.e1 | ||
| 47 Anterior Cruciate Ligament Reconstruction via the Anteromedial Portal and Single-Tunnel, Double-Bundle Techniques | 423 | ||
| Anterior Cruciate Ligament Reconstruction via the Anteromedial Portal | 423 | ||
| Technique | 423 | ||
| Discussion | 425 | ||
| Anterior Cruciate Ligament Reconstruction via Single-Tunnel, Double-Bundle Technique | 425 | ||
| Technique | 425 | ||
| Discussion | 427 | ||
| Key References | 427 | ||
| References | 427.e1 | ||
| 48 Complications of Anterior Cruciate Ligament Reconstruction | 428 | ||
| Intraoperative Complications | 428 | ||
| Tunnel Placement | 428 | ||
| Graft Tension | 428 | ||
| Graft Contamination | 429 | ||
| Graft Fixation and Maturation | 429 | ||
| Postoperative Complications | 429 | ||
| Infection | 429 | ||
| Stiffness | 430 | ||
| Graft Failure | 430 | ||
| Arthritis | 430 | ||
| Graft-Specific Complications | 430 | ||
| Bone-Patellar Tendon-Bone Autograft | 431 | ||
| Hamstring Autograft | 431 | ||
| Allograft Tissue | 433 | ||
| Medical Complications | 433 | ||
| Key References | 433 | ||
| References | 434.e1 | ||
| 49 Revision Anterior Cruciate Ligament Reconstruction | 435 | ||
| Causative Factors | 435 | ||
| Loss of Motion | 435 | ||
| Persistent Pain | 435 | ||
| Recurrent Instability | 435 | ||
| Patient Evaluation | 436 | ||
| Surgical Technique | 437 | ||
| Preoperative Planning | 437 | ||
| Anesthesia and Setup | 438 | ||
| Operative Procedure | 438 | ||
| Rehabilitation | 440 | ||
| Conclusion | 440 | ||
| Key References | 441 | ||
| References | 441.e1 | ||
| 50 Revision Anterior Cruciate Ligament Surgery: | 442 | ||
| Preoperative Workup | 442 | ||
| Treatment Options | 443 | ||
| Acceptable Femoral and Tibial Tunnel Locations | 445 | ||
| Unacceptable Femoral Tunnel Location | 446 | ||
| Unacceptable Tibial Tunnel Location | 446 | ||
| Surgical Procedures | 447 | ||
| One-Stage Technique | 447 | ||
| Two-Stage Technique | 448 | ||
| First Stage | 448 | ||
| Interim | 449 | ||
| Second Stage | 449 | ||
| Case Examples | 449 | ||
| Case 1 | 449 | ||
| Case 2 | 451 | ||
| Case 3 | 451 | ||
| Outcomes | 454 | ||
| Conclusion | 456 | ||
| Key References | 457 | ||
| References | 457.e1 | ||
| 51 Osteotomy and the Cruciate-Deficient Knee | 458 | ||
| Cruciate Injury and Arthrosis | 458 | ||
| Indications for Osteotomy | 458 | ||
| Treatment of Cruciate Deficiency and Arthrosis | 459 | ||
| Preoperative Evaluation | 460 | ||
| Surgical Procedure | 461 | ||
| Authors’ Preferred Technique | 461 | ||
| Operative Procedure With Anterior Cruciate Ligament Reconstruction | 461 | ||
| Postoperative Protocol | 462 | ||
| Outcomes | 463 | ||
| Complications | 464 | ||
| Key References | 464 | ||
| References | 464.e1 | ||
| 52 Unicompartmental Knee Arthroplasty in Anterior Cruciate Ligament–Deficient Knees | 465 | ||
| Indications and Contraindications | 465 | ||
| Unicompartmental Knee Arthroplasty in the Anterior Cruciate Ligament–Deficient Knee | 465 | ||
| Author’s Preferred Technique | 466 | ||
| Key References | 468 | ||
| References | 468.e1 | ||
| 53 Rehabilitation of the Surgically Reconstructed and Nonsurgically Treated Anterior Cruciate Ligament | 469 | ||
| Nonoperative Rehabilitation of Anterior Cruciate Ligament Injuries | 469 | ||
| Prescreening Examination Rehabilitation Phase | 470 | ||
| Postscreening Examination Rehabilitation Phase | 471 | ||
| Rehabilitation After Anterior Cruciate Ligament Reconstructive Surgery | 474 | ||
| Surgical Considerations | 474 | ||
| Timing of Surgery and General Rehabilitation Considerations | 474 | ||
| Cryotherapy | 474 | ||
| ROM and Weight Bearing | 475 | ||
| Bracing | 475 | ||
| Electrical Stimulation | 475 | ||
| Supervised versus Home-Based Rehabilitation | 475 | ||
| Proprioceptive Training | 475 | ||
| Closed Kinetic Chain versus Open Kinetic Chain Exercises | 475 | ||
| Accelerated Rehabilitation | 476 | ||
| Preoperative Rehabilitation | 476 | ||
| Postoperative Rehabilitation | 476 | ||
| Week 1 | 476 | ||
| Weeks 2 to 4 | 477 | ||
| Weeks 5 to 12 | 477 | ||
| Weeks 13 to 24 | 479 | ||
| Return to Sports Criteria | 479 | ||
| Rehabilitation Variations Based on Concomitant Procedures | 479 | ||
| Summary | 480 | ||
| Key References | 480 | ||
| References | 480.e1 | ||
| 54 Knee Bracing for Athletic Injuries | 481 | ||
| Rehabilitative Braces | 481 | ||
| Post–Anterior Cruciate Ligament Reconstruction Bracing | 481 | ||
| Prophylactic Knee Braces | 483 | ||
| Advantages and Disadvantages | 483 | ||
| No Benefit to Prophylactic Bracing | 483 | ||
| Potential Benefit to Prophylactic Bracing | 485 | ||
| Performance Impairments With Bracing | 485 | ||
| Functional Knee Braces | 486 | ||
| Biomechanical Findings | 488 | ||
| Patellofemoral Braces | 489 | ||
| Conclusion | 490 | ||
| Unloader Braces | 490 | ||
| Conclusions | 492 | ||
| Summary | 492 | ||
| Key References | 492 | ||
| References | 493.e1 | ||
| 55 Decision Making and Surgical Treatment of Posterior Cruciate Ligament Ruptures | 494 | ||
| Posterior Cruciate Ligament Anatomy | 494 | ||
| Vascular Anatomy and Variations | 495 | ||
| Posterior Cruciate Ligament Fiber Function | 497 | ||
| Diagnosis of Posterior Cruciate Ligament Function and Knee Joint Subluxations | 499 | ||
| Posterior Translation | 499 | ||
| Varus and Valgus Rotations | 500 | ||
| Tibiofemoral Rotational Subluxations | 501 | ||
| Clinical Evaluation | 503 | ||
| Physical Examination | 503 | ||
| Diagnostic Clinical Tests | 504 | ||
| Imaging Studies | 506 | ||
| Management Considerations | 507 | ||
| Posterior Cruciate Ligament Natural History | 507 | ||
| Treatment of Acute Posterior Cruciate Ligament Ruptures | 507 | ||
| Treatment of Chronic Posterior Cruciate Ligament Ruptures | 509 | ||
| Operative Techniques: Current Concepts | 510 | ||
| Surgical Options | 511 | ||
| Tibial Attachment Techniques: Arthroscopic All-Inside versus Open Tibial Inlay Approach | 511 | ||
| Posterior Cruciate Ligament Femoral Attachment Technique: Two-Tunnel versus Single-Tunnel Options | 511 | ||
| Single-Strand versus Two-Strand Posterior Cruciate Ligament Graft Constructs | 512 | ||
| Posterior Cruciate Ligament Grafts for Tibial Inlay and All-Inside Techniques | 513 | ||
| Intraoperative Evaluation | 513 | ||
| Posterior Cruciate Ligament Graft Harvest Options | 513 | ||
| Quadriceps Tendon–Patellar Bone Autograft | 513 | ||
| Achilles Tendon-Bone Allograft | 515 | ||
| Surgical Procedures | 515 | ||
| Anteromedial Approach and Outside-In Femoral Tunnels | 515 | ||
| Posterior Cruciate Ligament All-Inside Technique: One- and Two-Strand Graft Reconstructions | 515 | ||
| Patient Positioning and Setup | 515 | ||
| Tibial Tunnel Preparation | 516 | ||
| Drilling of the Tibial Tunnel | 518 | ||
| Posterior Cruciate Ligament Femoral Graft Technique | 520 | ||
| Femoral Placement of Two Tunnels and Graft Passage | 520 | ||
| Graft Tensioning and Fixation for All-Inside Grafts | 522 | ||
| Femoral Placement of a Single Tunnel: Outside-In Technique | 523 | ||
| Alternative Posterior Cruciate Ligament All-Inside Techniques | 524 | ||
| Femoral Placement of Rectangular (Oval) Tunnel for Bone Plug | 524 | ||
