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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 320 - 320
1 Jul 2014
Aframian A Jindasa O Khor K Vinayakam P Spencer S Jeer P
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Summary

Nearly one-third of patients in this series with an ACL rupture requiring reconstruction had evidence of MPFL injury. This should be considered when patients are seen, and when MRI scans are reviewed/reported.

Introduction

The Medial Patello-Femoral Ligament (MPFL) is the largest component of the medial parapatellar ligamentous complex. The senior surgeon felt that there was an anecdotally high rate of MPFL injury amongst his patients undergoing Anterior Cruciate Ligament (ACL) repair, but no discussion of this in the present literature.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_19 | Pages 10 - 10
1 Apr 2013
Elnikety S El-Husseiny M Kamal T Gregoras M Talawadekar G Jeer P
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Introduction

The transtibial approach is widely used for femoral tunnel positioning in ACL reconstruction. Controversy exists over the superiority of this approach over others. Few studies reflected on the reproducibility rates of the femoral tunnel position in relation to the approach used.

Methods

We reviewed AP and Lat X-ray radiographs post isolated ACL reconstruction for 180 patients for femoral tunnel position, tibial tunnel position and graft inclination angle. All patients had their operations performed by one surgeon in one hospital between March 2006 and Sep 2010. All operations were performed using one standard technique using transtibial approach for femoral tunnel positioning. Two orthopaedic fellows, with similar experiences, reviewed blinded radiographs. A second reading was done 8 weeks later. Pearson inter-observer and intra-observer correlation analyses were done using SPSS. Mean age was 29 years (range 16–54).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 35 - 35
1 Jul 2012
Chowdhry M Vinayakam P Jeer P
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Introduction

The Signature system has been hailed as a new way to perform arthroplasty of the knee. It combines the accuracy in restoring mechanical axes of navigation with the convenience and familiarity of classical surgical techniques. With this comes the expectation that they should produce better functional results. In the literature, thus far, there is little data to corroborate this. The aim of this paper is to compare the early functional outcomes of this with the cemented AGC knee replacement system.

Methods

Since April 2010, based on requirement, 25 patients underwent Signature knee replacements during this period for symptomatic degenerative or inflammatory arthritis with varying levels of deformity. Oxford functional scores were taken pre-operatively, at 6 weeks, 3 months and 6 months. These were then matched to an equal number of patients that had undergone an AGC knee replacement by the same surgeon. They were matched by pre-operative functional Oxford scores, age and gender.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 78 - 78
1 Jul 2012
Talawadekar G Rose B Elnikety S Grigoras I Jeer P
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Introduction

As intra-operative fluoroscopic identification of the isometric MPFL attachment to the femur can be imprecise and laborious in a surgical setting, we used clinical criteria to identify the isometric point and then studied post-operative radiographs to find out whether it was achieved and compared it with functional outcome.

Materials and Methods

Sixteen patients underwent 17 MPFL reconstructions using autologous semi-tendinosis tendon graft. Clinical judgement was used to identify the optimal point for femoral attachment of the MPFL without fluoroscopy control. Post-operative radiographs at 2 weeks were analysed to confirm whether an isometric point for the reconstructed MPFL was achieved by dividing the distal femur into 4 quadrants by 2 lines on the lateral radiograph. Telephonic interview was conducted to assess functional scores using the Kujala score at a mean follow-up of 13 months.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 268 - 269
1 May 2006
Gul R Jeer P Murphy M Stephens M
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Introduction: A retrospective evaluation of early results of arthroereisis.

Material and Methods: Eight feet in five patients with pathological flexible planovalgus deformity that had failed non-operative management were treated with subtalar arthroereisis using the Kalix prosthesis. Diagnosis include oblique talus (2), vertical talus (1), diplegia secondary to head injury (1) and type I neurofibromatosis (1). The average age of patients was 6.4 years (range 4–12), and average follow-up was 9.9 months(range 4–20). Outcome was assessed using clinical assessment of the foot axis and functional improvement and radiographic measurements of change in the talocalcaneal angle and talonavicular sag.

Results: Arthroereisis was never performed in isolation, additional procedure included achilles tendon lengthening (2), gastrocnemius recession (6), talonavivular and spring ligament plication (5) and split tibialis anterior tendon transfer (1). All patients had improvement of foot function and restoration of foot axis to a position parallel to the axis of progression. Restoration and maintenance of the talocalcaneal angle was excellent in all cases with preoperative average of 42 degrees (range 20–70), improved to a postoperative average of 23 (range, 0 – 40). Talonavicular sag improved from preoperative average of 16.5 degrees (range 0–32), to post operative average of 26 degrees (range 18–35). Complications include persistent first ray extension which required a Lapidus procedure (1), Ongoing minor discomfort (1). No patients or parents were dissatisfied.

