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(BQ) Part 2 book Noyes'' knee disorders surgery, rehabilitation, clinical outcomes presents the following contents: Posterolateral ligament injuries - diagnosis, operative techniques, and clinical outcomes; meniscus transplantation; tibial and femoral osteotomy for varus and valgus knee syndromes; unicompartmental knee replacement for varus or valgus malalignment,...
17 Posterolateral Ligament Injuries: Diagnosis, Operative Techniques, and Clinical Outcomes Frank R Noyes, Sue D Barber-Westin OUTLINE Indications, 527 Contraindications, 528 Clinical Evaluation, 528 Classification and Treatment of Partial to Complete PL Injuries, 535 Preoperative Planning: Timing of Surgery, 535 Acute Injuries, 535 Chronic Injuries, 536 Cruciate Graft Reconstruction, 538 Intraoperative Evaluation, 538 Operative Treatment of Acute PL Ruptures, 538 Operative Setup and Patient Positioning, 538 Identification of Ligament and Soft Tissue Rupture Pattern, 539 Common Peroneal Nerve Identification, 541 Surgical Repair and Reconstruction of Acute Injuries, 542 Surgical Approach and Order of Repair, 544 Operative Treatment of Chronic Posterolateral Ruptures, 544 Overview of Operative Options, 544 Anatomic Reconstruction of the Fibular Collateral Ligament and Popliteus Muscle-Tendon-Ligament Unit, 546 Posterolateral Capsule Reconstruction for Severe Varus Recurvatum, 550 Femoral-Fibular Reconstruction, 553 Proximal Advancement of the Posterolateral Structures, 556 Our Clinical Studies, 559 Anatomic Posterolateral Reconstruction, 560 Femoral-Fibular Allograft Reconstruction, 561 Proximal Advancement of Posterolateral Structures, 562 Causes of Failure of Posterolateral Operative Procedures, 563 Other Operative Techniques and Results, 564 Illustrative Cases, 569 VIDEO CONTENT CRITICAL POINTS Indications Video 2-1 The Key to the Knee: A Layer-by-Layer Demonstration of Posterior and Posterolateral Knee Anatomy Video 3-1 Comprehensive Knee Exam: Clinical Rationale and Diagnosis Video 11-1 Arthroscopic Treatment of Arthrofibrosis Following Major Knee Ligament Reconstruction Video 11-3 Cincinnati SportsMedicine Experience: Treatment of Knee Arthrofibrosis Video 16-5 Overview: Surgical Treatment of PCL and Posterolateral Ligament Injuries Video 16-6 Rehabilitation Principles Following PCL and Posterolateral Reconstruction • 6- to 10-mm increased lateral tibiofemoral joint opening 20 degrees of flexion • ≥15 degrees increased external tibial rotation 30 degrees, 90 degrees of flexion • ± Varus recurvatum, standing and supine • ± Hyperextension gait abnormality • Double or triple varus knee, after osteotomy • Acute injuries, bony avulsions amendable to internal fixation INDICATIONS The primary soft tissue–stabilizing structures of the posterolateral (PL) aspect of the knee joint are the fibular collateral ligament (FCL) and popliteus muscle-tendon-ligament unit (PMTL), including the popliteofibular ligament (PFL) and posterolateral capsule (PLC) shown in Figure 17-1 These structures function together to resist lateral joint opening (LJO), posterior subluxation of the lateral tibial plateau with tibial rotation, knee hyperextension, and varus recurvatum.13,14,38,39,55,64 The mechanism of injury may be contact or noncontact and usually involves a combined varus and hyperextension joint displacement The proper management of injuries involving the PL structures requires knowledge of the complex anatomy and potential variations that may exist, the function of the major soft tissue stabilizers, appropriate diagnostic techniques, and surgical options for reconstruction Isolated PL injuries are rare; however, on occasion an avulsion fracture at the femoral attachment occurs requiring internal fixation.29 PL injuries are frequently accompanied by anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) ligament ruptures.1,3,9,28 Although the incidence of PL injury is unknown (owing to misdiagnosis or failure to detect the injury), the consequences of untreated PL ruptures are readily apparent Chronic deficiency of the PL structures may be a factor in the failure of cruciate reconstructions43,44,49 and 527 528 CHAPTER 17 Posterolateral Ligament Injuries CRITICAL POINTS Contraindications Lateral gastrocnemius tendon Popliteofibular ligament Popliteus tendon • 10 mm indicate secondary restraints torn or physiologic slack (combined injury) CHAPTER 17 Posterolateral Ligament Injuries 531 TABLE 17-1 Comprehensive Knee Examination—cont’d Examination Technique Quadriceps active test Lachman (anterior drawer, 30 degrees of flexion) Pivot shift Reverse pivot shift test Varus stress testing Illustration Grading Significance Knee position at 70-90 degrees Foot stabilized by examiner, patient activates quadriceps by pushing foot against table or attempting to extend knee Anterior load proximal tibia Qualitative Observe, palpate tibiofemoral position Confirms posterior tibial subluxation, PCL injury at resting position Quadriceps contraction produces anterior translation knee position ≥70 degrees Observe anterior translation tibia; compare with opposite knee Estimate increase translation in millimeters Soft endpoint, ACL not resisting anterior translation, indicates ACL tear Increase 3- to 5-mm ACL tear >5 mm ACL plus secondary restraints Knee position 10-30 degrees of flexion Anterior load tibia, gentle internal tibial rotation (subluxation) followed by posterior load, gentle external rotation (reduction) Similar loading as pivot shift Qualitative Grade: I slipping II thud, clunk with reduction III gross anterior subluxation lateral tibiofemoral joint, anterior impingement tibia limits reduction event Grade I physiologic laxity, no or partial ACL tear II ACL tear Grade III ACL tear plus secondary restraints lax PL subluxation with external rotation confused for reduction in pivot shift No abnormal anterior tibial subluxation Observe obvious PL tibial subluxation with posterior and external rotation loading Dial test more accurate Thigh supported on examination table Knee position degree, 30 degrees Varus load with no external-internal tibial rotation Palpate lateral joint line opening Subtle 30 degrees increase LJO 2-4 mm complete FCL tear, further increase LJO with PLC injury Stress radiography more accurate 30 degrees of flexion Increase 2- to 4-mm FCL tear Increase 5- to 9-mm complete PLC tear (also perform valgus stress test) Continued 532 CHAPTER 17 Posterolateral Ligament Injuries TABLE 17-1 Comprehensive Knee Examination—cont’d Examination Technique External rotation recurvatum test Illustration Grading Significance Grasp and hold both feet above table, allow gravity knee hyperextension Qualitative Tibia externally rotates, varus position caused by PL joint opening, knee Hyperextension, indicates PLC injury, >10 degrees frequently associated ligament injury (ACL, PCL) Standing recurvatum test Patient stands, feet together pushes knees backward into hyperextension, compare knees Qualitative, observe varus hyperextension position (can be measured with goniometer) Increased loading over supine recurvatum test brings out deformity 10 degrees hyperextension with varus alignment PLC disruption, lateral, PL joint abnormal opening, often combined PLC, ACL tear, confirm with other tests Standing frontal alignment Standing 0-5 degrees of flexion Avoid hyperextension Confirm varus alignment Hip-knee-ankle radiographs 0-5 degrees of flexion Classify primary, double, triple varus based on all tests (see Chapter 26) CHAPTER 17 Posterolateral Ligament Injuries 533 TABLE 17-1 Comprehensive Knee Examination—cont’d Examination Technique Knee hyperextension gait or varus thrust Illustration Grading Significance Observe gait walking to and from examiner Qualitative Knee goes into hyperextension on stance phase Knee has varus thrust without hyperextension Two hyperextension patterns (see Chapter 29) Forward trunk position, loss of quadriceps control, ankle dorsiflexion push-off, requires gait retraining Varus thrust increases medial compartment loads and tensile forces lateral ligaments, osteotomy may be required Range of motion Perform passive flexion-extension Normal 3-0-135 degrees Hyperextension to neutral to flexion 10 degrees hyperextension posterior capsule possible ACL or PCL injury ≥15 degrees multiple ligament injury Effusion, soft tissue swelling, pain Palpate joint for effusion, tenderness, meniscus, ligament attachments Qualitative Complex examination necessary + meniscus tests Partial to complete tears PLC FCL local tenderness, pain varus, dial tests Patellofemoral examination Comprehensive examination All tests Alignment, PF crepitus, medial/ lateral translation, patella height See Chapter 35 Increased external tibial rotation 30 degrees, PLC tear, produces abnormal lateral shifting tibial tubercle, increases Q-angle Continued 534 CHAPTER 17 Posterolateral Ligament Injuries TABLE 17-1 Comprehensive Knee Examination—cont’d Examination Technique Illustration Neurovascular examination Complete examination Both lower extremities, PT, DP pulses, lower extremity muscle function Grading Significance Peroneal nerve injuries associated with severe PLC disruption (10%30%) Arterial studies indicated multiple ligament injuries, dislocations ACL, Anterior cruciate ligament; DP, dorsalis pedis; FCL, fibular collateral ligament; LJO, lateral joint opening; PCL, posterior cruciate ligament; PF, patellofemoral; PL, posterolateral; PLC, posterolateral capsule; PMTL, popliteus muscle-tendon-ligament; PT, posterior tibial Abnormal lateral joint opening (30°) 12 10 mm A Normal lateral joint opening (30°) Varus load mm B C FIG 17-2 The gap test A, The amount of lateral tibiofemoral joint opening is measured with the knee at 25 degrees of flexion Knees with insufficiency of the posterolateral structures will demonstrate 12 mm of joint opening at the periphery of the lateral tibiofemoral compartment, 10 mm at the midportion of the compartment, and 8 mm at the innermost medial edge B, Normal gap test C, Abnormal gap test The position of the medial and lateral tibial plateau is assessed at the starting position (neutral tibial rotation) with the knee flexed to 30 and 90 degrees and at the final position with the tibia in maximal external rotation The examiner palpates the position of the medial and lateral tibial plateau, which is compared with the normal knee to assess whether a subluxation (anterior or posterior) of the medial or lateral tibial plateau is present An increase in internal tibial rotation occurs with both lateral ligament, medial ligament, and PCL disruption (see Chapter 15) The axis of tibial rotation is observed in the involved knee and compared with the normal knee to detect a shift in the medial or lateral tibiofemoral compartment during tibial rotation It is not recommended that the dial test be performed in the prone position because the tibiofemoral joint cannot be accurately palpated to distinguish an anteromedial from a PL tibial subluxation It is not possible to clinically determine the actual millimeters of translation of the medial and lateral tibial plateaus in reference to the femoral condyle A qualitative determination is made of the anterior or posterior subluxation of the medial or lateral tibiofemoral joint CHAPTER 17 Posterolateral Ligament Injuries With PL injuries, there is an abnormal lateral deviation of the tibial tubercle in the dial test compared with the opposite knee The use of the dial test in knees with PCL ruptures requires maintenance of a normal anatomic tibiofemoral position This is accomplished by applying an anterior translation, loading the ACL in both limbs, during the external tibial rotation It is still necessary to use the supine position so that the examiner can palpate the tibiofemoral position.61 The dial test is less accurate with a PCL rupture because it is difficult to compare limbs, and other tests to be described (LJO, gap test at arthroscopy, varus recurvatum) for the integrity of the PL structures need to be carefully assessed When a posterior subluxation of the lateral tibial plateau is positively identified by the tibiofemoral rotation test, additional tests must be conducted to