| Two Separate Femoral and Tibial Tunnels and Two Separate Grafts | 526 | ||
| Posterior Cruciate Ligament Arthroscope-Assisted Open Tibial Inlay Technique | 526 | ||
| Posterior Cruciate Ligament Avulsion Fractures | 526 | ||
| Postoperative Rehabilitation | 528 | ||
| Clinical Studies | 529 | ||
| Posterior Cruciate Ligament Two-Strand Procedures | 530 | ||
| Quadriceps Tendon-Patellar Bone Autograft, Tibial Inlay | 530 | ||
| Quadriceps Tendon-Patellar Bone Autograft, Tibial Tunnel | 530 | ||
| Revision Quadriceps Tendon-Patellar Bone Autograft Reconstruction | 530 | ||
| Results of Posterior Cruciate Ligament Two-Strand Reconstructions from Other Investigators | 531 | ||
| Posterolateral Surgical Technique Options | 531 | ||
| Fibular Collateral Ligament Anatomic Reconstruction | 531 | ||
| Popliteus Muscle–Tendon–Ligament Procedures | 533 | ||
| Femoral-Fibular Reconstruction | 533 | ||
| Proximal Advancement of the Posterolateral Structures | 537 | ||
| Key References | 538 | ||
| References | 538.e1 | ||
| 56 Posterior Cruciate Ligament Reconstruction: | 539 | ||
| Anatomy | 539 | ||
| History and Physical Examination | 539 | ||
| Tibial Inlay Technique | 541 | ||
| Examination Under Anesthesia, Patient Positioning, and Diagnostic Arthroscopy | 541 | ||
| Patellar Graft Harvest | 541 | ||
| Graft Preparation | 541 | ||
| Femoral Tunnel Placement | 542 | ||
| Posterior Approach and Inlay | 542 | ||
| Graft Passage and Fixation | 544 | ||
| Closure | 545 | ||
| Postoperative Rehabilitation Program | 545 | ||
| Complications | 545 | ||
| Summary | 546 | ||
| Key References | 546 | ||
| References | 547.e1 | ||
| 57 Posterior Cruciate Ligament Reconstruction: | 548 | ||
| Surgical Indications | 548 | ||
| Surgical Timing | 548 | ||
| Graft Selection | 549 | ||
| Posterior Cruciate Ligament Reconstruction Surgical Technique | 549 | ||
| ACL Reconstruction | 552 | ||
| Posterolateral Reconstruction Surgical Technique | 552 | ||
| Medial Posteromedial Reconstruction | 553 | ||
| Overview of Graft Tensioning and Fixation | 554 | ||
| Postoperative Rehabilitation | 554 | ||
| Author’s Results of PCL Reconstruction | 554 | ||
| Author’s Double-Bundle Compared With Single-Bundle PCL Reconstruction Results | 555 | ||
| Summary | 556 | ||
| Key References | 556 | ||
| References | 556.e1 | ||
| 58 Posterior Cruciate Ligament Reconstruction: | 557 | ||
| Scientific Rationale | 557 | ||
| Mechanoreceptors in the Posterior Cruciate Ligament | 557 | ||
| Mechanoreceptors on the Remnant Fibers | 557 | ||
| Functions and Anatomy of the Meniscofemoral Ligaments | 557 | ||
| Surgical Indications | 558 | ||
| Surgical Technique | 558 | ||
| Arthroscopic Portals | 558 | ||
| Tibial Tunnel Preparation | 558 | ||
| Author’s Tips | 559 | ||
| Femoral Socket Preparation | 560 | ||
| Author’s Tips | 560 | ||
| Graft Preparation | 561 | ||
| Graft Passage | 561 | ||
| Graft Fixation | 561 | ||
| Additional Surgery | 562 | ||
| Postoperative Rehabilitation | 563 | ||
| Clinical Results | 563 | ||
| Author’s Experience | 563 | ||
| Conclusions | 564 | ||
| Acknowledgments. | 564 | ||
| Key References | 564 | ||
| References | 564.e1 | ||
| 59 The Dislocated Knee | 565 | ||
| Incidence | 565 | ||
| Mechanism | 565 | ||
| Vascular Injury | 565 | ||
| Neurologic Injury | 567 | ||
| Classification | 567 | ||
| Descriptive | 567 | ||
| Anterior Dislocation | 567 | ||
| Posterior Dislocation | 567 | ||
| Medial and Lateral Dislocations | 568 | ||
| Rotatory Dislocation | 568 | ||
| Anatomic | 568 | ||
| Evaluation | 569 | ||
| Treatment | 570 | ||
| Urgent Surgical Intervention | 570 | ||
| Nonoperative Management | 570 | ||
| Operative Management | 570 | ||
| Vascular Injury | 571 | ||
| Neurologic Injury | 571 | ||
| Current Surgical Controversies | 572 | ||
| Authors’ Approach | 572 | ||
| Timing | 572 | ||
| Anesthesia, Positioning, Surface Anatomy, and Examination Under Anesthesia | 573 | ||
| Surgical Approach | 575 | ||
| Graft Selection | 575 | ||
| Intra-articular Preparation | 575 | ||
| Cruciate Tunnel Preparation, Graft Passage, and Proximal Fixation | 576 | ||
| Cruciate and Medial-Sided Injury | 577 | ||
| Cruciate and Lateral-Sided Injury | 578 | ||
| Cruciate, Medial, and Lateral- Sided Injuries | 580 | ||
| Tensioning and Distal Fixation | 580 | ||
| Postoperative Regimen | 580 | ||
| Conclusion | 581 | ||
| Key References | 581 | ||
| References | 581.e1 | ||
| 60 Dislocation of the Proximal Tibiofibular Joint | 582 | ||
| Anatomy | 582 | ||
| Classification of Instability | 584 | ||
| Clinical Presentation | 584 | ||
| Physical Examination | 585 | ||
| Imaging Studies | 585 | ||
| Treatment of Instability | 586 | ||
| Conclusion | 588 | ||
| Key References | 589 | ||
| References | 589.e1 | ||
| 6 Sports Medicine: Patellar and Extensor Mechanism Disorders | 591 | ||
| 61 Disorders of the Patellofemoral Joint | 592 | ||
| Basic Anatomy and Biomechanics | 592 | ||
| Patellofemoral Disorders: Analysis | 594 | ||
| Clinical Symptoms | 594 | ||
| Physical Examination | 595 | ||
| Imaging | 596 | ||
| X-ray Analysis | 596 | ||
| AP View | 596 | ||
| Lateral View | 597 | ||
| Trochlea | 597 | ||
| Patella | 599 | ||
| Patellar Height. | 599 | ||
| Axial View | 600 | ||
| Merchant View | 601 | ||
| Laurin View | 602 | ||
| Malghem and Maldague Lateral Rotation View (30 Degrees LR) | 602 | ||
| Computed Tomography | 604 | ||
| The Protocol (Lyon’s Protocol) | 605 | ||
| Image Acquisition (Volumic Acquisition) | 605 | ||
| Knee-Specific Volumic Acquisition | 605 | ||
| Tibial Tubercle-Trochlear Groove Distance (TT-TG) | 605 | ||
| Patellar Tilt | 605 | ||
| Femoral Anteversion | 606 | ||
| External Tibial Torsion | 606 | ||
| Magnetic Resonance Imaging | 607 | ||
| Patellofemoral Instability | 610 | ||
| First Dislocation Management | 611 | ||
| Chronic Dislocation Management | 612 | ||
| Soft Tissue Procedures | 612 | ||
| Bony Procedures | 614 | ||
| Tibial Tubercle Transfers | 614 | ||
| Medial Tibial Tubercle Transfer. | 614 | ||
| Distal Tibial Tubercle Transfer. | 614 | ||
| Patellar Tendon Tenodesis. | 615 | ||
| Trochleoplasties | 615 | ||
| Lateral Facet–Elevating Trochleoplasty. | 616 | ||
| Sulcus-Deepening Trochleoplasty. | 616 | ||
| Bereiter’s Trochleoplasty. | 617 | ||
| Patellar Osteotomy | 617 | ||
| Femoral and Tibial Osteotomies. | 617 | ||
| Painful Patellar Syndrome (PPS)—Patellofemoral Pain Syndrome | 617 | ||
| Chondromalacia Patellae | 619 | ||
| Patellofemoral Arthritis | 619 | ||
| Lateral Retinacular Release and Vertical Lateral Patellectomy (Facetectomy) | 620 | ||
| Tibial Tubercle Osteotomies | 620 | ||
| Prosthetic Replacement | 620 | ||
| Patella Infera | 621 | ||
| Proximal Transfer of the Tibial Tubercle | 622 | ||
| Treatment by Lengthening of the Patellar Tendon | 623 | ||
| Key References | 623 | ||
| References | 623.e1 | ||
| 62 Distal Realignment of the Patellofemoral Joint: Indications, Effects, Results, and Recommendations | 624 | ||
| Pathophysiology of Patellofemoral Pain and Instability: Implications for Treatment | 624 | ||
| Observation | 625 | ||