Discussion: The preliminary report supports the use of this technique in selected cases. Sizing of the implant and intraoperative assessment of correction of deformity and balanced surgery are critical to success. It is a simple and rapid procedure with advantages over alternatives such as Osteotomy and fusion. Long term results need further evaluation.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 344 - 344
1 Sep 2005
Keene G Jeer P
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Introduction and Aims: The aim of this study was to report the two-year results of a new tibio-femoral Uni-compartmental Knee Arthroplasty (UKA) designed specifically to be implanted through a minimally invasive approach.

Method: A prospective review of a single surgeon’s experience with the Preservation UKA was undertaken. The initial 54 UKAs from a consecutive cohort of 253 UKAs that had reached two-year follow-up were evaluated, clinically using the AKSS and OKS scores, and also radiographically. The average age of patients was 66.9 (range 48–82), with a slight male preponderance (1.2:1). Forty-five UKAs were for medial compartment OA (40 all polyethylene fixed tibial bearing, five mobile bearing), with eight bilateral procedures, and nine were for lateral compartment OA (seven all polyethylene fixed tibial bearing, two mobile bearing).

Results: There were no losses to follow-up. The pre-operative AKSS knee and function scores improved from 39 and 56 respectively, to 93 (range 46–100) and 92 (range 10–100) respectively, at last review. The OKS had improved from 39 to 19 (range 12–40), and the average range of motion was 135 degrees (range 125–140). There were no failures requiring revision. Only two patients had poor results, one secondary to a post-operative work related injury and the other due to soft tissue impingement that responded to arthroscopic debridement. One patient was excluded due to a femoral neck fracture. One patient experienced a superficial wound infection, and one patient had a pulmonary embolus. Radiographs revealed minor tibial lucencies in three UKAs, none of which were symptomatic, or progressive to date.

Conclusion: This is the first report documenting two-year results of this new prosthesis, and preliminary results suggest it can produce good clinical and functional results.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 344 - 344
1 Sep 2005
Keene G Jeer P
Full Access

Introduction and Aims: The aim of this study was to report the two-year results of a new tibio-femoral Uni-compartmental Knee Arthroplasty (UKA) designed specifically to be implanted through a minimally invasive approach.

Method: A prospective review of a single surgeon’s experience with the Preservation UKA was undertaken. The initial 54 UKAs from a consecutive cohort of 253 UKAs that had reached two-year follow-up were evaluated, clinically using the AKSS and OKS scores, and also radiographically. The average age of patients was 66.9 (range 48–82), with a slight male preponderance (1.2:1). Forty-five UKAs were for medial compartment OA (40 all polyethylene fixed tibial bearing, five mobile bearing), with eight bilateral procedures, and nine were for lateral compartment OA (seven all polyethylene fixed tibial bearing, two mobile bearing).

Results: There were no losses to follow-up. The pre-operative AKSS knee and function scores improved from 39 and 56 respectively, to 93 (range 46–100) and 92 (range 10–100) respectively at last review. The OKS had improved from 39 to 19 (range 12–40), and the average range of motion was 135 degrees (range 125–140). There were no failures requiring revision. Only two patients had poor results, one secondary to a post-operative work-related injury and the other due to soft tissue impingement that responded to arthroscopic debridement. One patient was excluded due to a femoral neck fracture. One patient experienced a superficial wound infection, and one patient had a pulmonary embolus. Radiographs revealed minor tibial lucencies in three UKAs, none of which were symptomatic, or progressive to date.

Conclusion: This is the first report documenting two-year results of this new prosthesis, and preliminary results suggest it can produce good clinical and functional results.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 343 - 343
1 Sep 2005
Keene G Jeer P Oakeshott R Mahr C
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Introduction and aims: The aim of this study was to determine the relationship between pre-operative Single Photon Emission Tomography (SPECT) scan findings and intra-operative assessments of patello-femoral and tibio-femoral OA, in patients undergoing tibio-femoral uni-compartmental knee arthroplasty (UKA).

Method: Over a six-month period 36 knees in 30 patients, undergoing UKA, were investigated pre-operatively with a SPECT scan to confirm single compartment disease. The male to female ratio of patients was 18:12, with an average age of 63 years (range 44–78). A single radiologist reported all cases, and graded uptake in each compartment. At surgery, the degree of OA encountered in each compartment was assessed by size and grade by the two senior authors, and assigned an OA score. The data was analysed statistically for an association between the SPECT scan score and OA score, using Kendall’s Tau-b.

Results: A statistically significant relationship was demonstrated between positive uptake in a compartment and the presence of OA (p < 0.05), and this was consistent for all compartments. When analysed specifically, the associations were strongest in the medial femoral condyle (0.58) and the medial tibial plateau (0.67), and weakest in the patella (0.35) and trochlea (0.46), and lateral tibial plateau (0.34).

Conclusion: We conclude that SPECT scans can provide useful information regarding the degree of OA in knee compartments when planning UKA, particularly with medial compartment disease. The lower degree of association between scan findings and OA encountered in the patello-femoral compartment, and lateral tibial plateau, indicates greater vigilance should be applied when making intra-operative assessments of these areas.