determine the integrity of other ligament structures The amount of LJO at and 20 degrees of knee flexion should be determined to further assess the integrity of the FCL and other secondary ligament restraints The posterior tibial subluxation of the central tibial and medial tibiofemoral joint determines the amount of increased translation because of a PCL injury, which adds to the maximum posterior subluxation to the lateral compartment with external tibial rotation The presence of a varus recurvatum in both the supine and standing positions must be carefully assessed Often, the varus recurvatum reaches its maximum position when the patient is standing and asked to maximally hyperextend both knees The appropriate tests to determine the integrity of the ACL and PCL are performed, including KT-2000 (MEDmetric) arthrometer testing at 20 degrees of flexion (134 N) to quantify total anteroposterior (AP) displacement The pivot shift test is recorded on a scale of to III (grade 0, no pivot shift; grade I, slip or glide; grade II, jerk or clunk; grade III, gross subluxation with impingement of the PL aspect of the tibial plateau against the femoral condyle) A misdiagnosis of a positive pivot shift test may occur with PL injuries as the lateral tibial plateau is brought to a reduced position (starting from a posterior subluxated position) with knee extension and then posteriorly subluxates with knee flexion (reverse pivot shift test) The medial posterior tibiofemoral step-off on the posterior drawer test is done at 90 degrees of flexion Radiographs taken during the initial examination include AP, lateral at 30 degrees of knee flexion, weight-bearing PA at 45 degrees of knee flexion, and patellofemoral axial views Lateral stress radiographs may be required of both knees (20 degrees of flexion, neutral tibial rotation, and 67-N varus force) A comparison is made of the millimeters of lateral tibiofemoral compartment opening between knees A lateral radiograph is used to determine the approximate length required for FCL anatomic grafts The distance from the anatomic femoral insertion site to the anatomic fibular insertion site is measured and adjusted for magnification A measurement of the patellar tendon length is also made when a bone-patellar tendon-bone (B-PT-B) FCL autograft is planned; however, in most knees, a B-PT-B allograft is used, as will be discussed Posterior stress radiographs are obtained in patients with PCL ruptures, especially those in which the distinction of a partial versus complete PCL deficiency is difficult to determine on clinical examination.15 A lateral PCL stress radiograph is taken of each knee at 90 degrees of flexion The limb is placed in neutral rotation with the tibia unconstrained and the quadriceps relaxed, and 89-N force applied to the proximal tibia Measurement is made of the millimeters of posterior tibial translation in both knees Knees with 10 mm or more of increased posterior tibial translation are considered candidates for PCL reconstruction Full standing radiographs of both lower extremities, from the femoral heads to the ankle joints, are done in knees with varus lower 535 extremity alignment The mechanical axis and weight-bearing line are measured to determine whether HTO is indicated.11 Patients complete questionnaires and are interviewed for the assessment of symptoms, functional limitations, sports and occupational activity levels, and patient perception of the overall knee condition according to the Cincinnati Knee Rating System (CKRS; see Chapter 41).2 CLASSIFICATION AND TREATMENT OF PARTIAL TO COMPLETE PL INJURIES The classification and treatment of first-, second-, and third-degree acute PL injuries are detailed in Table 17-2 It is important to diagnose partial tears of the PL structures, with a mild to moderate increase in LJO and external tibial rotation, to allow protection and maintain lateral tibiofemoral joint closure in the initial weeks to allow “stick-down” and healing of lateral soft tissues This is a program similar to that recommended for medial ligament ruptures (see Chapter 19) PREOPERATIVE PLANNING: TIMING OF SURGERY Acute Injuries There is a distinct advantage for repairing completely disrupted PL structures and meniscal attachments in acute injuries (Fig 17-3) At the time of surgery, extensive disruption of these structures is observed Careful dissection is required to identify anatomic tissue planes and maintain an intact vascular and neural supply The so-called golden period to perform an acute surgical repair is within to 14 days of the injury After this time, scar tissue will obliterate tissue planes and make the dissection and repair difficult A lower extremity venous ultrasound is obtained before surgery in acute multiligament knee injuries that have swelling and soft tissue damage to detect occult venous thrombosis that requires urgent treatment and contraindicates surgery An initial delay in surgery for to days allows for observation of the neurovascular status, soft tissue swelling, skin integrity, and some clearing of hemorrhage in soft tissues in the injured extremity During this time, the lower extremity is supported in a soft-hinged full-leg brace in extension with a well-padded compression dressing In knees with extensive damage to the PL structures and PCL, a bivalved cylinder cast with a posterior plaster shell and posterior foam calf pad may be required to provide added stability and prevent posterior tibial subluxation Reduction of the tibiofemoral joint is verified by a lateral radiograph Lower limb elevation, ice, and compression are important The physical therapist initiates early protected knee motion, patellar mobilization, active quadriceps function, and electrical muscle stimulation Dislocated knees scheduled for surgery require vascular consultation, ankle/brachial studies (ankle/brachial index ≥90%), and possible arteriography to exclude arterial injuries, even when intact peripheral pulses are present Contraindications to acute surgical repair are excessive soft tissue swelling, hemorrhage, and edema that are frequently present in dislocated knees with multiple ligament ruptures The operative procedure adds to the injury by increasing edema and soft tissue swelling, risk of infection, vascular problems (including compartment syndromes), and skin flap necrosis In these cases, it is preferable to treat the acute injury and perform ligament reconstructive procedures later after tissue swelling is resolved and muscle function and knee motion have been restored In addition, there is a significant incidence of knee arthrofibrosis after acute surgical treatment of knee dislocations, which is lessened 536 CHAPTER 17 Posterolateral Ligament Injuries TABLE 17-2 Diagnosis and Classification of Acute Posterolateral Injuries First Degree Anatomic lesion Minor tearing fibers Signs Minor tenderness and swelling Increase in lateral joint opening‡ 30 degrees degree Increase in external tibial rotation (dial test, 30 degrees)‡ Treatment Second Degree Third Degree* † Partial tears, one third to two third fibers Tenderness and swelling lateral tissues FCL tear None None None None None None 2-3 mm None 3-5 degrees Progress per symptoms, no crutches Progress per symptoms, soft support brace Bivalved cylinder cast 3 wk ROM 0-90 degrees 2 wk Support brace 3-6 week Wean crutches 3-6 wk FCL tear, partial tear PMTL, PL capsule FCL tear, PMTL tear, PL capsule tear Tenderness and swelling lateral tissues 2-5 mm None 6-10 degrees 5-9 mm 3-5 mm 15 degrees Operative repair, reconstruction; usually associated ACL, PCL *Avulsion FCL, popliteus tendon: surgical indication to reattach † Even though FCL shows complete tear, adjacent lateral tissues maintain ligament continuity for healing Bivalved cylinder cast with protected motion, maintain lateral tibiofemoral joint closure ‡ See Chapter 15 Increases related to degrees of knee flexion, minor opening may be less under clinical conditions with lower joint loading ACL, Anterior cruciate ligament; FCL, fibular collateral ligament; PCL, posterior cruciate ligament; PL, posterolateral; PMTL, popliteus muscletendon-ligament; ROM, range of motion CRITICAL POINTS Preoperative Planning Acute Injuries • Golden period acute surgical repair: 7-14 days after injury • Lower extremity venous ultrasound, vascular consult for multiple ligament ruptures • Delay surgery 5-7 days, observe neurovascular status, soft tissue swelling, skin integrity • Soft hinged full-leg brace, well-padded compression dressing • PCL rupture: bivalved cast with posterior plaster shell, posterior calf pad • Verify tibiofemoral reduction with lateral radiograph in multiligament injuries • MRI for location of major ligament disruptions • Protected knee motion, patellar mobilization, isometrics • Contraindications to acute surgery in dislocated knees: excessive soft tissue swelling, hemorrhage, edema Delay reconstruction until swelling resolved, muscle function and knee motion restored Chronic Injuries • Muscle atrophy requires preoperative rehabilitation • Hyperextension gait abnormality requires gait-retraining program before PL reconstruction • Varus osseous malalignment requires osteotomy before PL reconstruction • Absent lateral meniscus, early tibiofemoral arthritis, consider lateral meniscus transplant Cruciate Graft Reconstruction • Ensure B-PT-B, Achilles tendon allografts available • Determine appropriate grafts for ACL or PCL reconstruction ACL, Anterior cruciate ligament; B-PT-B, bone-patellar tendon-bone; MRI, magnetic resonance imaging; PCL, posterior cruciate ligament; PL, posterolateral with a staged approach In our experience, the majority of multiligament disruptions in dislocated knees are not candidates for acute surgical procedures A delay in surgical reconstruction results in a decreased incidence of knee arthrofibrosis and markedly improves surgical outcomes Other obvious contraindications include open wounds and skin abrasions Magnetic resonance imaging (MRI) provides important information regarding ligament ruptures, articular cartilage damage, and meniscus tears Frequently, the sites of rupture to the FCL, popliteus muscle and tendon, PFL, and meniscal attachments may be identified before surgery One note of caution is the edema and swelling in the PL tissues leads to a conclusion of greater tissue damage and disruption than what is actually encountered at surgery Chronic Injuries Patients with chronic knee injuries often present with severe lower limb muscle atrophy requiring months of preoperative rehabilitation Patients with a hyperextension gait abnormality must complete a gait retraining program50 described in detail in Chapter 29 This program is done in addition to lower extremity muscle strengthening exercises In our experience, patients will convert to a more normal gait pattern after to weeks of training Varus osseous malalignment must be corrected before chronic PL reconstruction, as described previously Failure to address varus malalignment will greatly increase the risk of failure of any PL procedure (Fig 17-4) In anatomic PL reconstructions, the ligament surgery is staged after healing of the HTO The indications for the various PL procedures are described in detail under the “Operative Treatment of Acute Posterolateral Ruptures” and “Operative Treatment of Chronic Posterolateral Ruptures” sections Patients who have undergone prior lateral meniscectomy and who demonstrate early tibiofemoral arthritis are considered for a staged lateral meniscus transplantation after the PL reconstruction.48 INDEX Anterior-posterior translation, during normal walking, 131-132, 131f Anteroinferior popliteomeniscal fascicle, 31f Anterolateral ligament (ALL), 23-26, 27f-28f Anterolateral ligament reconstruction, 236-241, 239f-240f Anterolateral portal, arthrofibrosis and, 1080f-1082f Anterolateral posterior cruciate ligament (APCL), 441f Anteromedial approach and outside-in femoral tunnels, 476, 476b Anteromedial bundles, 144-154, 147f robotic studies on, 158, 158f-161f Anteromedial cortex oblique angle, 795f Anteroposterior displacement, 69, 69f Anteroposterior translation, 51-53, 51b, 54f-55f Anteroposterior translation limits, 407-408, 407f, 