| Provocative Tests | 626 | ||
| Palpation | 626 | ||
| Stability Testing | 627 | ||
| Flexibility | 628 | ||
| Radiologic Evaluation | 628 | ||
| Nonoperative Management | 629 | ||
| A Rational Approach to Distal Realignment | 630 | ||
| Distal Realignment Procedures | 630 | ||
| Theory | 630 | ||
| Clinical Data | 630 | ||
| Soft Tissue Medialization | 630 | ||
| Tuberosity Transfers | 631 | ||
| Anteriorization | 632 | ||
| Theory | 632 | ||
| Laboratory Data | 632 | ||
| Clinical Experience | 633 | ||
| Anteromedialization | 633 | ||
| Clinical Experience | 634 | ||
| Complications of Distal Realignment | 635 | ||
| Fulkerson’s Technique of Anteromedialization | 635 | ||
| Postoperative Care | 637 | ||
| Anteriorization | 638 | ||
| Clinical Experience | 638 | ||
| Our Recommended Treatment Approach | 638 | ||
| Patellofemoral Malalignment | 638 | ||
| Tilt | 638 | ||
| Lateral Translation (Subluxation) and Tilt Without Severe Chondral Damage | 638 | ||
| Lateral Translation (Subluxation) and Tilt With More Severe Chondral Damage or Arthrosis | 638 | ||
| Lateral Translation (Subluxation) | 639 | ||
| Patella Alta | 639 | ||
| Medial Patellofemoral Ligament (MPFL) Reconstruction Without Tibial Tubercle Transfer | 639 | ||
| Summary | 639 | ||
| Key References | 639 | ||
| References | 639.e1 | ||
| 63 Surgery of the Patellofemoral Joint: | 640 | ||
| Pathophysiology of Patellar Instability | 640 | ||
| Presentation of Patellofemoral Disorders | 640 | ||
| Pain | 640 | ||
| Instability | 641 | ||
| Locking | 641 | ||
| Swelling | 641 | ||
| Physical Examination | 642 | ||
| The Q Angle (Quadriceps Angle) | 643 | ||
| Summary of Physical Examination for Patellofemoral Instability | 647 | ||
| Radiographic Studies in the Diagnosis and Treatment of Patellofemoral Instability | 647 | ||
| Radiography | 647 | ||
| Anteroposterior View | 647 | ||
| Lateral View | 647 | ||
| Blumensaat’s Line. | 647 | ||
| Insall-Salvati Method. | 648 | ||
| Blackburne-Peel Ratio. | 648 | ||
| Modified Insall-Salvati Ratio. | 649 | ||
| Lyon School. | 650 | ||
| Norman Index. | 650 | ||
| MRI Method. | 651 | ||
| Conclusions and Author’s Recommendations. | 651 | ||
| Evaluating for Patellofemoral Dysplasia | 651 | ||
| Axial Views | 655 | ||
| Computed Tomography | 659 | ||
| Magnetic Resonance Imaging | 662 | ||
| Classification of Patellar Subluxation and Dislocation | 665 | ||
| Characteristics of Acute Patellar Dislocation | 666 | ||
| Physical Examination of Acute Patellar Dislocation | 667 | ||
| Chronic Subluxations and Dislocations | 667 | ||
| Treatments | 668 | ||
| Nonoperative Treatment | 668 | ||
| Operative Treatment | 669 | ||
| Lateral Release and Proximal Realignment | 669 | ||
| Lateral Retinacular Release. | 669 | ||
| Insall’s Proximal Realignment. | 670 | ||
| Results of Insall Proximal Realignment Procedure | 674 | ||
| Arthroscopically Assisted Proximal Soft Tissue Plication Procedures | 675 | ||
| Conclusion/Summary of Chapter | 676 | ||
| Acknowledgment. | 676 | ||
| Key References | 676 | ||
| References | 676.e1 | ||
| 64 Repair and Reconstruction of the Medial Patellofemoral Ligament for Treatment of Lateral Patellar Dislocations: | 677 | ||
| Surgical Indications | 677 | ||
| Anatomy of the Medial Side of the Knee: Surgical Implications | 677 | ||
| Medial Patellofemoral Ligament Repair | 677 | ||
| Primary Repair of the Medial Patellofemoral Ligament | 677 | ||
| Medial Patellofemoral Ligament Repair Technique | 678 | ||
| Rehabilitation After Medial Patellofemoral Ligament Repair | 679 | ||
| Medial Patellofemoral Ligament Reconstruction | 679 | ||
| Basic Principles | 679 | ||
| Procedures | 681 | ||
| Double-Strand Gracilis Autograft | 681 | ||
| Combined Medial Patellofemoral Ligament Repair and Medial Patellotibial Ligament Reconstruction | 682 | ||
| Single-Strand Middle Third Quadriceps Tendon Autograft | 683 | ||
| Single-Strand Adductor Magnus Split Tendon Transfer | 684 | ||
| Adductor Sling Technique | 684 | ||
| Medial Collateral Ligament Sling Technique | 685 | ||
| Rehabilitation After Medial Patellofemoral Ligament Repair Reconstruction | 685 | ||
| Skeletally Immature Patients | 686 | ||
| Complications | 686 | ||
| Supplementary Surgical Procedures | 686 | ||
| Clinical Results | 686 | ||
| Conclusions | 687 | ||
| Key References | 687 | ||
| References | 687.e1 | ||
| 65 Sulcus-Deepening Trochleoplasty | 688 | ||
| Normal and Pathologic Anatomy | 688 | ||
| Function and Biomechanics | 689 | ||
| Indications | 690 | ||
| Procedures and Options | 690 | ||
| Lateral Facet–Elevating Trochleoplasty | 690 | ||
| Sulcus-Deepening Trochleoplasty | 690 | ||
| Bereiter Trochleoplasty | 692 | ||
| Postoperative Care | 692 | ||
| Results | 693 | ||
| Group I | 693 | ||
| Group II | 694 | ||
| Complications | 695 | ||
| Conclusion | 695 | ||
| Key References | 695 | ||
| References | 695.e1 | ||
| 66 Quadriceps and Patellar Tendon Disruption* | 696 | ||
| Anatomy | 696 | ||
| Causes of Extensor Mechanism Disruption | 696 | ||
| Quadriceps Tendon Rupture | 697 | ||
| Overview of Surgical Management | 697 | ||
| Procedures | 698 | ||
| Acute Disruption | 698 | ||
| Chronic (Neglected) Disruption | 701 | ||
| Results of Surgical Management of Quadriceps Tendon Rupture | 703 | ||
| Quadriceps Tendon Disruption Associated With Total Knee Arthroplasty | 703 | ||
| Patellar Tendon Rupture | 703 | ||
| Overview | 703 | ||
| Procedures | 704 | ||
| Acute Disruption | 704 | ||
| Chronic (Neglected) Disruption | 706 | ||
| Results of Surgical Repair of Patellar Tendon Disruption | 707 | ||
| Patellar Tendon Disruption Associated With Total Knee Arthroplasty | 707 | ||
| Key References | 710 | ||
| References | 710.e1 | ||
| 7 Knee Arthritis | 711 | ||
| 67 Gout and Other Crystalline Arthropathies | 712 | ||
| Crystalline Arthropathies | 712 | ||
| Gout | 712 | ||
| Acute Gout: Presentation and Evaluation | 712 | ||
| Chronic Gout | 714 | ||
| Diagnosing Gout | 714 | ||
| Treatment | 714 | ||
| Treating Acute Gouty Arthropathy | 714 | ||
| Prophylaxis of Attacks | 715 | ||
| Urate Lowering: Addressing the Root of the Problem | 715 | ||
| Pseudogout | 716 | ||
| Other Crystal Deposition Diseases | 717 | ||
| Key References | 717 | ||
| References | 717.e1 | ||
| 68 Knee Osteoarthritis | 718 | ||
| Lessons from Epidemiology/Role of Joint Stress | 718 | ||
| Lessons from Radiology | 720 | ||
| Lessons from Cell Biology and Genetics | 720 | ||
| Therapy | 721 | ||
| Conclusion | 722 | ||
| Key References | 722 | ||
| References | 722.e1 | ||
| 69 Overview of Psoriatic Arthritis | 723 | ||
| General Considerations | 723 | ||
| Epidemiology | 723 | ||
| Patterns of Arthritis | 723 | ||
| Radiographic Features | 723 | ||
| Immunogenetics | 723 | ||
| Immunopathogenesis and Synovial Histology | 723 | ||
| Medical Comorbidities | 726 | ||
| Agents Used to Treat Psoriasis and Psoriatic Arthritis | 726 | ||
| Unique Management Issues | 726 | ||
| Surgical Problems | 726 | ||
| Psoriasis at Incision Site | 726 | ||
| Heterotopic Ossification | 726 | ||
| Other Issues | 726 | ||
| Immunosuppressive Therapy | 726 | ||
