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Knee Research
 | Interobserver Variability of the Insall-Salvati
Ratio. This clinical investigation, published in the journal Orthopedics in
2003, revealed that a traditional technique used in the measurement of
knee X-ray films was more reliable than a newer technique. |
| Quadriceps Tendon Impingement from Femoral
Interference Screw: A Case Report. This clinical report, published in the
journal, Arthroscopy, in 2003, shares with the world a hitherto
unreported complication of anterior cruciate ligament (ACL) reconstruction. A
patient came to see Dr. Ilahi for persistent pain and stiffness following ACL
reconstruction done elsewhere. The patient's original surgeon was at a loss to
explain this. Dr. Ilahi's investigation revealed that a screw-type device used to secure
the ligament reconstruction was protruding from the femur (thigh bone) and
rubbing on the tendon of the quadriceps muscle, just above the knee. The
resulting pain was hampering rehabilitation, especially the ability of the
patient to regain knee joint flexion. In addition, the protruding screw was
actually leading to slow tearing of the tendon. After Dr. Ilahi surgically
removed the offending hardware and addressed the partially torn quadriceps
tendon by an outpatient arthroscopic procedure, full flexion of the knee joint
was quickly restored, and the patient's pain alleviated. |
| Arthroscopic Findings in Knees Undergoing Proximal
Tibial Osteotomy.
A proximal tibial
osteotomy is a joint re-alignment procedure used to treat certain cases of
knee arthritis where the joint has worn out primarily in one region and is
associated with an abnormal alignment of the lower extremity. By
correcting the alignment of the lower extremity, the forces across the joint
are redistributed so the worn out area sees less force and the more healthy
part of the joint carries more force. This can result in many years of
relief from arthritic pain yet allow unrestricted activities, unlike knee
replacement procedures, which often require restriction from strenuous
activities lest the artificial components wear out prematurely. The
osteotomy is open surgery and does not involve the knee joint itself. In
this clinical investigation, published in 2008 in the Journal of Knee Surgery, patients undergoing the
osteotomy also had arthroscopic evaluation of the knee joint and were found to
have a rather high and previously unknown incidence of correctable knee
problems in addition to arthritis. Correcting these arthroscopically at
the same time as the osteotomy may lead to better outcomes than performing the
osteotomy alone. Performing minimally invasive knee arthroscopy at the time
of the open osteotomy surgery was not found in this investigation to lead to
any increased complications. |
| Intra-tunnel Fixation vs. Extra-tunnel Fixation of
Hamstring ACL Reconstructions. A Meta-analysis.
Reconstruction of a torn anterior cruciate ligament (ACL) involves drilling a
tunnel in the tibia (shin bone) and the femur (thigh bone). A tendon
graft that will act as the new ACL for that knee is then inserted into both
tunnels. There are many ways to secure such grafts in both tunnels.
The use of some minor hamstring tendons, taken from the injured extremity at
the time of surgery, is a popular and effective choice for the tendon graft.
Such grafts can be secured to each tunnel with special hardware that is
inserted inside the tunnel (intra-tunnel fixation) or with hardware placed
outside the tunnel (extra-tunnel fixation). There are advantages and
disadvantages to each fixation method. This investigation, published in
2009 in the Journal of Knee Surgery, compared the pooled results from
several clinical studies employing one method for fixation of both tunnels or
the other to pooled results of clinical studies of ACL reconstructions
performed using a patellar tendon graft (another popular and effective graft
choice although a somewhat older technique, associated with a bigger incision,
more postoperative pain, more effort required for rehabilitation, but with
excellent results). The results of this meta-analysis indicate
superiority of intra-tunnel fixation in the femur and tibia over extra-tunnel
fixation in the femur and tibia. A hybrid fixation technique, in which
extra-tunnel fixation is used for the femur and intra-tunnel fixation is used
for the tibia, could not be evaluated in this investigation, but combines the
advantages of both and has been used at TASMI for many years with excellent
clinical results. |
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