408t Anteversion, femoral, 1021 Anticonvulsants, complex regional pain syndrome (CRPS) and, 1145 Antidepressants, complex regional pain syndrome (CRPS) and, 1146 AOSSM online scoring system, for 2000 International Knee Documentations Committee Subjective Knee Evaluation Form, 1209 AP drawer test, 52, 53f APCL see Anterolateral posterior cruciate ligament (APCL) Apex of head (styloid process), 24f-25f Aponeurotic layer, anatomy of, 15 Aquatic therapy, 938, 1141 for arthritic knee, 956-968 applications of, 959-967, 959b aqua physics and, 957 aquatic balance activities and, 966t aquatic strengthening activities and, 965t balance, stabilization, gait and, 963-964, 966f, 966t buoyancy and, 957, 957f-958f, 961-962, 962f-963f cardiopulmonary training and, 964-967 clinical research of, 959 hydrodynamics and, 958-959, 958f hydrostatic pressure and, 957-958 mobility and, 959-961, 960f-961f, 962t muscle performance and, 961 scientific basis for, 957b scientific foundation for, 956-959 strengthening exercises and, 961 transition to land and, 967 viscosity and, 958-959, 958f, 962-963, 964f-965f, 965t Arciform fibers, 15 Arcuate sign, 670 Arm swing with resistance band, 388-389 Arm swing with TheraBand, 388f Army/Navy retractor, 980-982 Arteriography, 665-666 Arthrex femoral opening wedge osteotomy system, 815f Arthritis patellofemoral, secondary, 1036 tibiofemoral joint, 1037 Arthrofibrosis, 1059-1102, 1059b-1060b ACL reconstruction and, 205 anterolateral portal and, 1080f-1082f arthroscopic lysis of adhesions and, 1084f-1086f arthroscopic soft tissue releases and, 1079 authors’ clinical studies and, 1093, 1093t-1094t classification systems and, 1062, 1062b, 1062t, 1063f, 1064t clinical presentation and, 1069-1072, 1070b, 1070t, 1071f-1074f, 1073t clinical studies and, 1089-1093, 1090t-1092t, 1091b diagnosis and, 1069-1072, 1070b, 1070t, 1071f-1074f, 1073t experimental prevention studies and, 1066-1068, 1066b gentle manipulation under anesthesia and, 1078-1079, 1078b illustrative cases of, 1094-1098, 1095f-1098f incidence of, 1059-1060, 1061t injury and, severity of, 1063, 1064b inpatient physical therapy program and, 1079-1086, 1079b, 1087f intraoperative prevention and, 1068b, 1069 knee dislocation and, 1064f knee ligament reconstruction and, 1062-1066, 1064b Arthrofibrosis (Continued) limitation of knee extension and, 1072-1074, 1074b, 1075f-1076f limitation of knee flexion and, 1074-1076, 1075b, 1077f-1078f open Z-plasty and, 1079, 1083f operative management of severe restriction, 1079 oral corticosteroids and, 1076-1078, 1076b overpressure extension and flexion program, 1087t pain management and, 1086-1088 patella infera and, 1088-1089, 1088f-1090f, 1089b, 1089t patellar mobilization and, 1069f pathophysiology and, 1066-1068, 1066b posterior capsular releases and, 1084f-1086f posterior medial-lateral capsulotomy and, 1079 postoperative course and rehabilitation and, 1065-1066 postoperative prevention and, 1068b, 1069 preoperative issues and, 1063-1065, 1064b preoperative prevention and, 1068-1069, 1068b prevention and, 1068-1069, 1068b primary, 1059, 1060b risk factors for, 1064t, 1066 scar tissue and, 1060f secondary, 1060 technical factors at surgery and, 1065, 1065f terminology and, 1062, 1062b, 1063f tibial and femoral osteotomy, 828 treatment intervention, results of, 1092t Arthrokinematics, joint, 940, 941f Arthroplasty knee, 1235-1244 lateral unicompartmental knee, 901 clinical outcomes of, 902t-903t survival rates of, 901t medial unicompartmental knee, 894 clinical outcomes of, 897t-898t survival rates of, 895t-896t patellofemoral, 1036 Avon, clinical studies and, 1049-1052 contraindication to, 1037, 1037b, 1042 implants for, 1037, 1049 indications for, 1036 operative technique for, 1038-1039 prostheses, 1038t rehabilitation for, 1044t-1048t total knee, 1037, 1235 see also Knee arthroplasty unicompartmental knee arthroplasty versus, 899-901, 900t unicompartmental effect of factors on failure of, 894t versus high tibial osteotomy, 894-899, 899t Noyes Knee Institute rehabilitation for, 889t-893t versus total knee arthroplasty, 899-901, 900t Arthroscope, 1069 Arthroscopic gap test, 797-798, 799f Arthroscopic lysis, of adhesions, 1084f-1086f Arthroscopic-assisted open tibial inlay technique, 493b graft conditioning, tensioning, and fixation, 496-497, 497f patient positioning and setup, 493-494 posteromedial approach, 494 Arthroscopy all-inside approach and, 467 soft tissue releases and, 1079, 1080f-1082f tibial and femoral PCL graft sites and, 480f Arthrosis, 1016 Articular cartilage, 1014 loose flaps of, 976-979 Articular cartilage defects, of knee, 936 Articular cartilage degeneration, 990 Articular cartilage fractures, 1016 Articular cartilage lesions, 976-979 Articular cartilage procedure rehabilitation, 936-955 after repair procedures, 944-946 autologous chondrocyte implantation and, 951-953, 951t-952t chondroplasty and, 946 creating healing environment and, 938-939, 939f-940f debridement and, 946 early protection phase and, 944-945 individualization of, 937-938, 938t key principles to, 937t knee biomechanics and, 939-940, 941f 1247 Articular cartilage procedure rehabilitation (Continued) lesion location diagram, 941f load applications and, 943, 945f maturation phase and, 946 microfracture and, 946-948, 947t-948t muscle function restoration and, 942-943, 943f neuromuscular control and, 943, 944f-945f osteochondral autograft transplantation and, 948-951, 949t-950t philosophy and, 943 principles of, 936-943, 937b, 937t proprioception enhancement and, 943, 944f-945f reducing pain and effusion and, 940-941, 941f-942f remodeling phase and, 946 soft tissue balance restoration and, 941-942, 942f specific postoperative guidelines of, 946-953 specific variables and, 938t team communication and, 943 transition phase and, 945-946 Articular cartilage rating systems, 1222-1234 Cincinnati Knee Rating System as, 1222-1228, 1223b, 1223t commonly used, 1222-1229, 1223b, 1223t of International Cartilage Repair Society, 1223b, 1223t, 1228-1229, 1229t Outerbridge on, 1222, 1223b, 1223t reliability and validation studies of, 1229-1233, 1231b Articular cartilage restoration procedures, knee, 912-921 clinical biomechanics and, 914-915, 915b, 916f clinical evaluation of, 915-917, 915b clinical outcomes of, 919-920 contraindications of, 913b, 914 diagnostic tests of, 917 history of, 915-916 indications of, 912-914, 913b, 913f-914f, 913t intraoperative evaluation and operative technique of, 918-919, 919b physical examination of, 916-917 preoperative planning of, 917-918, 917b, 917t Articular cartilage surfaces, operative procedures and, 1175, 1176f-1178f ASMA see α-smooth muscle actin (ASMA) Athletic activities, rating of, 1211-1221 see also Sports Activity Scale Atrophy of lower extremity, after surgery, 271, 271b Augmentation procedures, for allografts, in primary anterior cruciate ligament reconstruction clinical studies, 201t Autograft transfer, osteochondral, 1004 Autografts see also Osteochondral grafts versus allografts, in ACL reconstruction, 200-201, 202t irradiation effect after implantation of, 105-107, 106b, 106f, 106t-107t osteochondral, 922 Autoimmune disorder, complex regional pain syndrome (CRPS) and, 1134-1135 Autologous chondrocyte implantation for patellofemoral lesions study demographics, 999-1004, 999t-1003t rehabilitation and, 951-953, 951t-952t Autonomic dysfunction, complex regional pain syndrome (CRPS) and, 1131, 1131f Autonomic ganglions, 1126 Autonomous robotic systems, 883-884 Avastin see Bevacizumab Avulsion fractures, 92, 94, 497-499, 498b B Baclofen, 1146 Balance and medial ligament injury rehabilitation, 650, 650f and meniscus repair and transplantation rehabilitation, 764-766, 765b and proprioception, 875 Balance training, 315f ACL reconstruction rehabilitation and, 310-314 bone-patellar tendon-bone (B-PT-B) reconstruction and, 296t-303t neuromuscular retraining after ACL reconstruction, 332, 332f and PCL reconstruction rehabilitation, 593-595, 594f techniques of, 866f tibial and femoral osteotomy and, 863-865 1248 INDEX BAPS see Biomechanical Ankle Platform System (BAPS) Barrier hop forward and backward, 384, 384f Barrier hop side to side, 383-384, 383f, 396t Barrier jump forward and backward, 379t, 380-381, 381f Barrier jump side to side, 378-380, 379t, 381f Basketball training, 398t, 401t results of, 401t Bereiter technique, trochleoplasty and, 990 Bevacizumab, 1068 Biceps femoris longus muscle, 29f Biceps femoris muscle, 12f, 27f, 33f long head of, 29f, 32f-33f short head of, 32f-33f Biceps femoris tendon, 12f, 34f lateral restraint and, 59 long head of, 26f Bicruciate injury, 659f-660f Bilateral knee injuries, 655f Biodex, for meniscus repair and transplantation rehabilitation, 765f Biodex Balance Systems, 315f Biodex Medical Systems, 314, 315f Biofeedback, 942 in ACL rehabilitation, 274 Biofeedback therapy, 295, 295f, 582, 646, 859 Biomechanical Ankle Platform System (BAPS), 315f Biomechanical properties, PCL graft based on, 472-473, 474t Biomechanics ACL injuries and, 349-363, 349b, 349t ACL reconstruction and, 140-165, 141b articular cartilage procedure rehabilitation and, 939-940, 941f knee articular cartilage restoration procedures and, 914-915, 915b, 916f of medial and lateral patellofemoral restraints, 972-974, 972b, 974f-975f valgus malalignment and, 849-850 Bisphosphonates, complex regional pain syndrome (CRPS) and, 1145 BMI see Body mass index (BMI) Body mass index (BMI), 348, 938 in ACL reconstruction, 203 ACL revision and, 223 excessive, valgus-aligned lower extremity with, 1042 Body weight, and tibial and femoral osteotomy, 775-776, 775f “Bone boss” “intralesional osteophyte” effect, 915 Bone fragment, distal realignment and, 983-984 Bone graft femoral fixation options for, 469t tibial fixation options for, 470t Bone ingrowth modulation, 115-117, 116f-117f Bone loss, prosthesis-related, as factors leading to failure, 1049 Bone plug, femoral placement of rectangular tunnel for, 489-491, 491b, 492f Bone tunnel, femoral fixation options for soft tissue graft plug in, 470t Bone-patellar tendon-bone (B-PT-B) autograft, 793 ACL reconstruction and, 160, 170-173, 171f-172f femoral tunnel placement and, 180-182, 183f, 185f graft tunnel passage, conditioning and fixation, 182 healing of, 119f versus semitendinosus-gracilis tendon autograft, 201 tibial and femoral technique, 176-182, 177b, 181f tibial tunnel placement and, 177-180 Bone-patellar tendon-bone (B-PT-B) graft, in ACL revision reconstruction, 224-225, 241b, 242-245, 244f-245f, 244t-246t failure in, 246, 248t-249t femoral tunnel placement and, 234-235 graft tunnel passage, conditioning and fixation of, 235 tibial and femoral technique, 230-235, 233f, 234b tibial tunnel placement and, 230-234 Bone-patellar tendon-bone (B-PT-B) reconstruction autogenous, 294 balance, proprioceptive, and perturbation training and, 310-314, 313f conditioning and, 315 early return to strenuous activities, 295-319 fibular collateral ligament, 548-549 flexibility and, 305-306, 307f modalities, 295-304 patellar mobilization and, 305, 307f Bone-patellar tendon-bone (B-PT-B) reconstruction (Continued) plyometric training and, 316-319, 316f postoperative bracing and, 304 range of knee motion and, 304-305, 304f rehabilitation protocol for, 295-319 return to sports activities and, 319 running and agility program and, 316 strengthening and, 306-310, 308f-309f weight bearing and, 304f, 305 Bones, geometry of, 1014, 1015f Bone-to-bone healing, in ACL autograft reconstruction, 118-119, 118b, 119f Bony instability, 825-826 Bounding for distance, 379t, 385 Bounding in place, 382-383, 383f Box-hopping, exercise, 316 B-PT-B autograft see Bone-patellar tendon-bone (B-PT-B) autograft Bracing after ACL reconstruction, 269-271, 269b distal femoral osteotomy and, 859 high tibial osteotomy and, 859 knee extension and, 581f, 582 and meniscus repair and transplantation, 762-763, 763b and posterolateral reconstructive procedures, 604 postoperative B-PT-B reconstruction and, 304 for medial ligament injury rehabilitation, 646 Bridge with alternating-leg hamstring glide, 388 Bridge with double-leg hamstring glide, 388 Broad jump, 379t, 382, 382f Budapest clinical diagnostic criteria, for