| Thromboembolic Disease | 726 | ||
| Arthrofibrosis | 727 | ||
| Enthesitis | 727 | ||
| Postoperative Inflammation of the Operative Site | 727 | ||
| Key References | 727 | ||
| 70 Systemic Allergic Dermatitis in Total Knee Arthroplasty | 728 | ||
| Systemic Allergic Dermatitis | 728 | ||
| Pathophysiology | 728 | ||
| Other Types of Reaction to Implants | 729 | ||
| Epidemiology | 729 | ||
| Allergenic Substances Used in Orthopedics | 729 | ||
| Genetics of Contact Sensitization | 729 | ||
| Prevalence of Contact Sensitization | 729 | ||
| Risk Factors | 730 | ||
| For Nickel Sensitivity | 730 | ||
| For Chromium Sensitivity | 730 | ||
| For Cobalt Sensitivity | 730 | ||
| Sensitivity to Implants | 730 | ||
| Systemic Allergic Dermatitis to Implants | 730 | ||
| Development of a New Hapten Sensitization from Prosthesis Implantation | 731 | ||
| Workup Prior to Implantation | 732 | ||
| History and Physical Examination | 732 | ||
| Patch Testing | 732 | ||
| Post–Knee Arthroplasty | 733 | ||
| Clinical Cutaneous Signs of Sensitivity | 733 | ||
| Workup After Implantation | 733 | ||
| Conclusions | 733 | ||
| Key References | 733 | ||
| References | 733.e1 | ||
| 71 Rheumatoid Arthritis of the Knee: | 734 | ||
| Key References | 737 | ||
| References | 737.e1 | ||
| 8 Miscellaneous Conditions and Treatments | 739 | ||
| Chapter 72 | 740 | ||
| 72 The Synovium: | e190 | ||
| Normal Synovium: Microanatomy and Function | e190 | ||
| Microanatomic Structure | e190 | ||
| Ultrastructure | e191 | ||
| Functions of the Synovium | e193 | ||
| Synovial Fluid | e194 | ||
| Iron-Related Changes | e195 | ||
| Hemosideric Synovitis | e197 | ||
| Hemophilia | e198 | ||
| Hemochromatosis | e200 | ||
| Lead Synovitis | e200 | ||
| Arthritis | e201 | ||
| Degenerative Joint Disease and Rheumatoid Arthritis | e201 | ||
| Variants | e203 | ||
| Crystal-Induced Synovitis | e203 | ||
| Gout | e203 | ||
| Calcium Pyrophosphate Dihydrate Crystal Deposition | e206 | ||
| Hydroxyapatite Deposition | e207 | ||
| Corticosteroid-Related Pathology | e207 | ||
| Transient Synovitis | e207 | ||
| Hylan Viscosupplementation | e207 | ||
| Plica | e208 | ||
| Tumors | e208 | ||
| Synovial Hemangioma | e208 | ||
| Hoffa’s Disease and Lipoma Arborescens | e209 | ||
| Juxta-articular Myoma | e210 | ||
| Synovial (and Ganglion) Cysts | e210 | ||
| Loose Bodies (“Joint Mice”) | e210 | ||
| Secondary Chondromatosis | e210 | ||
| Primary Synovial Chondromatosis (Synovial Osteochondromatosis) | e211 | ||
| Synovial Chondrosarcoma | e214 | ||
| Pigmented Villonodular Synovitis | e214 | ||
| Synovium (Miscellaneous) | e217 | ||
| Malignant Tumors | e218 | ||
| Epithelioid Sarcoma | e218 | ||
| Clear Cell Sarcoma | e218 | ||
| Alveolar Soft Part Sarcoma | e219 | ||
| Synovial Sarcoma | e219 | ||
| Key References | e221 | ||
| References | e221 | ||
| 73 Hemophilia and Pigmented Villonodular Synovitis | e223 | ||
| Hemophilia | e223 | ||
| Laboratory Evaluation | e223 | ||
| Clinical Manifestations | e224 | ||
| Factor Replacement Therapy | e224 | ||
| Potential Risks of Clotting Factor Concentrates: Blood-Borne Pathogens | e225 | ||
| Treatment of Inhibitors | e225 | ||
| Pathophysiology of Hemophilic Arthropathy | e225 | ||
| Radiology of Hemophilic Arthropathy of the Knee | e226 | ||
| Pseudotumors | e227 | ||
| Treatment | e227 | ||
| Nonsurgical | e227 | ||
| Prophylaxis | e228 | ||
| Medical Therapy | e228 | ||
| Surgical Therapy | e228 | ||
| Open Synovectomy | e228 | ||
| Joint Débridement | e229 | ||
| Arthroscopic Synovectomy | e229 | ||
| Radiation Synovectomy | e229 | ||
| Osteotomy | e230 | ||
| Arthrodesis | e230 | ||
| Total Knee Replacement | e230 | ||
| Pigmented Villonodular Synovitis | e233 | ||
| Key References | e235 | ||
| References | e235 | ||
| Chapter 74 | 741 | ||
| 74 Anesthesia for Knee Surgery | e237 | ||
| Preoperative Assessment | e237 | ||
| Intraoperative Anesthesia | e238 | ||
| Choice of Anesthetic Technique | e238 | ||
| Monitoring Requirements | e238 | ||
| Blood Loss and Pneumatic Tourniquet Inflation | e238 | ||
| Postoperative Analgesia | e238 | ||
| Multimodal Analgesia | e239 | ||
| Systemic Analgesics | e239 | ||
| Opioid Analgesics | e239 | ||
| Nonopioid Analgesics (Acetaminophen and Nonsteroidal Anti-Inflammatory Drugs) | e239 | ||
| Neuraxial Analgesia | e241 | ||
| Single-Dose Spinal and Epidural Opioids | e241 | ||
| Epidural Analgesia | e241 | ||
| Peripheral Regional Anesthetic Techniques | e242 | ||
| Neuraxial Anesthesia and Analgesia in the Orthopedic Patient Receiving Antithrombotic Therapy | e243 | ||
| Ambulatory Knee Arthroscopy and Ligament Reconstruction | e244 | ||
| Key References | e246 | ||
| References | e246 | ||
| 75 Complex Regional Pain Syndrome of the Knee | e248 | ||
| Etiology and Pathophysiology | e248 | ||
| Diagnosis | e249 | ||
| Diagnostic Tests | e250 | ||
| Radiographs | e250 | ||
| Thermography | e250 | ||
| Bone Scans | e250 | ||
| Magnetic Resonance Imaging | e250 | ||
| Sympathetic Blockade | e250 | ||
| Treatment Methods | e251 | ||
| Early Mobilization Using Physical and Occupational Therapy | e251 | ||
| Oral Medication | e251 | ||
| Intravenous Medication | e251 | ||
| Topical Agents | e252 | ||
| Psychologic Counseling | e252 | ||
| Immune Modulation | e252 | ||
| Intravenous Regional Anesthesia and Regional Sympathetic Blocks | e252 | ||
| Spinal Cord Stimulation and Intrathecal Infusions | e252 | ||
| Sympathectomy | e253 | ||
| Surgical Procedures | e253 | ||
| Amputation | e253 | ||
| Prognosis | e253 | ||
| Summary | e253 | ||
| Key References | e253 | ||
| References | e253 | ||
| Chapter 76 | 742 | ||
| 76 Partial Denervation for the Treatment of Painful Neuromas Complicating Total Knee Replacement | e255 | ||
| Pathophysiology of Neuroma Formation | e255 | ||
| Treatment of a Painful Neuroma | e256 | ||
| History of Partial Joint Denervation in the Extremities | e256 | ||
| Cutaneous Innervation of the Knee Region | e257 | ||
| Innervation of the Knee Joint | e258 | ||
| Innervation of the Proximal Tibiofibular Joint | e259 | ||
| Rationale for Denervation for Persistent Pain After Total Knee Arthroplasty | e260 | ||
| Diagnosis of Knee Pain of Neural Origin | e260 | ||
| Operative Technique | e262 | ||
| Postoperative Care | e265 | ||
| Rehabilitation | e265 | ||
| Complications | e265 | ||
| Results of Partial Knee Denervation | e266 | ||
| Conclusion | e267 | ||
| Key References | e267 | ||
| References | e267 | ||
| 77 HIV Infection and Its Relationship to Knee Disorders | e269 | ||
| Epidemiology of HIV Infection | e269 | ||
| HIV Virology | e270 | ||
| Transmission of HIV | e270 | ||
| Sexual Transmission | e270 | ||
| Transmission Associated With Intravenous Drug Use | e271 | ||
| Transmission by Blood Transfusion and Bone Grafts | e271 | ||
| Transmission Related to Sports | e271 | ||
| Occupational Transmission of HIV from Patient to Provider | e272 | ||
| HIV-Infected Health Care Workers: Risk of Transmission to Patients | e273 | ||
| Diagnosis of HIV Infection | e273 | ||
| Clinical Manifestations of HIV Infection | e274 | ||
| Primary HIV Infection | e275 | ||
