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Additional info for AANA Advanced Arthroscopy. The Knee
The patient with a stiff knee will have altered gait mechanics, which can then affect the hip or contralateral knee. If a stiff knee is not appropriately treated, the loss of motion may become permanent, leading to significant disability. The purpose of this chapter is to review the normal functional range of motion of the knee with relevant anatomy and discuss possible causes of arthrofibrosis and treatment options in an effort to help manage the complicated stiff knee patient effectively. ANATOMY AND PATHOANATOMY Anatomy Normal Knee Range of Motion The knee has been described as having 6 degrees of freedom— internal-external rotation, compression-distraction, medial-lateral translation, abduction-adduction, anterior-posterior translation, and flexion-extension.
4-mm wire on the medial side of the fragment. FIGURE 2-5 A second wire is passed on the lateral side of the ACL. secondary procedures (hardware removal) 25,26 These authors favor the suture technique in all cases. 4-mm guide pin through the anteromedial tibial metaphysis, entering the joint on the medial side of the fragment (Fig. 2-4). A second wire is passed starting 1 to 2 cm lateral to the first hole on the tibial cortex, entering the knee at the lateral side of the fragments (Fig. 2-5). 4-mm wire is withdrawn, a suture passer is placed in the hole, and two Ultrabraid sutures (Smith & Nephew Endoscopy, Andover, Mass) are passed.
This is usually AANA ADVANCED ARTHROSCOPY: THE KNEE 26 POSTOPERATIVE MANAGEMENT ACL FIGURE 3-10 The fracture is reduced by pulling down on the suture ends, which are tied over the tibial tubercle. (Adapted from Lubowitz, J, Elson, W, Guttmann, D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fracture. Arthroscopy. 2005;21:86-92). not seen on the arthroscopic view, and as long as the surgeon is certain that the meniscus is not entrapped, this should not be considered a failure of surgical treatment.
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