complex regional pain syndrome (CRPS), 1124t Buoyancy exercises, aquatic therapy and, 957, 957f-958f, 961-962, 962f-963f Burmester curves, 90, 90b, 91f C Calcitonin, complex regional pain syndrome (CRPS) and, 1145 Calcium channel blockers, complex regional pain syndrome (CRPS) and, 1145 Calculated ACL forces, 274 Calf stretch, 396t Cancellous allograft, freeze-dried dense, 230 Capsaicin, complex regional pain syndrome (CRPS) and, 1145-1146 Capsular condensations, 66 Capsular restraints, 53-61, 57b Capsulotomy, posterior medial-lateral, 1079, 1084f-1086f Cardiopulmonary training, aquatic therapy and, 964-967 Cardiovascular exercise program, 315 Cartilage-sensitive magnetic resonance imaging (MRI), 971 Caton-Deschamps index, 989 Cellular necrosis, ACL healing and, 104-105, 104b, 105f, 105t Cement technique, for patellofemoral arthroplasty, 1041, 1041f Center of rotation, 86-88 Central nervous system and, alterations of, 1132, 1133f Central sensitization, complex regional pain syndrome (CRPS) and, 1132 Chondral defects management of, 913f-914f prevalence of, 912, 913t Chondromalacia, 1016 Chondropathy, patellar, 1016, 1017f-1018f Chondroplasty, articular cartilage rehabilitation and, 946 Chondroprotective effects, and meniscus transplantation, 720-721 Chondrosclerosis, 1222 Chronic anterior cruciate ligament ruptures, 138 Chronic extensor mechanism malalignment disorders, 972 Chronic insufficiency, gait abnormality and, 868 Chronic medial and posteromedial ligament repairs, 621-625, 623t Chronic medial and posteromedial ruptures, 618 Chronic posterior cruciate ligament ruptures, 448f, 465-466, 465f Chronic posterolateral ligament ruptures, operative treatment of, 544-559 and anatomic reconstruction of fibular collateral ligament and popliteus muscle-tendon-ligament, 546-550, 547b fibular collateral ligament bone-patellar tendon bone reconstruction in, 548-549, 548b patient positioning and surgical approach to, 546-547 peroneal nerve dissection and visualization in, 547-548 femoral-fibular reconstruction in, 553-556, 556b, 557f and graft replacement of popliteus muscle-tendonligament, 549-550, 550b, 551f-552f overview of operative options for, 544-545, 544b posterolateral capsule reconstruction, for severe varus recurvatum, 550-552, 553b, 553f-555f Chronicity, of injury, in primary anterior cruciate ligament reconstruction clinical studies, 201t Cincinnati Knee Rating System, 461b, 1162-1185, 1164b, 1190, 1222-1228, 1223b, 1223t, 1240 complex lesions of, 1228, 1228f components of, 1164t, 1165-1179 final rating form for, 1189, 1189f independent institutions assessment of, 1180-1182, 1181b knee examination for, 1172-1173, 1174f “modified,” versus IKDC Subjective Evaluation Form, 1208 modified scales of, 1182 objective testing for, 1173-1174, 1175f operative procedures and articular cartilage surfaces in, 1175, 1176f-1178f overall rating assessment in, 1179 patient history for, 1172, 1173f postoperative complications in, 1175, 1178f rating of occupational activities in, 1169-1172, 1172f rating of patient perception of the knee condition in, 1166b, 1168-1169, 1168f rating of sports and daily activities in, 1169, 1169b, 1170f-1171f, 1170t rating of symptoms in, 1165-1168, 1166b, 1166f-1167f reliability, validity, and responsiveness testing in, 1179-1180 schematic illustration of, 1225f-1226f Sports Activity Scale, 1169, 1170f visual appearance of, 1226-1228, 1227f Cincinnati Sports Medicine and Orthopaedic Center Rehabilitation Protocol, 639t-645t primary anterior cruciate ligament reconstruction, 296t-303t Circumflex fibular artery, 19f, 33f CKC exercises see Closed kinetic chain (CKC) exercises Clamshell exercise, 875f “Climbing,” factor of, 1170-1171 Clonidine, 1145 Closed kinetic chain (CKC) exercises, 274-275, 307 Closing wedge osteotomy and double and triple varus knees, 816-818, 817b, 817f-818f versus high tibial osteotomy, 822 opening wedge osteotomy compared with, 794 and survival rates, 820-822, 821t-822t Closing wedge tibial osteotomy, 805-809, 805b arthroscopy for, 805 fibular osteotomy, 805-808 and fluoroscopic verification of corrected alignment, 808-809, 809f initial anterolateral tibial approach to, 805, 806f-807f initial operating room preparation in, 805 and proximal osteotomy, 808 and tibial wedge removal, 808 Cold-stored osteochondral allografts, 923 Collagen fibers alignment, 85f bundle failure, 85-86, 87f fiber length patterns of, 83 Collagen stress-strain curve, 84-86, 85f Collateral ligament, medial, Common peroneal nerve, 12f, 29f, 34f anatomy of, 1105, 1105f neurolysis of, 1112, 1115f INDEX Complex regional pain syndrome (CRPS), 140, 223, 1122-1160, 1123f alpha-adrenergic antagonists and, 1145 anatomy and, 1123-1130, 1124b anticonvulsants and, 1145 antidepressants and, 1146 autoimmune disorder and, 1134-1135 autonomic dysfunction and, 1131 bisphosphonates and, 1145 calcitonin and, 1145 calcium channel blockers and, 1145 capsaicin and, 1145-1146 central nervous system and, alterations of, 1132, 1133f central sensitization and, 1132 clinical presentation and, 1135-1138, 1136t-1137t cortical reorganization and, 1132, 1133f corticosteroids and, 1141-1145 diagnosis and, 1135-1139, 1135b diagnostic blocks and, 1138-1139, 1139t diagnostic criteria for, 1124t differential diagnosis and, 1135, 1135t edema abnormalities and, 1136 epidural infusion and, 1149 etiology and, 1130-1135, 1130b free radical scavengers and, 1145 ganglions and, 1124-1126, 1127f hypoxia and, 1132-1133, 1134f illustrative case reports, 1150-1153, 1151f inciting event and, disproportionate pain to, 1136 interventions and, 1146-1149 intravenous immunoglobulin and, 1148 knee-related, graded motor imagery program for, 1141t lidocaine and, 1145-1146 limb ischemia and, 1132-1133 magnetic resonance imaging (MRI) and, 1138 medications and, 1141-1146 motor abnormalities and, 1137 movement disorders and, pharmacotherapy for, 1146 N-methyl-D-aspartate receptor antagonists, intravenous ketamine, 1146, 1147t-1148t natural history of, 1138 nerves around the knee and lower limb, 1129-1130, 1129f nervous system and, 1123-1124, 1125f neurogenic inflammation and, 1131-1132 neurons and, 1124, 1125f-1126f neurostimulation and, 1149 nonsteroidal antiinflammatories and, 1141-1145 objective tests and, 1138-1139 occupational and physical therapy, 1140-1141, 1140f opioids and, 1146 parasympathetic nervous system and, 1129 pathophysiology and, 1130-1135, 1130b pharmacology treatment options for, 1142t-1144t pharmacotherapy guide and, 1150t psychological factors in, 1133-1134 psychological issues and, 1137-1138 psychotherapy and, 1141 radiographs and, 1138 sensory abnormalities and, 1136-1137, 1137f sudomotor measurement and, 1139 surgery and, 1149 surgical sympathectomy and, 1149 sympathetic block and, 1148-1149, 1148f sympathetic nervous system and, 1128-1129 synapses and, 1126-1128, 1128f terms relevant to, 1123t treatment and, 1139-1150, 1139b triple phase bone scintigraphy (TPBS) and, 1138, 1138f trophic changes and, 1137 tumor necrosis factors-α inhibitors (TNF-α) and, 1148 vasomotor abnormalities and, 1136 disturbances and, 1131f measurement and, 1139 Computed tomography (CT), knee dislocation evaluation with, 658 Computer navigated robotic unicompartmental knee arthroplasty, accuracy of, 885t Concomitant operative procedures, in primary anterior cruciate ligament reconstruction clinical studies, 201t Concurrent validity, 1165 see also Criterion validity Conditioning activities, 865-867 aerobic, bone-patellar tendon-bone (B-PT-B) reconstruction and, 296t-303t bone-patellar tendon-bone (B-PT-B) reconstruction and, 315 and medial ligament injury rehabilitation, 650-651 for meniscus repair and transplantation rehabilitation, 768-770, 768b, 769t programs, 595 Cone walking, 865f Congenital abnormality, patella alta and, 987 Constrained motion, defined, 78t-79t Construct validity, 1165, 1180t Content validity, 1165, 1180t Continuous passive motion (CPM), 939 Contracture, iliotibial band Z-plasty release for, 991, 991f Controlled compression, 938 Conventional radiographic techniques, 975 Core reamer, 232-234 Coronal T1 magnetic resonance imaging, 1043f Coronary ligament, 11-13 Corrective osteotomy, 1015 Cortical reorganization, complex regional pain syndrome (CRPS) and, 1132, 1133f Corticosteroids complex regional pain syndrome (CRPS) and, 1141-1145 oral, arthrofibrosis and, 1076-1078, 1076b Cosmetic skin incisions, 622f Coupled displacement, defined, 78t-79t Coupled rotation, 62, 63t CPM see Continuous passive motion (CPM) CPRS see Complex regional pain syndrome (CRPS) Cradle walk, 396t Crest, of tibia, 18f Criterion validity, 1165 Cross-country skiing, 315 Cruciate ligaments, 53, 61 restraining for lateral joint opening caused by, 59t restraining for medial joint opening caused by, 58t Crutch support, and meniscus repair and transplantation, 762-763, 763b Cryotherapy B-PT-B reconstruction and, 295, 295f and medial ligament injury rehabilitation, 646 and meniscus repair and transplantation, 762f PCL reconstruction and, 582 tibial and femoral osteotomy and, 859 CT scans, for patellofemoral arthroplasty, 1038-1039 Cup walking, 310, 313f, 865f, 875-876, 876f for meniscus repair and transplantation rehabilitation, 765f Cyclical fatigue testing, 442-443, 442b, 443f Cylinder casts, 617, 617f, 638f Cytokines, 1066-1067 D Daily functional activities, rating of, 1211-1221 Daily living scales, activities of, 1215-1217, 1215b of knee outcome survey, 1215b, 1217, 1217t Daniel Sports Activity Rating, 1212b, 1215 De Mayo Knee Positioner (Innovative Medical Products), 886 Debridement, articular cartilage rehabilitation and, 946 Decompression forces, 938 Decorin, 1067-1068 Deep fascia anatomy, 2-5, 4f Deep medial collateral ligament (DMCL), 3f, 64 Deep peroneal nerve, anatomy of, 1105 Deep transverse fibers, 985 Deep transverse retinaculum, 15f Deep venous thrombosis (DVT), 828-829, 858 Deficiency, defined, 80t Degenerative meniscus tears, 678 Degrees of freedom, 39 limits for, 41-46, 41t Dejour technique, trochleoplasty and, 990 Delayed union, 818-819 Deltoid, 393 stretching, 394f 1249 Demographic Form, of International Knee Documentations Committee, 1193, 1198f-1199f Denervation, of proximal tibiofibular joint, 1112, 1115f Dense scar tissue, 1059 Descending genicular artery, 19f-20f DFO see Distal femoral osteotomy (DFO) DFVO see Distal femoral varus osteotomy (DFVO) Dial test, 529, 530t-534t Discharge criteria, and PCL reconstruction, 596, 597t Dislocations acute medial ligament ruptures and, 618 and anatomic classification system, 658-661, 658b, 659f-661f, 659t assessment of, 654b classification of, 654-662 defined, 77t and energy of injury classification system, 656-658, 657b, 657f knee dislocations, definition of, 654, 655f-656f position classification of, 654-656, 656b, 657f Displacement, defined, 78t-79t Distal femoral osteotomy (DFO) balance and proprioceptive training and, 863-865 complications of, 856 conditioning and, 865-867, 867t contraindications for, 849, 849b flexibility and, 862-863 indications for, 848-849, 849b operative technique of, 851-854, 851f-854f patellar mobilization and, 862, 862f perturbation training and, 863-865, 866f postoperative bracing and weight bearing and, 859-860, 859f, 861f postoperative rehabilitation protocol and, 859-867, 860t range of knee motion and, 860-861, 861f-862f, 861t rehabilitative goals and, 858 return to activities and, 865-867 strengthening and, 863, 863f, 864t, 865f subsequent knee replacement and, 856 Distal femoral varus osteotomy (DFVO), 855 Distal realignment, 983-985, 984f-985f contraindications of, 972 Disuse, ligament biomechanical properties and, 92b, 95-96, 96f, 96t DMCL see Deep medial collateral ligament (DMCL) Dog and bush (hip rotator) walk, 376, 378f Dorsal root ganglions, 1126, 1127f Double varus knees, 776, 777f, 816-818, 817b, 817f-818f Double- and single-leg balance exercises, 310, 313f-314f Double-stacked suture technique, 691, 692f-693f Dovetail meniscus allograft technique, 728f, 730 Dowel allograft, 926-927, 926f-927f Drawer motions, 40 Drop-jump, video, 319 Dumbbell weights, 309f Duplex ultrasonography, 666 DVT see Deep venous thrombosis (DVT) Dynamic postural control, ACL reconstruction and, 277-278 