| Asymptomatic Infection | e275 | ||
| Early Symptomatic Disease, AIDS, and Opportunistic Infections and Tumors | e275 | ||
| Treatment of HIV Infection | e276 | ||
| Management of Antiretroviral Drugs | e276 | ||
| Specific Issues Related to Perioperative Management of HIV-Infected Patients | e276 | ||
| Perioperative Morbidity and Mortality | e276 | ||
| Preoperative Evaluation of HIV-Infected Patients | e276 | ||
| Postoperative Management of HIV-Infected Patients | e277 | ||
| Management of Occupational Exposure to HIV | e277 | ||
| HIV Infection and Musculoskeletal Disease | e277 | ||
| Musculoskeletal Infections | e277 | ||
| Noninfectious Inflammatory Conditions of the Joints | e278 | ||
| Avascular Necrosis | e279 | ||
| Osteoporosis and Fragility Fractures | e280 | ||
| Summary | e280 | ||
| Key References | e280 | ||
| References | e280 | ||
| 9 Plastic Surgery | 743 | ||
| 78 Soft Tissue Healing | 744 | ||
| History | 744 | ||
| Phases of Wound Healing | 744 | ||
| Inflammation Phase | 745 | ||
| Fibroblastic Proliferative Phase | 745 | ||
| Wound Maturation Phase | 745 | ||
| Cellular Elements of Healing | 745 | ||
| Factors Affecting Soft Tissue Healing | 745 | ||
| Scarring and Tissue Perfusion | 745 | ||
| Smoking | 746 | ||
| Diabetes Mellitus | 746 | ||
| Other Factors | 747 | ||
| Anemia | 747 | ||
| Radiation Exposure | 747 | ||
| Steroids | 747 | ||
| Aspirin and Nonsteroidal Medications | 748 | ||
| Chemotherapy | 748 | ||
| Age | 748 | ||
| Nutrition | 748 | ||
| Vitamin C | 748 | ||
| Zinc | 748 | ||
| Vitamin E | 748 | ||
| Mechanical Stress of Healing | 748 | ||
| Skin Closure | 749 | ||
| Skin Healing | 749 | ||
| Preoperative Preparation | 749 | ||
| Intraoperative Factors | 750 | ||
| Postoperative Factors | 751 | ||
| Elements of Wound Care | 752 | ||
| Influence of Growth Factors | 753 | ||
| Key References | 753 | ||
| References | 753.e1 | ||
| 79 The Problem Wound: | 754 | ||
| Local Soft Tissue Manipulation | 754 | ||
| Sham Incision | 754 | ||
| Soft Tissue Expansion | 754 | ||
| The Problem Wound | 755 | ||
| Skin Grafting | 755 | ||
| Muscle and Myocutaneous Flaps | 756 | ||
| Fascial and Fasciocutaneous Flaps | 757 | ||
| Free Flap Coverage | 758 | ||
| Conclusion | 759 | ||
| Key References | 759 | ||
| References | 759.e1 | ||
| 10 Fractures About the Knee | 761 | ||
| 80 Distal Femur Fractures | 762 | ||
| Anatomy | 762 | ||
| General Anatomy | 762 | ||
| Radiographic Anatomy | 762 | ||
| Surface Anatomy | 762 | ||
| Incidence and Etiology | 762 | ||
| Classification | 763 | ||
| Diagnosis | 763 | ||
| History and Physical Examination | 763 | ||
| Radiographic Examination | 763 | ||
| Management | 765 | ||
| Conservative versus Operative Management | 765 | ||
| Surgical Approaches | 765 | ||
| Lateral | 765 | ||
| Alternative Exposures | 765 | ||
| Medial | 765 | ||
| Anteromedial and Anterolateral | 765 | ||
| Anterior | 765 | ||
| Implants—Design and Function | 765 | ||
| Treatment | 766 | ||
| Conservative Treatment | 766 | ||
| Operative Management | 766 | ||
| Operative Treatment: General Principles | 768 | ||
| Intramedullary Devices | 768 | ||
| Plates | 769 | ||
| Complications | 770 | ||
| Summary and Future Directions | 772 | ||
| Key References | 772 | ||
| References | 772.e1 | ||
| 81 Tibial Plateau Fractures | 773 | ||
| Relevant Anatomy | 773 | ||
| Mechanism of Injury | 773 | ||
| Classification | 773 | ||
| Clinical Evaluation | 775 | ||
| History | 775 | ||
| Physical Examination | 775 | ||
| Imaging Studies | 776 | ||
| Angiography | 776 | ||
| Treatment | 776 | ||
| Initial Management | 776 | ||
| Nonoperative Management | 777 | ||
| Operative Management | 777 | ||
| Schatzker Injuries | 777 | ||
| Type I | 777 | ||
| Type II | 778 | ||
| Type III | 779 | ||
| Type IV | 779 | ||
| Types V and VI | 781 | ||
| Open Fractures | 783 | ||
| Orthobiologic Agents | 783 | ||
| Complications | 783 | ||
| Infection | 783 | ||
| Arthrofibrosis | 783 | ||
| Post-Traumatic Complications | 783 | ||
| Nonunion | 784 | ||
| Conclusions | 785 | ||
| Key References | 785 | ||
| References | 785.e1 | ||
| 82 Fractures of the Patella | 786 | ||
| Anatomy | 786 | ||
| Biomechanics | 786 | ||
| Diagnosis | 787 | ||
| History and Physical Examination | 787 | ||
| Diagnostic Studies | 788 | ||
| Classification | 789 | ||
| Nonoperative Treatment | 789 | ||
| Operative Treatment | 790 | ||
| Internal Fixation | 790 | ||
| External Fixation | 794 | ||
| Partial Patellectomy | 794 | ||
| Total Patellectomy | 795 | ||
| Complications | 796 | ||
| Loss of Knee Motion | 796 | ||
| Infection | 796 | ||
| Loss of Reduction | 796 | ||
| Osteoarthrosis | 796 | ||
| Hardware Irritation | 796 | ||
| Delayed Union and Nonunion | 796 | ||
| Patellar Fracture in Total Knee Arthroplasty | 796 | ||
| Summary | 797 | ||
| Key References | 798 | ||
| References | 798.e1 | ||
| 83 Treatment of Periprosthetic Fractures Around a Total Knee Arthroplasty | 799 | ||
| Patient Evaluation | 799 | ||
| Open Reduction and Internal Fixation | 799 | ||
| Supracondylar Periprosthetic Fractures | 799 | ||
| Percutaneous Technique of Distal End of the Femur Using Locked Plating Designs | 802 | ||
| Periprosthetic Tibial Fractures | 803 | ||
| Role of Revision Arthroplasty | 804 | ||
| Supracondylar Fractures | 806 | ||
| Periprosthetic Fractures of the Tibia | 806 | ||
| Conclusions | 806 | ||
| Key References | 806 | ||
| References | 807.e1 | ||
| 11 Pediatric Knee | 809 | ||
| 84 Normal Knee Embryology and Development | 810 | ||
| Overview of Embryology | 810 | ||
| Timing and Staging of Development | 810 | ||
| Normal Sequential Embryologic Development of the Knee* | 810 | ||
| Week 6 | 810 | ||
| Week 7 | 810 | ||
| Week 8 | 810 | ||
| Week 10 | 810 | ||
| Week 12.5 | 810 | ||
| Week 15.5 | 810 | ||
| Week 16.5 | 811 | ||
| Week 18 | 811 | ||
| Week 19 | 812 | ||
| Week 20 | 812 | ||
| Week 40 (Full Term) | 812 | ||
| Embryologic Development of Variants and Specific Abnormalities | 812 | ||
| Discoid Lateral Meniscus | 812 | ||
| Congenital Dislocation of the Knee | 815 | ||
| Bipartite Patella | 815 | ||
| Synovial Plica | 815 | ||
| Patellofemoral Instability and Congenital Dislocation of the Patella | 815 | ||
| Congenital Absence of the Anterior Cruciate Ligament | 815 | ||
| Key References | 815 | ||
| References | 815.e1 | ||
| 85 Congenital Deformities of the Knee | 816 | ||
| Congenital Dislocation of the Knee | 816 | ||
| Treatment | 816 | ||
| Nonoperative Management | 816 | ||
| Surgical Management | 818 | ||
| Reduction and Flexion With Femoral Shortening | 818 | ||
| Anterior Cruciate Ligament Reconstruction | 824 | ||
| Summary | 826 | ||
| Congenital Dislocation of the Patella | 827 | ||
| Clinical Features | 828 | ||
| Treatment | 828 | ||
| Results and Comments | 829 | ||
| Flexion Deformity of the Knee | 830 | ||
| Pterygium Syndromes | 830 | ||
| Pathoanatomy | 831 | ||
| Treatment | 832 | ||
| Acute Correction: Pterygium and Arthrogryposis | 832 | ||
| Gradual Correction: Ilizarov Technique | 838 | ||
| Anterior Femoral Guided Growth (Hemiepiphysiodesis) | 840 | ||