Dynamic test, 277-278 Dynamic warmup, 376-377 E Eccentric muscle training, 275-276 Edema abnormalities, complex regional pain syndrome (CRPS) and, 1136 Efferent neurons, 1124 Effusion articular cartilage procedure and, 940-941, 941f-942f knee joint, 273-274 Elastic band gait retraining, 876f Electrical muscle stimulation (EMS), 295, 295f, 637, 859, 942 in ACL rehabilitation, 274 Electrical synapses, 1126 Electrochemical synapse, 1126 Electrode, 295 Electrogoniometer, 45f Ellis clamp, 473 EMS see Electrical muscle stimulation (EMS) EndoButton, 262 1250 INDEX Endurance training, 313t American College of Sports Medicine (ACSM) during, 313t Energy of injury classification system, 656-658, 657b, 657f Epidural blocks, 1139 Epidural infusion, 1149 Epinephrine, synapses and, 1127 EUA see Examination under anesthesia (EUA) Examination under anesthesia (EUA), 659 Excitatory neurotransmitters, 1126 Exercise program, cardiovascular, 315 Extension of knee, limitation of, 1071f, 1072-1074, 1074b, 1075f-1076f limits of knee joint motion in, 41t loss of, 1064t overpressure exercises, 1087f Extension cast application, 271f Extension limits, posterior cruciate ligament, 406-407 Extension overpressure hanging- weight, 764f Extensor mechanism anatomy of, 129, 129f disorders of, 970 Extensor mechanism malalignment clinical studies of, 993-1008 medial patellofemoral ligament reconstruction and, 993-999, 994t-998t patellofemoral articular cartilage lesions and, 999-1005, 1005f trochleoplasty procedures and, 1005-1008, 1007t complications of, 992-993, 993b contraindications of, 972, 972b, 973f illustrative case of, 1008, 1008f indications of, 970-972, 971b operative options for, 970-1013, 970b postoperative management of, 991-992, 991b, 992t preoperative planning of, 974-976, 975b, 976f-977f surgical techniques of, 976-991, 978b, 979f distal realignment for, 983-985, 984f-985f iliotibial band Z-plasty release for contracture, 991, 991f lateral patellofemoral (iliopatellar tract) reconstruction for, 985-987, 986f lateral retinacular release for, 979 medial patellofemoral ligament reconstruction for, 980-983, 980f-983f, 982t patella alta correction for, 987-990, 987f-989f, 987t, 990t proximal realignment for, 979-980 trochleoplasty for, 990-991 Extensor mechanism surgery, 980 contraindications to, 972 External knee adduction moment, 134f External rotation limits of knee joint motion in, 41t limits to, 43, 44f, 64f, 413f, 417t recurvatum test and, 530t-534t tibial, 70-72, 408-409, 408f-409f, 415-417, 417f in uninjured knee, 75f External rotation test, ligamentous restraints of knee joint in, 50t Extrinsic risk factors in ACL injuries climate conditions and, 346, 346b footwear and, 346, 346b playing surface and, 346, 346b F Fabella, 12f, 29f anatomy of, 28, 29t Fabella syndrome, 28 Fabellofibular ligament, 12f, 29f, 32f, 34f anatomy of, 26-28, 30f Fabellum, 541 Failure, definition of, 269 Failure-mode mechanisms, ligaments and, 93-95, 93f-94f Fascia lata, 15 Fascial layers, of anterior knee, 14-16, 17f Fat pad, 34f palpation of, 974-976 Fatigue, and ACL, risk factors, 363, 364t-365t FCL see Fibular collateral ligament (FCL) Femoral anterior cruciate ligament graft locations, 162-165, 163f-166f Femoral anteversion, 975, 1021 Femoral artery, 12f, 19f, 29f Femoral attachments of ACL, 153, 154f-155f fiber-length patterns and, 88-90, 89f ligament length-tension patterns and, 86-90, 87b, 87f-90f measurements, 457t posterior cruciate ligament, 449f Femoral condyle clock-face markings, 455f medial anatomy of, 9f posterior cruciate ligament, 449-458 Femoral-fibular allograft reconstruction, 561-562 Femoral-fibular graft reconstruction, 545 Femoral-fibular reconstruction, 553-556, 556b, 557f Femoral fixation anterior cruciate ligament and, 186f B-PT-B graft plugs and, 495-496 options for bone graft, 469t options for soft tissue graft plug in bone tunnel, 470t Femoral footprint, 146-154, 149t, 150f, 152f insertion size and shape, 152t landmarks for identifying, 151t radiographic description of, 153t Femoral insertion, of ACL, 156f Femoral nerve, 1129 Femoral nerve block, 887 Femoral notch, 233f Femoral placement of rectangular tunnel for bone plug, 489-491, 492f of single tunnel, 489, 489b, 490f-491f of two tunnels and graft passage, 484-487, 486f-487f Femoral surface, shortening and lengthening of, 89f Femoral torsion, measurements lack standards, 1021-1023, 1021f-1023f Femoral tunnel in ACL revision reconstruction bone grafting procedure for, 228-230, 228b, 230t, 231f-232f misplaced, 222 placement of, 234-235, 234b prior, 226-228, 229f anteromedial approach and outside-in, 476, 476b enlargement, after MPFL reconstruction, 995 flexible guide pin and drill for, 189, 193f malposition of, 189-190 placement of, 180-182, 183f, 185f Femoral vein, 12f, 29f Femur, 5f-6f, 12f, 18f, 29f lateral shaft of, 1026 Fiber function, posterior cruciate ligament, 428-442, 429f-440f Fiber length-tension properties, of ligament, 83, 84b, 84f Fibrin clot, 114 Fibrocartilaginous zone, at ligament insertion, 95 Fibrous adhesions, within joint, 1059, 1060f Fibula, 5f-6f, 18f Fibular collateral ligament (FCL), 12f, 29f, 33f-34f anatomic reconstruction of, 546-550, 547b bone-patellar tendon bone reconstruction in, 548-549, 549f-550f patient positioning and surgical approach to, 546-547 peroneal nerve dissection and visualization in, 547-548 anatomy of, 26, 29f forces in, 414f Fibular head, 26f-27f, 29f, 32f, 34f anatomy of, 34, 34t Fibular tunnel placement, 548-549, 549f Figure-four test, 685 First-generation implants, for patellofemoral arthroplasty, 1037, 1038t First-time patella dislocations, nonoperative treatment of, 971 Flap tears, 696, 697f Flexibility bone-patellar tendon-bone (B-PT-B) reconstruction and, 305-306, 307f exercises, 306 and medial ligament injury rehabilitation, 647 Flexibility (Continued) and meniscus repair and transplantation rehabilitation, 763-764, 763b, 763t and PCL reconstruction, 590-591 sportsmetrics training and, 391-394 tibial and femoral osteotomy and, 862-863 Flexion contracture, 1062 of knee, limitation of, 1071f, 1074-1076, 1075b, 1077f-1078f limits of knee joint motion in, 41t loss of, 1064t overpressure exercises, 1087f Flexion angle, 128f Flexion exercises, 590f, 764f Flexion-extension axis, 39-40, 40f Flexion-extension moment and ACL-deficient knee, 127-128, 127f-128f and ACL-reconstructed knee, 129-130, 130f Flexion overpressure exercises, 618f using rolling stool, 591f using wall-slide technique, 591f Flexion-rotation drawer, pivot-shift test, ligamentous restraints of knee joint in, 50t Flexion-rotation drawer tests, 44, 46f, 143f FlipCutter (Arthrex) technique, 483 for femoral tunnel, 184, 188f second-generation, 189, 189f-192f Fluid extravasation, 208 Foot progression angle (FPA), 1017-1018, 1019f-1020f Foot pronation, 347-348 Footwear, ACL injury risk and, 346, 346b Force(s) calculated ACL, 274 defined, 78t-79t Force platform, articular cartilage procedures and, 938 Force-displacement test, 66f Four-ligament disruption, 661f Four-strand semitendinosus-gracilis (STG) autograft, 793 Four-strand semitendinosus-gracilis (STG) graft, 182 FPA see Foot progression angle (FPA) Free radical scavengers, complex regional pain syndrome (CRPS) and, 1145 Full lower extremity-strengthening program, 310 Full passive knee extension, 305 Functional Index Questionnaire, 1240 Functional restoration, 1140 Fundamentals phase, 377 G Gabapentin, 1145 Gait abnormal knee hyperextension and, 871-877, 873b, 873t, 874f-876f injury effects on, 331 joint kinetics during, 126-130, 126b maximum energy conservation during, 1017 Gait analysis, 223 and varus knee syndromes, 778-779, 779b, 818t Gait training, 315f Ganglions, complex regional pain syndrome (CRPS) and, 1124-1126, 1127f Gap angle, 795, 796f Gap test, 225, 225f, 534f, 538 Gastrocnemius, 393 lateral head of, 29f stretching, 394f Gastrocnemius-soleus strength, 308, 310 Gastrocnemius-soleus towel-pull stretch, 307f Gastrocnemius tubercle, 3f, 5f-6f, 9f-10f, 24f-25f Gender ACL reconstruction and, 195, 196f, 196t in primary anterior cruciate ligament reconstruction clinical studies, 201t Gender differences during cutting, 360t-362t in hip and core strength, 354t in lower extremity, muscle strength, 352-355, 352t, 353f during running, 360t INDEX Gender differences (Continued) in strength, lower extremity function, and alignment during running, cutting stop-jump tasks, 359-363, 360t-362t in strength lower extremity function and alignment during two-legged landings, 355-359, 357t-358t, 359f on two-legged landings, 357t-358t, 359f General health outcome instruments, psychometric properties for, 1162-1164, 1164t Genetics, and anterior cruciate ligament, 345-346, 345b Gerdy’s tubercle, 24f-27f Giving-way episodes, 624f Global outcome instruments, 1211-1221, 1218b Glute kicks exercise, 376 Goals, bone-patellar tendon-bone (B-PT-B) reconstruction and, 296t-303t, 304 Goutallier procedure, trochleoplasty and, 990 Gracilis, Gracilis tendon, 3f-4f, 20f Grade 1A, of Cincinnati Knee Rating System, 1222, 1224f Grade 1B, of Cincinnati Knee Rating System, 1222, 1224f Grade 2A lesion, of Cincinnati Knee Rating System, 1222, 1224f Grade 2B lesions, of Cincinnati Knee Rating System, 1222, 1224f Grade 3A lesion, of Cincinnati Knee Rating System, 1224, 1225f-1226f Grade 3B lesion, of Cincinnati Knee Rating System, 1224, 1225f-1226f “Grade I laxity”, 60-61 Grade I pivot shift, 51f Graded motor imagery, 1140, 1141t Graded pain exposure therapy, 1141 Graft, type of, in primary anterior cruciate ligament reconstruction clinical studies, 201t Graft contamination, 208 Graft healing, ACL reconstruction and, 165-167 Graft tensioning and fixation, 487-489, 488b, 488f posterior translation with, 439t H Half round foam rolls, 314 Hamstring(s) curls, 308, 310f isokinetic, 353t modified hurdler stretch, 305-306, 307f muscle strength, 319 musculature, 350 strength, 352t stretching, 392, 392f, 396t Hand walk, 396t Haptic systems, 883-884 Head of fibula, 12f, 18f-19f, 24f-25f, 31f Health Assessment Form, of International Knee Documentations Committee, 1199, 1200f-1201f Heel walk, 376 Heel wedge, hyperextension gait abnormalities and, 873 Hemostasis, distal realignment and, 985 Hemovac drain, distal realignment and, 985 Hiatus of adductor magnus, 29f High knees exercise, 376 High quadriceps forces, 350 High tibial osteotomy (HTO) and associated cartilage restorative procedures, 821t-822t, 822-823 balance and proprioceptive training and, 863-865 versus closing wedge, 822 conditioning and, 865-867, 867t effect of, on long term knee symptoms and function, 823-824, 823t flexibility and, 862-863 patellar mobilization and, 862, 862f perturbation training and, 863-865, 866f postoperative bracing and weight bearing and, 859-860, 859f, 861f postoperative rehabilitation protocol and, 859-867, 860t range of knee motion and, 860-861, 861f-862f, 861t rehabilitative goals and, 858 return to activities and, 865-867 High tibial osteotomy (HTO) (Continued) strengthening and, 863, 863f, 864t, 865f subjective results of, 825t unicompartmental knee arthroplasty versus, 894-899, 899t versus unicompartmental knee replacement, 824 High-Activity Arthroplasty Score, 1239, 1240t High-knee skip exercise, 376 Hip, standard lateral approach to, 1026 Hip abductor resistance band kicking, 391 Hip abductor TheraBand kicking, 392f Hip flexor, 392-393 Hip flexor resistance band kicking, 390-391 Hip flexor stretch, 394f, 396t Hip flexor TheraBand kicking, 391f Hip rotator walk, 396t Hip-knee-ankle (HKA), 1014 HKA see Hip-knee-ankle (HKA) Home-based rehabilitation, 281-282 Hop, hop, hop, stick exercise, 385 Horizontal tears, meniscus, 694-695 Hormonal risk factors in ACL injury, 348-349, 349b menstrual cycle and, 348-349, 349b sex hormones and, 348-349, 349b Hospital for Special Surgery Sports Scale, 1212b, 1214 HTO see High tibial osteotomy (HTO) Human ligament grafts, for reconstruction, 95b, 97, 97t-98t, 98f Hunter’s canal, saphenous nerve in, 1109f neurolysis of, 1116, 1119f Hyaline articular cartilage, 922 Hyaluronic acid, 1068 Hydrodynamics, aquatic therapy and, 958-959, 958f Hydrostatic pressure, aquatic therapy and, 957-958 Hydroxycamptothecin, 1068 Hyperbaric oxygen, 118 Hyperextension gait abnormalities abnormal knee hyperextension patterns of, 869-871, 869b, 870f-872f, 870t analysis after retraining, 877-878 analysis before retraining, 877, 877t, 878f clinical investigation and, 877-878, 878b correction of, 868-881 diagnosis of, 868-869, 869b, 869f exercises for, 874f-876f flexion angles and, 878f gait retraining program for, 871-877, 873b, 873t, 874f-876f illustrative cases of, 879-880, 879f-880f methods and materials in, 877 normal gait cycle and, 870f pattern I and, 869-870, 871f pattern II and, 869-870, 872f peak values for control and involved limbs, 877t retraining effect in, 878 varus recurvatum and, 879f Hyperextension gait or varus thrust, 530t-534t Hypertrophy training, 312t American College of Sports Medicine (ACSM) and, 312t Hypoxia, complex regional pain syndrome (CRPS) and, 1132-1133, 1134f I ICRS see International Cartilage Repair Society (ICRS) IKDC see International Knee Documentations Committee (IKDC) Iliac crest harvest site pain, 828 Iliopatellar band, 23, 26f Iliopatellar tract, 985 Iliopatellar tract reconstruction, 985-987, 986f Iliotibial band, 12f, 14f-15f, 26f, 29f, 32f-33f, 392 anatomy of, 23, 26f stretching, 306, 308f, 393f Iliotibial band extraarticular reconstruction, 235-236, 235b, 237f-238f Iliotibial band extraarticular tenodesis, 176 Iliotibial band graft, 261-262, 262f Iliotibial band Z-plasty release, for contracture, 991, 991f Iliotibial tract, 34f lateral restraint and, 59, 59f-60f Immediate knee motion, after ACL reconstruction, 269-271, 269b, 270f 1251 Immobilization for acute knee dislocation, 669, 669b of knee joint, 269-271 ligament biomechanical properties and, 92b, 95-96, 96f, 96t Incision, surgical technique, for patellofemoral arthroplasty, 1040 Indian hedgehog, 118 Infection, ACL reconstruction and, 205, 207t Inferior lateral genicular artery, 33f Inferior lateral geniculate artery, 32f Inflammatory response, modulation of, 114-115, 115f-116f Infrapatellar branch, of saphenous nerve, 18 Infrapatellar contracture, 1043, 1043f Infrapatellar fat pad, anatomy of, 16-17 Inhibitory neurotransmitters, 1126 Injury chronicity, ACL reconstruction and, 195-196, 196t Injury prevention and performance, warmup for, 394-395, 396t Innervation of human knee joint, 1104, 1104f of proximal tibiofibular joint, 1104-1105, 1104f Inpatient physical therapy program, arthrofibrosis and, 1079-1086, 1079b, 1087f, 1087t Insall-Salvati method, 988-989 Instability, defined, 38, 76-77, 78t-79t Instron model 1321 biaxial testing system, 54-55 Instrumented kinetic chain, 57f Insurance, 200, 200f in primary anterior cruciate ligament reconstruction clinical studies, 201t Intercondylar eminence, 24f-25f Intercondylar fossa, 24f-25f Intercondylar notch, 346-347 Internal consistency, 1165 Internal femoral torsion, 1019-1021 Internal rotation limits of knee joint motion in, 41t limits to, 64f Internal rotation test, ligamentous restraints of knee joint in, 50t Internal tibial rotation limits to, 41-43, 43f, 45f ACL reconstruction and, 140-144, 142f, 144f-145f maximal, 69 Internal-external motions, of knee, 131-132, 131f Internal-external tibial rotation, 40, 40f, 70 limits, 408-409 International Cartilage Repair Society (ICRS), 1223b, 1223t, 1228-1229, 1229t Cartilage Injury Evaluation Package, 923 macroscopic cartilage assessment score of, 1229, 1230t Mankin scoring system and, 1231, 1231t, 1232f-1233f mapping system of, 1229, 1230f International Knee Documentations Committee (IKDC), 1229 Demographic Form, 1193, 1198f-1199f Health Assessment Form, 1199, 1200f-1201f history of, 1190-1191, 1191b Knee Evaluation system, 1162 knee scoring system of, components of, 1191-1199, 1191b members of 1987, 1191t 1997, 1193t outcomes of, comparison with other knee rating system, 1199-1208, 1208b International Knee Documentations Committee Rating System, 1190-1210 see also International Knee Documentations Committee (IKDC) our comment on, 1208-1209 Interneurons, 1124 Interosseous border, 24f-25f Intersegmental moment, 126-127, 126f Intraarticular corticosteroids, on ligament properties, 98b, 102 Intraarticular graft healing, 119, 119b Intravenous immunoglobulin, complex regional pain syndrome (CRPS) and, 1148 Intravenous ketamine, 1146 Irradiated meniscus transplants, 735, 736f Irradiation, in allografts and autografts, 105-107, 106b, 106f, 106t-107t Irreparable meniscus tears, 681f 1252 INDEX Isokinetic quadriceps, 352t Isolated posterior cruciate ligament reconstructions, 418-421 Isometric quadriceps contractions, 306, 591-592 Isometric wall sits, 874 Isometrics, wall-sitting, 308 Item-discriminant validity, 1165, 1181t Item-divergent validity, 1165 see also Item-discriminant validity J Joint arthritis preexisting, ACL reconstruction and, 198, 198f, 198t tibiofemoral, 1037 Joint arthrokinematics, 940, 941f Joint arthrosis, preexisting, in primary anterior cruciate ligament reconstruction clinical studies, 201t Joint aspiration, 1070 Joint compression, limits of knee joint motion in, 41t Joint distraction, limits of knee joint motion in, 41t Joint kinetics, 126-130, 126b Joint motions, during clinical examination, 60-61, 60t Joint repositioning, 332 Joint rotations, 40f Jump, jump, jump, vertical jump, 383 Jump into bounding exercise, 386 Jump training, 377-386, 379t Jump training component, 379t Jump up, jump down, 180 degrees, vertical, 385 K Kaiser Permanente National Total Joint Registry, 888 Kinematics, 39 during walking, 130-132, 130b after anterior cruciate ligament injury, 132 after anterior cruciate ligament reconstructed knee, 132, 133f anterior-posterior translation and, 131-132 internal-external rotation and, 131-132, 131f methods for defining and measuring, 130-131, 131f Kinesophobia, 330 Kinesthetic motor imagery (KMI), 276 Kinetic chain, instrumented, 57f Kinetic chain exercises, 274-275 KMI see Kinesthetic motor imagery (KMI) “Knee abuser”, 1168 Knee arthrofibrosis, incidence of, after acute surgical treatment, 535-536 Knee arthroplasty, 1235-1244 total, outcome instruments for, 1235-1239, 1236b American Knee Society scoring system in, 1235-1236, 1236t-1238t High-Activity Arthroplasty Score in, 1239, 1240t Oxford knee score in, 1236-1239, 1238t-1239t University of California Los Angeles (UCLA) Activity-Level Rating Score in, 1235, 1236t Knee articular cartilage restoration procedures, 912-921 clinical biomechanics and, 914-915, 915b, 916f clinical evaluation of, 915-917, 915b clinical outcomes of, 919-920 contraindications of, 913b, 914 diagnostic tests of, 917 history of, 915-916 indications of, 912-914, 913b, 913f-914f, 913t intraoperative evaluation and operative technique of, 918-919, 919b physical examination of, 916-917 preoperative planning of, 917-918, 917b, 917t Knee capsule, anatomy of, 11-13, 34, 34f Knee compression sleeve, 942f Knee condition, patient perception of, rating of, 1166b, 1168-1169, 1168f Knee Evaluation Form, of 2000 International Knee Documentations Committee, 1193, 1197f Knee examination, 1172-1173, 1174f Knee extension, 590, 590f brace for, 581f limitation of, 1071f, 1072-1074, 1074b, 1075f-1076f Knee flexion, limitation of, 1071f, 1074-1076, 1075b, 1077f-1078f Knee History Form, of 2000 International Knee Documentations Committee, 1199, 1202f-1203f Knee Injury and Osteoarthritis Outcome Score (KOOS), 912, 1218-1219, 1218b, 1235 versus Tegner activity scale, 1214 Knee instability, subjective complaints of, 868-869 Knee joint innervation of, 1104, 1104f lateral denervation of, 1110, 1111f ligamentous restraints of, 50t medial denervation of, 1110, 1111f motion, twelve limits of, 41t Knee ligament, testing of, 67-75, 68b study limitations and conclusions in, 72-75, 75f Knee ligament injuries classification system for, 37-51, 38b biomechanical data in, 39 degree of freedom in, limits for, 41-46, 41t instability in, 38 joint rotations in, 40f kinematic and biomechanical concepts in, 38-39, 39f laxity in, 38 ligament restraints in, 49-51 manual stress examinations in, 39 purposes of, 37 rotatory subluxations in, 46-49, 48f tibiofemoral motions in, 38-39 scientific basis for, 37-82 Knee ligament reconstruction, risk factors after, 1062-1066, 1064b, 1064t injury and, severity of, 1063, 1064f postoperative course and, 1065-1066 preoperative issues and, 1063-1065 rehabilitation and, 1065-1066 technical factors at surgery and, 1065, 1065f Knee Ligament Standard Evaluation Form, 1190-1191, 1192f Knee motions, 75-77, 76b, 78t-79t, 590 as factors leading to failure, 1049 limits, 406-410, 407b PCL and posterolateral reconstruction on restoring, 418-422, 418b, 419t-420t, 420f loss of, 1059, 1066 operative management of, 1079 arthroscopic soft tissue releases and, 1079, 1080f-1082f medial-lateral retinacular tissues and, 1079 open Z-plasty and, 1079, 1083f posterior medial-lateral capsulotomy and, 1079, 1084f-1086f problems, incidence of, 1061t restoration of, 1060 Knee outcome survey, daily living scale of, activities of, 1215b, 1217, 1217t Knee overpressure exercises, 270f Knee positions, definition of terms for, 75-77, 76b, 77t Knee Self-Efficacy Scale, 284, 284t Knee Society Scoring system, 1190 Knee stiffness, 354t Knee syndromes, varus clinical algorithm for, 785f clinical evaluation of, 779-783, 780b diagnostic clinical tests in, 781 physical examination in, 780-781 radiographic assessment in, 783, 783f subjective and functional outcome of, 779 tibiofemoral rotation test in, 781-783 clinical studies, 812-825, 812b, 820b closing wedge tibial osteotomy, 805-809, 805b diagnosis of abnormalities in, 782t double varus, 776, 777f, 816-818, 817b, 817f-818f and dynamic muscle forces, 780f and external adducting moment, 781f intraoperative evaluation for, 797-798, 798b, 799f knee adduction moment and, 778f-779f, 781f and lower limb alignment, 776-778, 777b, 778f gait analysis in, 778-779, 779b manual knee tests for, 782f and opening wedge tibial osteotomy, 798-805, 799b Knee syndromes, varus (Continued) preoperative planning for, 783-797, 784b and angular correction calculations, 783-787, 784f, 786f-787f coronal and slope alignment, final recommendations to obtain correct, 797 cruciate graft options in, 793 opening versus closing wedge osteotomy in, 794 and preservation of tibial slope, 794-797, 797f and tibial slope, 787-791, 788t, 789f-792f timing of procedures in, 791-793, 792t, 793f prevention and management of complications of, 825-839, 826b arterial injury, 827 arthrofibrosis and patella infera, 828 bony instability, 825-826 deep vein thrombosis, 828-829 delayed union or nonunion, 825-839 iliac crest harvest site pain, 828 inadequate or loss of axial correction, 826-827 peroneal nerve injury or palsy, 827-828 tibial plateau fracture, 827 primary varus, 777, 777f and tibial and femoral osteotomy contraindications, 775-776, 775b and tibial and femoral osteotomy indications, 774-775, 774b triple varus, 777, 777f, 816-818, 817b, 817f-818f and varus angulation, 776t Knee-foot adaptation, 872 Knees ACL-deficient flexion-extension moment and, 127-128, 127f-128f joint kinetics during gait and, 126-130, 126b ACL-reconstructed flexion-extension moment and, 129-130, 130f kinematics of, 132, 133f complex, rehabilitation protocol and, 319-327, 320t-327t examination, 319 extension, 319 flexion, 305 joint proprioception, 310 muscular protection of, 349-351, 350f-351f Knee-specific outcome instruments, psychometric properties for, 1163t Knee-specific scales, 1211-1221 KOOS see Knee Injury and Osteoarthritis Outcome Score (KOOS) KT-2000 (MEDmetric), 319 Kujala Scale see Anterior Knee Pain Scale L Lachman test, 46, 50f, 530t-534t Landing mechanics, in skeletally immature patients, 259 Lateral aponeurotic expansion, 33f Lateral circumflex femoral artery, 19f Lateral condyle, 18f, 24f-25f Lateral denervation of the knee joint, 1110, 1111f Lateral epicondyle, 15f, 18f, 24f-25f Lateral femoral condyle, 29f, 31f-32f Lateral femoral cutaneous nerve anatomy of, 1106, 1106f clinical sign of compression of, 1109f neurolysis of, 1116, 1118f Lateral gastrocnemius, 32f Lateral gastrocnemius insertion, 29f Lateral gastrocnemius muscle, 33f Lateral gastrocnemius tendon, 27f Lateral inferior genicular artery, 12f, 19f, 29f Lateral inferior geniculate artery, 34f Lateral intercondylar