| Amputation, Arthrodesis, and Rotationplasty | 840 | ||
| Summary and Comments | 840 | ||
| Key References | 840 | ||
| References | 841.e1 | ||
| 86 Meniscal Disorders | 842 | ||
| Meniscal Tears | 842 | ||
| Anatomy and Classification | 842 | ||
| Diagnosis | 842 | ||
| Treatment | 843 | ||
| Outcome | 844 | ||
| Discoid Meniscus | 845 | ||
| Cause | 845 | ||
| Classification | 845 | ||
| Diagnosis | 846 | ||
| Imaging Studies | 846 | ||
| Treatment | 846 | ||
| Key References | 848 | ||
| References | 848.e1 | ||
| 87 Osteochondritis Dissecans | 849 | ||
| History and Causes of JOCD and OCD | 849 | ||
| Diagnosis | 849 | ||
| Clinical Presentation | 849 | ||
| Imaging Studies | 850 | ||
| Nonoperative Management | 852 | ||
| Operative Management | 852 | ||
| Summary | 854 | ||
| Key References | 854 | ||
| References | 854.e1 | ||
| 88 Reconstructing the Anterior Cruciate Ligament in Pediatric Patients | 855 | ||
| The Natural History of ACL Injury | 855 | ||
| Skeletal Maturity | 855 | ||
| Growth and Development | 856 | ||
| Basic Research on Physeal Injury | 856 | ||
| Causes of Iatrogenic Growth Disturbance | 857 | ||
| Treatment Options | 857 | ||
| ACL Reconstruction Recommendations | 858 | ||
| Surgical Techniques and Postoperative Rehabilitation Procedures | 858 | ||
| Transepiphyseal ACL Reconstruction | 858 | ||
| Postoperative Rehabilitation | 860 | ||
| Physeal-Sparing ACL Reconstruction With the Iliotibial Band | 860 | ||
| Postoperative Rehabilitation | 861 | ||
| Transphyseal ACL Reconstruction | 861 | ||
| Postoperative Rehabilitation | 863 | ||
| Key References | 864 | ||
| References | 864.e1 | ||
| 89 Tibial Spine Fractures | 865 | ||
| Mechanism of Injury | 865 | ||
| Physical Examination | 865 | ||
| Imaging | 866 | ||
| Associated Injuries | 866 | ||
| Classification | 866 | ||
| Surgical and Applied Anatomy | 867 | ||
| Current Treatment Options | 867 | ||
| Authors’ Preferred Treatment | 868 | ||
| Arthroscopic Reduction and Internal Fixation With Epiphyseal Cannulated Screws | 869 | ||
| Arthroscopic Reduction and Internal Fixation With Suture | 869 | ||
| Pearls and Pitfalls | 870 | ||
| Prognosis and Complications | 871 | ||
| Key References | 871 | ||
| References | 871.e1 | ||
| 90 Physeal Fractures About the Knee | 872 | ||
| Background | 872 | ||
| Distal Femur | 872 | ||
| Proximal Tibia | 872 | ||
| Tibial Tubercle Fractures | 874 | ||
| Complications | 875 | ||
| Patellar Sleeve Fractures | 875 | ||
| Tibial Eminence Fractures | 878 | ||
| Key References | 880 | ||
| References | 880.e1 | ||
| 91 Patellar Instability | 881 | ||
| Embryology | 881 | ||
| Anatomy and Biomechanics | 881 | ||
| Risk Factors | 884 | ||
| Classification | 886 | ||
| Natural History | 886 | ||
| Injury History | 887 | ||
| Physical Examination | 887 | ||
| Patellofemoral Imaging | 888 | ||
| Treatment | 888 | ||
| Nonoperative Care | 888 | ||
| Operative Care | 889 | ||
| Surgery Addressing the Medial Patellofemoral Ligament | 889 | ||
| Medial Patellofemoral Ligament Repair/Reconstruction | 890 | ||
| Preferred MPFL Reconstruction Technique. | 890 | ||
| Non–Medial Patellofemoral Ligament Reconstruction in Younger Patients | 893 | ||
| Congenital, Developmental, and Habitual Dislocation | 893 | ||
| Summary | 893 | ||
| Acknowledgment. | 894 | ||
| Key References | 894 | ||
| References | 894.e1 | ||
| 12 Joint Replacement and Its Alternatives | 895 | ||
| 92 Nonoperative Treatment of Knee Arthritis | 896 | ||
| Education | 896 | ||
| Physical Therapy and Modalities | 897 | ||
| Exercise | 897 | ||
| Range of Motion and Stretching Exercises | 897 | ||
| Strengthening Exercises | 897 | ||
| Aerobic Conditioning | 897 | ||
| Weight Loss | 898 | ||
| Biomechanical Treatment | 898 | ||
| Taping | 898 | ||
| Knee Bracing and Orthotics | 898 | ||
| Assistive Devices: Cane or Walker | 898 | ||
| Hydrotherapy | 898 | ||
| Electrical and Related Energy Treatments | 898 | ||
| Heat Modalities | 898 | ||
| Diathermy | 899 | ||
| Ultrasound | 899 | ||
| Summary of Heat Treatment Modalities | 899 | ||
| Interferential Therapy | 899 | ||
| Transcutaneous Electrical Neuromuscular Stimulation | 899 | ||
| Acupuncture | 899 | ||
| Cryotherapy | 900 | ||
| Other Methods | 900 | ||
| Magnetism, Electrical Stimulation, and Low-Intensity Pulsed Ultrasound | 900 | ||
| Pharmacologic Measures | 900 | ||
| Analgesics | 900 | ||
| Nonsteroidal Anti-Inflammatory Drugs | 900 | ||
| Nonselective Nonsteroidal Anti-inflammatory Drugs | 901 | ||
| Selective COX-2 Inhibition | 901 | ||
| Nonsteroidal Anti-Inflammatory Drugs versus Analgesics | 901 | ||
| Possible Chondroprotective Action of Nonsteroidal Anti-Inflammatory Drugs | 902 | ||
| Future Medications | 902 | ||
| Summary | 903 | ||
| Injectable Corticosteroids | 903 | ||
| Effects on Cartilage | 904 | ||
| Chondroprotective Agents | 904 | ||
| Hyaluronic Acid | 904 | ||
| Glucosamine | 905 | ||
| Rationale for Glucosamine | 905 | ||
| Human Studies | 906 | ||
| Chondroitin | 906 | ||
| Glucosamine-Chondroitin Synergy | 907 | ||
| Dangers of “Nutraceuticals” | 907 | ||
| Key References | 908 | ||
| References | 908.e1 | ||
| Chapter 93 | 909 | ||
| 93 Scoring Systems and Their Validation for the Arthritic Knee | e284 | ||
| Background and Rationale | e284 | ||
| Scoring System Structure | e285 | ||
| Item Development | e285 | ||
| Scoring Methods | e286 | ||
| Statistical Requirements | e287 | ||
| Psychometric Principles | e287 | ||
| Item Response Theory | e288 | ||
| Classifications of Outcome Measures | e289 | ||
| Generic Outcome Measures | e289 | ||
| Specific Outcome Measures | e290 | ||
| Global Knee Rating Systems | e290 | ||
| Disease-Specific Rating Systems | e291 | ||
| Functional Rating Systems | e291 | ||
| Performance-Based Rating Systems | e292 | ||
| Patient-Specific Rating Systems | e292 | ||
| Patient Factors Affecting Outcome | e293 | ||
| Pain | e293 | ||
| Range of Motion | e293 | ||
| Age | e293 | ||
| Gender | e293 | ||
| Obesity | e294 | ||
| Mental Health | e294 | ||
| Comorbidities and Diagnosis | e294 | ||
| Physical Activity | e294 | ||
| Expectations | e295 | ||
| Future Development | e295 | ||
| Key References | e295 | ||
| References | e296 | ||
| 94 Osteotomy About the Knee: | 910 | ||
| Patient Selection Process | 910 | ||
| Historical Variables | 910 | ||
| Examination | 911 | ||
| Counseling | 911 | ||
| Radiographic Evaluation | 912 | ||
| Preoperative Planning | 912 | ||
| Surgical Techniques | 915 | ||
| Varus Deformity | 915 | ||
| Lateral Closing Tibial Wedge Osteotomy | 916 | ||
| Medial Opening Tibial Wedge Osteotomy | 918 | ||
| Barrel Vault (Dome) Tibial Osteotomy | 920 | ||
| Dual (Double) Osteotomy | 920 | ||
| Valgus Deformity | 920 | ||
| Medial Closing Femoral Wedge Osteotomy | 921 | ||
| Arthroscopy: Diagnostic versus Therapeutic | 922 | ||
| Fixation | 922 | ||
| Complications | 923 | ||
| Results | 924 | ||
| High Tibial Osteotomy | 924 | ||
| Distal Femoral Osteotomy | 925 | ||
| Summary | 925 | ||
| Key References | 925 | ||
| References | 925.e1 | ||
| 95 Osteotomy for the Arthritic Knee: | 926 | ||