tubercle, 18f, 24f-25f Lateral joint opening, 53-61, 57b restraining caused by cruciate ligaments for, 59t Lateral knee attachments, 24f-25f Lateral knee bony landmarks, 24f-25f Lateral layers, of anterior knee, 15, 15f Lateral meniscus, 31f, 34f Lateral meniscus popliteomeniscal fascicles and attachments, repair of, 696-697 Lateral meniscus repair, exposure for, 688-690, 691f-692f Lateral meniscus transplant technique, 725-726, 725b, 726f-729f INDEX Lateral patellar compression syndrome, 985 Lateral patellar retinaculum, 34f Lateral patellofemoral (iliopatellar tract) reconstruction, 985-987, 986f Lateral patellofemoral restraints, biomechanics of, 972-974, 972b, 974f-975f Lateral plateau, 24f-25f Lateral radial tears associated with a cyst, meniscus, 694, 695f Lateral radiograph, distal realignment and, 983-984 Lateral restraints, 58-59, 59f Lateral retinacular nerve, 15, 15f Lateral retinacular release, 979, 1042b, 1043 Lateral retinaculum, passive patellar tilt and tightness of, 974-976 Lateral soft tissue restraints, reconstruction of, 986-987 Lateral step exercise, 396t Lateral stress radiography, 462f Lateral superior genicular artery, 19f Lateral tibiofemoral compartments, 414b posterior subluxation of, 414-418, 414b Lateral translation, limits of knee joint motion in, 41t Lateral unicompartmental knee arthroplasty, 901 clinical outcomes of, 902t-903t survival rates of, 901t Lateral walking with resistance band, 391 Latissimus dorsi, 393-394 stretching, 395f Laxity, defined, 38, 76, 78t-79t Leg cradle exercise, 376, 377f Leg press exercise, 939f Length-tension properties, fiber, of ligament, 83, 84b, 84f Lesion, 938 Lidocaine, complex regional pain syndrome (CRPS) and, 1145-1146, 1149 “Lifting/carrying,” factor of, 1170-1171 Ligament(s) anterior cruciate, reconstruction of, 137-220 acute ruptures and, 138-139 age in, 201-203 all-inside anterior cruciate ligament graft-link technique, using second-generation FlipCutter and TightRope devices for, 189, 189f-192f allografts versus autografts in, 200-201, 202t alternative procedures for, 184-189, 184b anterior tibial translation and, 140-144, 140f, 142f, 144f anteromedial and posterolateral bundles and, 144-154, 147f, 158, 158f-161f arthrofibrosis and, 205 attachment outlines and, 155f, 158f augmentation procedures and, 193, 195f bone-patellar tendon-bone autograft and, 170-173, 171f-172f bone-patellar tendon-bone graft anatomic tibial and femoral technique for, 176-182, 177b, 181f chronic ruptures and, 138 clinical biomechanics and, 140-165, 141b clinical evaluation of, 167, 167b clinical measurement of graft function in, 159-162 clinical studies on, 191-200, 201t complication prevention and management in, 205-208, 205b concomitant operative procedures and, 196-198, 197f, 197t contraindications and, 139-140, 140b femoral and tibial graft positions in, 166f femoral fixation techniques for, 186f fluid extravasation and, 208 four-strand STG graft for, 182 gender and, 195, 196f, 196t graft contamination and, 208 graft harvest for, 168b, 170-173, 171f-172f graft healing in, 165-167 graft malposition management in, 189-191 graft selection and, 168-169, 168b graft size in, 201-203 graft type in, 192, 194t, 195f iliotibial band extraarticular tenodesis and, 176 illustrative cases for, 208-212, 209f-212f indications for, 138-139, 138b, 139f infection and, 205, 207t injury chronicity and, 195-196, 196t insurance (workers’ compensation) and, 200, 200f Ligament(s) (Continued) internal tibial rotation limits and, 140-144, 142f, 144f-145f intraoperative evaluation in, 168 notchplasty technique and rules for, 184t operative techniques for, 168-191, 168b osteoarthritis rates and, 205, 206t patient setup and positioning in, 168b, 169-170, 170f preexisting joint arthritis and, 198, 198f, 198t preoperative planning and, 167-168, 167b prior meniscectomy and, 198, 198f, 198t quadriceps tendon-patellar bone autograft and, 173, 174f recommended tibial and femoral graft locations, 162-165, 163f-166f rehabilitation program for, 199-200, 199t revision and, 140 role of anteromedial and posterolateral divisions in, 154-158, 156f-158f secondary sterilization process and, 193-195 semitendinosus-gracilis autograft and, 173-176, 175f-176f, 177t, 178f-180f single- versus double-bundle reconstructions, 161t, 203-205, 204t surgery principles and, 169t techniques using other grafts for, 182-184, 186f-187f tibial and femoral insertion in, 156f tibial fixation techniques for, 187f two-incision technique with STG graft for, 182 varus osseous malalignment and, 199 biomechanical properties of, 92b, 95-96, 96f, 96t vascularized and nonvascularized ACL grafts on, 103-104, 103b, 104f failure-mode mechanisms and, 93-95 fiber length-tension and, 83, 84b, 84f, 90, 90b, 91f fiber microgeometry and, 84-86, 84b, 85f-87f function and failure of, 83-109 injuries to, in acute knee dislocations, 669, 669b injury, definition of terms for, 75-77, 76b, 80t intraarticular corticosteroids and, 98b, 102 length-tension patterns and, 86-90, 87b, 87f mechanical properties of, 91-95, 91b meniscofemoral, 425-427, 425b, 426f-427f strain rate and, 91b, 92-93, 92f-93f, 93t testing of, 67-75, 68b study limitations and conclusions in, 72-75, 75f Ligament reconstruction, of knee, risk factors after, 1062-1066, 1064b, 1064t injury and, severity of, 1063, 1064f postoperative course and, 1065-1066 preoperative issues and, 1063-1065 rehabilitation and, 1065-1066 technical factors at surgery and, 1065, 1065f Ligamentization, 111, 119 Ligamentous restraints, 49-51 to AP translation, 51-53, 51b, 52f-56f of knee joint, 50t medial and lateral joint opening and, 53-61 Limb alignment, 1014 Limb ischemia, complex regional pain syndrome (CRPS) and, 1132-1133 Limb torsion, with PF instability and pain biomechanic evidence relating, 1018-1019 clinical evidence relating, 1019-1021 Limits of motion, defined, 78t-79t Linclau ratio, 988-989 Linear aspera of femur, 24f-25f Linear load, 92 Load applications, 943, 945f Load-deformation curve, 85f Locus of control, 284 Long bone torsion, affecting patellofemoral joint, 1016-1018, 1019f-1020f Low back, 394 Low back stretch, 395f Lower extremity, 349-351, 350f-351f muscle strength, gender differences in, 352-355, 352t, 353f Lower Extremity Functional Scale, 1218b, 1219 Lower extremity muscle atrophy, 306 Lower extremity muscle strength atrophy, after surgery, 271, 271b Lower extremity rotational profiles, 917 1253 Lower extremity-strengthening program, full, 310 Lower limb, surgical positioning of, 1040, 1040f Lower Limb Core Scale, 1219 Lower Limb Outcomes Questionnaire, 1219 Lower limb rotational alignment, 975 Low-level irradiation, 1068 Lumbar sympathetic ganglion block, 1139 side effects after, 1139t Lysholm Knee Score, 1215-1216, 1215b, 1216t M Macrophage accumulation, tendon grafts and, 114 Magnetic resonance imaging (MRI) complex regional pain syndrome (CRPS) and, 1138 for evaluation of ligament injury, 659 of infrapatellar scar contracture, 1043f of knee with patella infera, 1074f for patellofemoral arthroplasty, 1037 revision knees and, 223-224 for scar tissue formation, 1072 Major periarticular fracture, 661f MAKO robotic technique, 1042 MAKOplasty Partial Knee Resurfacing System, 883-884 Malalignment term, 1015 valgus, 848-857 clinical biomechanics and, 849-850 clinical evaluation of, 850 clinical examination of, 884 clinical outcomes of, 854-856 clinical studies of, 894-901 complications and factors leading to failure of, 888-894, 894t complications of, 856 contraindications of, 883 distal femoral osteotomy contraindications and, 849, 849b distal femoral osteotomy indications and, 848-849, 849b history and physical examination of, 850 illustrative cases of, 903, 904f-905f implant design in, 883, 883t-884t indications of, 882-883 operative technique of, 851-854, 851f-854f postoperative management of, 887-888, 889t-893t postoperative regimen for, 853b preoperative planning and, 850-851, 850f radiographic evaluation of, 850, 850b robotic technology of, 883-884, 885t surgical technique of, 851b, 884-887, 886f-888f unicompartmental knee replacement for, 882-910 varus, 564t clinical examination of, 884 clinical studies of, 894-901 complications and factors leading to failure of, 888-894, 894t contraindications of, 883 illustrative cases of, 903, 904f-905f implant design in, 883, 883t-884t indications of, 882-883 postoperative management of, 887-888, 889t-893t robotic technology of, 883-884, 885t surgical technique of, 884-887, 886f-888f unicompartmental knee replacement for, 882-910 Mankin scoring system, articular cartilage deterioration using, 1231, 1231t, 1232f-1233f Manual knee tests, 616f, 782f Manual muscle testing, 668 Manual stress examinations, 39 Marx sports activity scale, 1212b, 1215 Mattress jump forward and backward, 385, 386f Mattress jump side to side, 385, 386f MCL see Medial collateral ligament (MCL) McMurray test, 685 Measurement lines, posterior cruciate ligament, 456f Medial and posteromedial ligament injuries, 608-635 anatomy and, 610f clinical biomechanics of, 611-615 classification of ligament injury and instability, 611-615, 612t published classification systems and, 612t 1254 INDEX Medial and posteromedial ligament injuries (Continued) clinical evaluation and, 615-617 diagnostic clinical tests in, 616 history and physical examination in, 615 radiographs and imaging studies in, 616-617 clinical studies on, 625-626, 626t results from, 626-631, 627f complications of, 625 conservative versus operative treatment, rules and planning for, 617-618 in acute medial and posteromedial ligament ruptures, 611f, 617-618 in acute medial ligament ruptures with knee dislocation, 618 in chronic medial and posterolateral ruptures, 618 contraindications for, 611 cosmetic skin incisions and, 622f external rotation limits and, 613f and femoral osseous landmarks of, 625f giving-way episodes and, 624f illustrative case for, 631-634, 631f-633f indications for, 608-611, 609f-610f and internal rotation limits, 614f-615f intraoperative evaluation for, 618-620, 619f and long bone-patellar tendon-bone allografts, 625f magnetic resonance imaging and, 617, 617f major injury patterns, 615f manual knee stability tests and, 616f medial knee attachments and, 609f operative treatment of acute medial and posteromedial ligament repairs as, 620-621, 621t chronic medial and posteromedial ligament repairs as, 621-625, 623t reconstruction of, selection of grafts for, 620 semimembranosus muscle attachments and, 610f and superficial medial collateral ligament, distal advancement of, 623f surgical plication procedure and, 622f treatment results of, 628t-630t Medial collateral ligament (MCL), 2, 1065 deep, 11-13, 13f force versus time for failure tests on, 86f restraining moment of, 57f sectioning effect on posterior tibial translation, 66-67 superficial, 5-11, 7f Medial condyle, 12f, 18f, 20f, 24f-25f Medial denervation of the knee joint, 1110, 1111f Medial epicondyle, 3f, 5f-6f, 8f-10f, 18f, 24f-25f Medial femoral condyle anatomy of, 9f posterior cruciate ligament, 449-458 Medial femoral cutaneous nerve, 18, 20f Medial gastrocnemius muscle, 3f, 9f-10f, 20f, 29f, 32f Medial gastrocnemius tendon, 3f, 9f-10f Medial inferior genicular artery, 19f-20f Medial intercondylar tubercle, 18f, 24f-25f Medial joint opening, 53-61, 57b restraining caused by cruciate ligaments for, 58t Medial layers of knee, 2-13, 3f in anterior knee, 15, 16f attachments and, 609f, 620f deep fascia in, 2-5, 4f deep medial collateral ligament in, 11-13, 13f distal medial collateral ligament in, 11-13 knee capsule in, 11-13 medial patellofemoral ligament in, 5-7, 8f osseous landmarks of, 5f-6f posterior oblique ligament in, 5-11, 7f, 10f semimembranosus tendon in, 10-11, 11f-12f soft tissue attachments and, 2, 5f-6f superficial medial collateral ligament in, 5-11, 7f Medial ligament injury rehabilitation, 636-652 Cincinnati Sports Medicine and Orthopaedic Center Rehabilitation Protocol for, 639t-645t clinical concepts of, 636 conservative treatment and, 636-645, 637t-638t of concomitant cruciate ligament injuries, 645 of third-degree injuries: weeks to 3, 637-638 of third-degree injuries: weeks to 6, 638 of third-degree injuries: weeks to 9, 638-645 of