| Osteotomy: General Principles and Indications | 926 | ||
| Why an Osteotomy? | 926 | ||
| Anatomic and Clinical Findings | 926 | ||
| Patient Expectations | 926 | ||
| Concept of Functional Envelope Applied to Gonarthrosis | 926 | ||
| Functional Results of an Osteotomy | 926 | ||
| Radiologic Workup | 927 | ||
| Indications | 928 | ||
| Physical Indications | 928 | ||
| Radiologic Indications | 928 | ||
| Disputable Indications | 928 | ||
| Activity Level | 928 | ||
| Factors Influencing Choice of Osteotomy | 928 | ||
| Type of Arthritis | 928 | ||
| Medial Gonarthritis | 928 | ||
| Opening Wedge Osteotomy. | 928 | ||
| Closing Wedge Osteotomy. | 928 | ||
| Lateral Gonarthrosis | 928 | ||
| Opening Wedge Distal Femoral Osteotomy. | 928 | ||
| High Tibial Osteotomy for Varisation (Medial Closing Wedge High Tibial Osteotomy). | 930 | ||
| Clinical Criteria | 930 | ||
| Radiologic Criteria | 930 | ||
| High Tibial Osteotomy | 930 | ||
| Radiologic Workup | 930 | ||
| Lateral Closing Wedge High Tibial Osteotomy | 930 | ||
| Patient Preparation | 930 | ||
| Osteotomy of the Neck of the Fibula | 930 | ||
| Peroneal Nerve Protection | 930 | ||
| Closing Wedge Osteotomy of the Tibia | 930 | ||
| Medial Opening Wedge High Tibial Osteotomy | 931 | ||
| Patient Preparation and Skin Incision | 931 | ||
| Procedure | 932 | ||
| Osteosynthesis | 933 | ||
| Postoperative Guidelines | 933 | ||
| Results | 933 | ||
| Complications | 935 | ||
| Infection | 935 | ||
| Nonunion | 935 | ||
| Peroneal Nerve Dysfunction | 935 | ||
| Compartment Syndrome | 935 | ||
| Future Improvements | 935 | ||
| High Tibial Varus Osteotomy | 936 | ||
| Radiologic Workup | 936 | ||
| Medial Closing Wedge High Tibial Osteotomy | 936 | ||
| Patient Preparation | 936 | ||
| Procedure | 936 | ||
| Postoperative Recommendations | 937 | ||
| Complications | 937 | ||
| Future Considerations | 937 | ||
| Distal Opening Wedge Femoral Osteotomy for Treatment of Valgus Deformity | 937 | ||
| Surgical Technique | 938 | ||
| Introduction of the Blade | 938 | ||
| Procedure | 939 | ||
| Postoperative Guidelines | 939 | ||
| Complications | 939 | ||
| Results | 940 | ||
| Double Osteotomy | 940 | ||
| Indications | 940 | ||
| Varus Knee | 941 | ||
| Valgus Knee | 941 | ||
| Malunion With Torsional Problem | 941 | ||
| Surgical Technique | 941 | ||
| On the Femur | 941 | ||
| Lateral Opening Wedge Osteotomy for Valgus Knee | 941 | ||
| Closing Wedge Osteotomy for Varus Knee | 941 | ||
| Derotation Osteotomy in Case of Femoral Malrotation | 941 | ||
| On the Tibia | 941 | ||
| Conclusion | 942 | ||
| Key References | 942 | ||
| References | 943.e1 | ||
| 96 Osteotomy About the Knee: | 944 | ||
| 13 Medical/Surgical Consideration in Managing the Total Knee Replacement Patient | 1413 | ||
| Chapter 135 | 1414 | ||
| 135 Perioperative Management of the Patient With Coronary Stents | e303 | ||
| Limitations of Percutaneous Transluminal Coronary Angioplasty and Benefits of Coronary Stents | e303 | ||
| Evolution of Drug-Eluting Stents | e303 | ||
| Elective Surgery After Coronary Stent Implantation | e304 | ||
| Timing | e304 | ||
| Guidelines | e304 | ||
| Summary | e305 | ||
| Key References | e305 | ||
| References | e305 | ||
| 136 American Academy of Orthopaedic Surgeons Guidelines | e307 | ||
| Background | e307 | ||
| Rationale and Methodology | e307 | ||
| Recommendations | e308 | ||
| Discussion | e310 | ||
| Key References | e311 | ||
| References | e311 | ||
| 137 Prevention of Venous Thromboembolism in Knee Surgery: | e312 | ||
| Methods of Prophylaxis | e312 | ||
| Mechanical Prophylaxis | e312 | ||
| Graduated Compression Stockings | e312 | ||
| Intermittent Pneumatic Compression | e312 | ||
| Foot Impulse Technology and Venous Foot Pump | e313 | ||
| Pharmacologic Prophylaxis | e313 | ||
| Low-Dose Unfractionated Heparin | e313 | ||
| Low-Molecular-Weight Heparin | e313 | ||
| Fondaparinux | e313 | ||
| Vitamin K Antagonists | e313 | ||
| Acetylsalicylic Acid | e313 | ||
| New Oral Anticoagulants | e313 | ||
| Dabigatran Etexilate. | e313 | ||
| Rivaroxaban. | e314 | ||
| Apixaban. | e314 | ||
| Combined Mechanical and Pharmacologic Prophylaxis | e314 | ||
| Bleeding Risk | e314 | ||
| Neuraxial (Epidural and Spinal) Anesthesia | e315 | ||
| Duration of Prophylaxis | e315 | ||
| Other Considerations | e315 | ||
| Estrogen Preparations | e315 | ||
| Thrombophilia | e315 | ||
| Travel-Related Venous Thromboembolism | e315 | ||
| Cost-Effectiveness of Venous Thromboembolism Prophylaxis | e316 | ||
| Implementation of Best Practice Venous Thromboembolism Prophylaxis Guidelines | e316 | ||
| Venous Thromboembolism Prophylaxis for Total Knee Arthroplasty | e316 | ||
| Conclusions | e316 | ||
| Key References | e316 | ||
| References | e317 | ||
| Chapter 138 | 1415 | ||
| 138 Venous Thromboembolism Prophylaxis After Knee Surgery: | e318 | ||
| Effect of Prophylaxis After Knee Arthroscopy | e318 | ||
| Risk Assessment | e318 | ||
| Prophylaxis | e318 | ||
| Duration | e318 | ||
| Types | e320 | ||
| Mechanical Prophylaxis | e320 | ||
| Elastic Stockings | e320 | ||
| Compression Devices | e320 | ||
| Chemical Prophylaxis | e320 | ||
| Low-Molecular-Weight Heparin | e320 | ||
| Fondaparinux | e321 | ||
| Direct Anti–Factor Xa Inhibitors and Direct Thrombin Inhibitors | e321 | ||
| Key References | e321 | ||
| References | e322 | ||
| 139 Thromboembolic Disease and Unicompartmental Knee Arthroplasty | e323 | ||
| Study Designs | e323 | ||
| Study Results | e323 | ||
| Discussion | e324 | ||
| Key References | e325 | ||
| References | e325 | ||
| 140 Treatment of Hematoma and Hemarthrosis Following Total Knee Arthroplasty | e326 | ||
| Definition of a Bleed | e326 | ||
| Treatment | e326 | ||
| Preventive Measures | e326 | ||
| Nonoperative Treatment | e327 | ||
| Surgical Technique | e327 | ||
| Conclusion | e329 | ||
| Key References | e329 | ||
| References | e329 | ||
| Chapter 141 | 1416 | ||
| 141 Multimodal Approach to Transfusion Avoidance and Blood Loss Management in Total Knee Arthroplasty | e330 | ||
| Risk of Infection | e330 | ||
| Risk Factors for Transfusion | e331 | ||
| Preoperative Blood Management | e331 | ||
| Preoperative Autologous Donations | e331 | ||
| Use of Erythropoietins | e332 | ||
| Insall-Scott Kelly Institute Protocol | e333 | ||
| Intraoperative Blood Management | e333 | ||
| Acute Normovolemic Hemodilution | e333 | ||
| Intraoperative Blood Salvage | e333 | ||
| Hypotensive Anesthesia | e334 | ||
| Tissue Hemostasis | e334 | ||
| Pharmacologic Strategies | e335 | ||
| Tranexamic Acid | e335 | ||
| Aprotinin | e335 | ||
| Postoperative Management | e336 | ||
| Drain Usage | e336 | ||
| Special Situations | e337 | ||
| Infected Total Knee Arthroplasty | e337 | ||
| Revision of Total Knee Arthroplasty | e337 | ||
| Bilateral Total Knee Arthroplasty | e337 | ||
| Conclusion | e338 | ||
| Key References | e338 | ||
| References | e338 | ||
| 142 Advances in Anticoagulation for Total Joint Arthroplasty— The Newer Agents | e342 | ||
| Direct Factor Xa Inhibitors | e342 | ||
| Mode of Action | e342 | ||
| Apixaban | e342 | ||
| Pharmacokinetics and Pharmacodynamics | e342 | ||
| Phase III Studies | e343 | ||
| Rivaroxaban | e343 | ||
| Pharmacokinetics and Pharmacodynamics | e343 | ||
| Phase III Studies | e344 | ||
| Direct Thrombin Inhibitors | e345 | ||
| Mode of Action | e345 | ||
| Dabigatran Etexilate | e346 | ||
| Pharmacokinetics and Pharmacodynamics | e346 | ||
| Phase III Studies | e346 | ||
| Other Anticoagulants in Development | e347 | ||
| Conclusions | e347 | ||
| Key References | e347 | ||
| References | e347 | ||
| 143 Advances in Mechanical Compression Devices | e349 | ||
| Mechanical Devices | e349 | ||
| The Role of Mechanical Compression After TKA | e350 | ||
| Emerging Technology | e351 | ||
| Summary and Recommendations | e352 | ||
| Key References | e353 | ||
| References | e353 | ||
| Chapter 144 | 1417 | ||
| 144 Prevention of Thrombophlebitis and Pulmonary Embolism in Total Knee Arthroplasty | e355 | ||
| Knee Surgery and Thrombotic Risk | e355 | ||
| Options for Thromboprophylaxis in Knee Surgery | e356 | ||
| Pharmacologic Thromboprophylaxis | e356 | ||
| Warfarin | e356 | ||
| Low-Molecular-Weight Heparins | e357 | ||
| Indirect Factor Xa Inhibitors | e358 | ||
| Direct Factor Xa Inhibitors | e358 | ||
| Direct Thrombin Inhibitors | e358 | ||
| Aspirin | e359 | ||
| Bleeding Issues | e359 | ||
| Mechanical Thromboprophylaxis | e359 | ||
| Thromboprophylaxis in Knee Arthroscopy | e359 | ||
| Thromboprophylaxis in Trauma Surgery | e360 | ||
| Risk Stratification | e360 | ||
| Duration of Thromboprophylaxis | e361 | ||
| Eighth ACCP Guidelines for Knee Surgery Patients | e362 | ||
| AAOS Guidelines for Knee Surgery Patients | e363 | ||
| Conclusions | e364 | ||
| Key References | e364 | ||
| References | e364 | ||
| 145 A Multimodal Approach to Pain Management in Total Joint Arthroplasty | e367 | ||
| Acute Pain Medicine Service | e368 | ||
| NSAIDs, COX-2 Inhibitors, and Acetaminophen | e368 | ||
| Nonselective NSAIDs | e368 | ||
| Ketorolac | e368 | ||
| Acetaminophen | e368 | ||
| COX-2 Inhibitors | e369 | ||
| Gabapentinoids | e369 | ||
| Ketamine | e369 | ||
| Opioids | e370 | ||
| Interventional Techniques | e370 | ||
| Regional Blockade | e370 | ||
| Periarticular Infiltration | e370 | ||
| Protocol | e370 | ||
| Conclusion | e371 | ||
| Key References | e371 | ||
| References | e371 | ||
| 146 Pain Management: | e373 | ||
| Anxiety Reduction | e373 | ||
| Preemptive Analgesia | e373 | ||
| Regional Anesthesia and Blocks | e374 | ||
| Intraoperative Interventions | e375 | ||
| Local Injection/Tissue Infiltration | e375 | ||
| Injection Technique | e375 | ||
| PACU and Immediate Postoperative Period | e377 | ||
| Summary | e378 | ||
| Key References | e378 | ||
| References | e378 | ||
| 14 Tumors About the Knee | 1419 | ||
| Chapter 147 | 1420 | ||
| 147 Evaluation of the Patient With a Bone Lesion About the Knee | e380 | ||
| History | e380 | ||
| Symptoms | e380 | ||
| Patient Age | e380 | ||
| Activity Level | e380 | ||
| Past Medical History | e380 | ||
| Physical Examination | e380 | ||
| Imaging | e381 | ||
| Local | e381 | ||
| Systemic Imaging | e382 | ||
| Laboratory Evaluation | e382 | ||
| Differential Diagnosis | e382 | ||
| Biopsy | e382 | ||
| General | e382 | ||
| Needle versus Open Biopsy | e382 | ||
| Biopsy Technique | e382 | ||
| Staging of Bone Tumors | e384 | ||
| Summary | e384 | ||
| Key References | e384 | ||
| References | e385 | ||
| 148 Surgical Treatment of Benign Bone Lesions | e386 | ||
| Staging of Benign Bone Tumors | e386 | ||
| Treatment of Specific Benign Conditions | e386 | ||
| Benign Bone-Forming Tumors | e386 | ||
| Osteoid Osteoma | e386 | ||
| Osteoblastoma | e388 | ||
| Osteofibrous Dysplasia | e388 | ||
| Benign Cartilage-Forming Tumors | e388 | ||
| Enchondroma | e388 | ||
| Periosteal Chondroma | e389 | ||
| Osteochondroma | e389 | ||
| Chondroblastoma | e391 | ||
| Benign Fibrous Tumors of Bone | e392 | ||
| Fibrous Cortical Defect | e392 | ||
| Nonossifying Fibroma | e392 | ||
| Fibrous Dysplasia | e392 | ||
| Benign Cystic Lesions of Bone | e393 | ||
| Simple Bone Cyst | e393 | ||
| Aneurysmal Bone Cyst | e394 | ||
| Giant Cell Tumor of Bone | e395 | ||
| Intraosseous Lipoma | e396 | ||
| Conclusion | e396 | ||
| Key References | e396 | ||
| References | e396 | ||
| 149 Surgical Management of Malignant Bone Tumors Around the Knee | e399 | ||
| Tumor Biology | e399 | ||
| Principles of Surgical Management | e399 | ||
| Surgical Margins | e399 | ||
| Patient Selection for Limb Salvage versus Amputation | e400 | ||
| Principles of Tumor Resection | e400 | ||
| Principles of Reconstruction | e401 | ||
| Arthrodesis | e401 | ||
| Local Autografts | e401 | ||
| Large Bulk Allograft | e402 | ||
| Rotationplasty | e402 | ||
| Common Malignant Bone Tumors of the Knee | e403 | ||
| Osteosarcoma | e403 | ||
| Chondrosarcoma | e403 | ||
| Ewing’s Sarcoma | e404 | ||
| Lymphoma of Bone | e404 | ||
| Conclusion | e405 | ||
| Key References | e405 | ||
| References | e405 | ||
| Chapter 150 | 1421 | ||
| 150 Allograft Prosthetic Composite Reconstruction of the Knee | e406 | ||
| Basic Principles of Allograft Prosthetic Reconstruction | e407 | ||
| Allograft Prosthetic Composite Reconstruction of the Tibia—Technique | e408 | ||
| Extensor Mechanism Repair | e409 | ||
| Allograft Prosthetic Composite Reconstruction of the Distal Femur | e409 | ||
| Allograft Extensor Mechanism Transplantation | e411 | ||
| References | e413 | ||
| 151 Megaprostheses for Reconstruction Following Tumor Resection About the Knee | e415 | ||
| Rationale for Use of Megaprostheses | e415 | ||
| Indications | e415 | ||
| Methods of Fixation of Megaprostheses | e415 | ||
| Surgical Technique | e417 | ||
| Distal Femoral Replacement Arthroplasty | e417 | ||
| Proximal Tibial Replacement Arthroplasty | e418 | ||
| Clinical Results | e418 | ||
| Distal Femur | e418 | ||
| Proximal Tibia | e419 | ||
| Complications | e419 | ||
| Revision of Failed Hinge Megaprostheses | e420 | ||
| Summary | e420 | ||
| Key References | e420 | ||
| References | e420 | ||
| 152 Metastatic Disease About the Knee: | e422 | ||
| Treatment Principles | e422 | ||
| Evaluation | e423 | ||
| Prediction of Impending Fracture | e425 | ||
| Orthopedic Management | e425 | ||
| Key References | e430 | ||
| References | e430 | ||
| Chapter 153 | 1422 | ||
| 153 Soft Tissue Tumors of the Knee | e432 | ||
| Clinical Features | e432 | ||
| Evaluation | e432 | ||
| Differential Diagnosis | e433 | ||
| Cystic Lesions | e433 | ||
| Intra-articular Pathology | e434 | ||
| Benign Extra-articular Soft Tissue Neoplasms | e437 | ||
| Malignant Soft Tissue Tumors | e438 | ||
| Summary | e438 | ||
| Key References | e438 | ||
| References | e439 | ||
| Index | 1423 | ||
| A | 1423 | ||
| B | 1427 | ||
| C | 1428 | ||
| D | 1431 | ||
| E | 1432 | ||
| F | 1433 | ||
| G | 1434 | ||
| H | 1435 | ||
| I | 1436 | ||
| J | 1436 | ||
| K | 1437 | ||
| L | 1438 | ||
| M | 1439 | ||
| N | 1442 | ||
| O | 1442 | ||
| P | 1445 | ||
| Q | 1451 | ||
| R | 1451 | ||
| S | 1453 | ||
| T | 1455 | ||
| U | 1461 | ||
| V | 1461 | ||
| W | 1462 | ||
| X | 1463 | ||
| Z | 1463 |