third-degree injuries: weeks 10 to 12, 645 Medial ligament injury rehabilitation (Continued) cylinder cast split and, 638f postoperative, 646-651 balance, proprioceptive, and perturbation training in, 650, 650f bracing in, 646 conditioning in, 650-651 modalities of, 646 patellar mobilization in, 647, 648f plyometric training in, 651 range of motion in, 646-647, 647f-648f and return to sports, 651 running and agility program in, 651 strengthening in, 647-650, 649f weight bearing in, 646 range of motion exercises for, 638f treatment rationale for, 637f Medial ligaments, in ACL-deficient knees, 61-66, 61b, 62t-63t, 63f-68f Medial meniscus, 3f, 9f Medial meniscus central bone bridge technique, 729-731, 731b, 731f Medial meniscus repair, exposure for, 688, 689f-690f Medial meniscus transplant technique, 726-733, 729b Medial meniscus two-tunnel technique, 731-733, 732b, 732f-733f Medial patellofemoral ligament (MPFL), 3f, 8f anatomy of, 5-7, 8f insufficient, 1042-1043 reconstruction of, 1036-1037 tightening, 1043 Medial patellofemoral ligament (MPFL) deficiency, 980 Medial patellofemoral ligament (MPFL) reconstruction, 980-983, 980f-983f clinical studies of, 993-999, 994t-998t key points to, 982t restraint to lateral patellar translation, 974 using quadriceps tendon, 971 Medial patellofemoral restraints, biomechanics of, 972-974, 972b, 974f-975f Medial patellomeniscal (MPML) plication, 979 Medial patellotibial ligament, anatomy of, 16f Medial plateau, 10f, 24f-25f Medial restraints, 56-58, 58f Medial retinacular nerve, 18, 20f Medial retinaculum, pain in, 1023 Medial soft tissue tightening, excessive, 1043 Medial subluxation, syndrome of, 985 Medial tibiofemoral compartments, posterior subluxation of, 414-418, 414b Medial translation, limits of knee joint motion in, 41t Medial unicompartmental knee arthroplasty, 894 clinical outcomes of, 897t-898t survival rates of, 895t-896t Medial-lateral compartment translations, 70-72, 75f Medial-lateral joint space opening, 70, 74f study limitations and conclusions in, 73 Medial-lateral patellar translation, instrumented measurement of, 974 Meniscectomy, prior, ACL reconstruction and, 198, 198f, 198t Meniscofemoral ligaments, 3f, 9f, 425-427, 425b, 426f-427f anatomy of, 11-13, 13f Meniscotibial ligaments, 3f, 9f anatomy of, 11-13, 13f Meniscus attachment root tears, 695-696, 696f Meniscus repair and transplantation rehabilitation, 760-771 and balance training, 764-766, 765b Biodex for, 765f brace and crutch support in, 762-763, 763b clinical concepts, 760, 761b and conditioning, 768-770, 768b, 769t and cryotherapy, 762f cup walking in, 765f extension overpressure hanging-weight exercise for, 764f and flexibility, 763-764, 763b, 763t flexion exercises for, 764f immediate postoperative management in, 761-762, 762b minisquats for, 768f and neuromuscular electric stimulation, 762f and neuromuscular training, 764-766, 765b Meniscus repair and transplantation rehabilitation (Continued) patellar mobilization exercises for, 764f and plyometric training, 770, 770b postoperative signs and symptoms in, 762t and proprioception, 764-766, 765b protocol summary of, 761t and range of motion, 763-764, 763b, 763t and return to sports activities, 770-771, 771b and running program, 770, 770b straight leg raises for, 766f strengthening in, 766-768, 766b, 767t wall-sit exercises for, 768f Meniscus tears, 677-718 and all-inside suture systems, 702-705, 706f arthroscopic examination of, 685, 686f arthroscopic second look failure of, 700t author’s clinical studies of, 698-702 arthroscopic evaluation of 79 meniscus repairs in R/R and R/W zones, 698, 698b, 698t-699t long-term outcome of 29 meniscus repairs in the R/W zone in patients 20 years of age or younger, 702, 702b outcome of 30 meniscus repairs in R/W zone in patients 40 years of age and older, 700, 700b, 700t outcome of 71 meniscus repairs in the R/W zone in patients 20 years of age or younger, 700-702, 701b, 701f, 701t outcome of 198 meniscus repairs in the R/W zone, 698-700, 699b classification of, 678-679 and clinical biomechanics, 680-682, 680b meniscus functions in, 680-682 meniscus repair healing in, 682 meniscus suture repair biomechanics in, 682, 683t-684t and clinical evaluation, 682-685, 684b contraindications to repair of, 679-680, 680b, 681f degenerative, 678 follow-up arthroscopy for, 699t healing rate factors for, 698t illustrative cases of, 707-712, 707f-712f indications for repair of, 678-679, 678b candidates for, 678 intraoperative evaluation of, 685-686, 685b irreparable, 681f operative technique for, 686-698, 687b flap tears, 696, 697f horizontal tears, 694-695 inside out suture repair, meniscus, patient positioning and equipment for, 690 lateral meniscus repair, exposure for, 688-690, 691f-692f lateral radial tears associated with a cyst, 694, 695f medial meniscus repair, exposure for, 688, 689f-690f meniscus attachment root tears, 695-696, 696f operating room setup for, 688f patient preparation in, 686-688 radial tears, 694, 695f repair of lateral meniscus popliteomeniscal fascicles and attachments, 696-697 single and double longitudinal tears, 690-694, 692f-694f suture repair techniques for, 690 preoperative planning for, 685, 685b red-red, 678 red-white, 678-679 repairs for, techniques to stimulate healing of, 697-698 results of repairs, from other clinical studies, 702-706, 703t-705t, 706f single, 679 sports activities of patients before repair of, 702t tear patterns, 679, 679f tibiofemoral joint symptoms and, 700t and tissue integrity, 679-680 white-white, 678-679 Meniscus transplant extrusion, 739-742, 740t-741t, 742b Meniscus transplantation, 719-759 accessory posteromedial approach to, 730f allograft, coronal section of, 737f author’s clinical studies, 733-742 initial studies in, 733-737, 733b, 734f long-term study, 738-739, 739b INDEX Meniscus transplantation (Continued) meniscus transplant extrusion in, 739-742, 740t-741t, 742b MRI image study results and, 737-738, 737t, 738b, 738f axial plane, 739f chisel use in, 728f clinical biomechanics of, 720-722, 721b effect of fixation and location in, 721-722 knee joint contact mechanics in, 721 clinical evaluation for, 722-723, 722b conclusion for, 746-747, 746b contraindications to, 720, 720b distribution of, 736f dovetail meniscus allograft technique, 728f, 730 height and width measurements, 738t illustrative cases for, 747-753, 748f-752f, 754f-756f incision sites for, 726f indications for, 719-720, 720b intraoperative evaluation for, 724, 724b irradiated meniscus transplants, 735, 736f lateral graft in place and sutured, 729f lateral meniscus transplant technique for, 725-726, 725b, 726f-729f medial meniscus transplant technique for, 726-733, 729b central bone bridge technique in, 729-731, 731b, 731f two-tunnel technique, 731-733, 732b, 732f-733f and meniscus allograft classification, 734t occupational levels before and after, 735t preoperative planning for, 723-724, 723b meniscus sizing issues in, 723-724 tissue bank and sterilization issues in, 723 results from other clinical studies, 742-746, 743t-746t sports activity levels before and after, 735t tibial slot technique for, 727f visual inspection of, 722f Menstrual cycle, 348-349, 349b Meralgia paresthetica, 1109f Merchant technique, 975 Mesenchymal stem cells, 117 Metalloproteinases, modulation of, 117-118, 118f N-methyl-D-aspartate receptor antagonists, intravenous ketamine, 1146, 1147t-1148t Microfracture, articular cartilage rehabilitation and, 946-948, 947t-948t Mid-third lateral capsular ligament, 34 Miller-Galante (Zimmer), 883 Minisquat, 592, 593f for meniscus repair and transplantation rehabilitation, 768f Minisquat with TheraBand, 387f Minisquats with resistance band, 387 Minitrampoline platform, 310 Miserable malalignment, 1014, 1023f Mitomycin C, 1068 Mobil-bearing implant designs, 883 Mobility, 331-332 aquatic therapy and, 959-961, 960f-961f, 962t Modified plank, 396t Modified symptom rating scale, 1167-1168, 1167f Moment adduction, ACL injury and, 132-133, 133b, 134f-135f defined, 78t-79t flexion-extension and ACL-deficient knee, 127-128, 127f-128f and ACL-reconstructed knee, 129-130, 130f intersegmental, 126-127, 126f Motion defined, 78t-79t limits and sectioning, 62t, 614t loss, 1062 Motor abnormalities, complex regional pain syndrome (CRPS) and, 1137 Motor imagery, 276 Motor skill development stages, 331-332 MPFL see Medial patellofemoral ligament (MPFL) MRI see Magnetic resonance imaging (MRI) Multihip cable system machine, 311f Multiligament injuries, posterior cruciate ligament and, 463b, 464-465 Multiple training programs, 402t Muscle activation gender differences and, 355 patterns, 275, 277t-279t Muscle atrophy, 140 inspection for, 917 Muscle strength gender differences in, 353-355 options to regain, 271-276, 272b Musculotendinous units, 1014 N Native tendon-bone insertion, anterior cruciate ligament and, 111, 112b, 112f Nebraska drill, 396t Nervous system, complex regional pain syndrome (CRPS) and, 1123-1124, 1125f Neural origin, knee pain of, 1103-1121, 1103b authors’ clinical studies and, 1119, 1119b clinical evaluation of, 1106-1107, 1107b clinical studies and, 1116-1119, 1118b common peroneal nerve and, 1105, 1105f neurolysis of, 1112, 1115f deep peroneal nerve and, 1105 human knee joint and, innervation of, 1104, 1104f infrapatellar branch of the saphenous nerve and, resection of, 1112, 1113f lateral denervation of the knee joint, 1110, 1111f lateral femoral cutaneous nerve and, 1106, 1106f neurolysis of, 1116, 1118f local anesthesia and, use of, 1108f medial cutaneous nerve of the thigh and, resection of, 1112, 1114f medial denervation of the knee joint, 1110, 1111f meralgia paresthetica, 1109f operative techniques and, 1110-1116, 1110b partial knee denervation and, 1107, 1107b peripheral nerve anatomy and, 1104-1106, 1104b preoperative planning and, 1107-1110, 1108b proximal tibial nerve and, 1105-1106 neurolysis of, 1115-1116, 1117f proximal tibiofibular joint and denervation of, 1112, 1115f innervation of, 1104-1105, 1104f reflex sympathetic dystrophy and, 1119-1120, 1120b, 1120f saphenous nerve and, 1106 saphenous nerve in Hunter’s canal and neurolysis of, 1116, 1119f sites to palpate and, 1106f superficial peroneal nerve and, 1105 neurolysis of, 1112-1115, 1116f Tinel’s sign, 1107, 1109f NeuroCom, 314 Neurogenic inflammation, complex regional pain syndrome (CRPS) and, 1131-1132 Neurologic injuries, in acute knee dislocation before surgical intervention, 667-668, 667b, 667f Neuromuscular activities, advanced, 279, 280t-281t Neuromuscular control, 943, 944f-945f Neuromuscular electrical stimulation, 762f, 942, 943f Neuromuscular factors, ACL injuries and, 349-363, 349b, 349t Neuromuscular function, restoration of, in ACL rehabilitation, 276-279 Neuromuscular retraining after ACL reconstruction, 330-342 acute phase exercise, 334-335, 334f-336f balance training, 332, 332f control drills and, 338-339, 338f-339f dynamic stability drills and, 336-338, 336f-338f functional/skill phase, 339, 340f goals and, 334t injury effects on gait, 331 injury effects on proprioception, 331 joint repositioning and, 332 motor skill development stages and, 331-332 perturbation training and, 332 plyometric training drills and, 332 postoperative rehabilitation program, 334-339, 334t rehabilitation after, 334t technique training, 333 training program, 332-333, 332f-333f 1255 Neuromuscular retraining program, 373-375, 374f, 374t strategies for implementation of, 402-403 widespread implementation of, 402 Neuromuscular training, for ACL reconstruction, 266 Neuromuscular training program, 332-333, 332f-333f Neurons, complex regional pain syndrome (CRPS) and, 1124, 1125f-1126f Neurostimulation, complex regional pain syndrome (CRPS) and, 1149 Neurovascular examination, 530t-534t Neutral tibial rotation, 53f Nifedipine, 1145 Nitric oxide, 118 Nonanatomic reconstruction, 553 Nonsteroidal antiinflammatories, complex regional pain syndrome (CRPS) and, 1141-1145 Nonvascularized ACL grafts, 103-104, 103b, 104f Notch volume, in skeletally immature patients, 259 Notchplasty rules, 234-235 Notchplasty techniques, and rules, 184t O OAS see Oswestry Arthroscopy Score (OAS) OAT see Osteochondral autograft transplantation (OAT) Obesity, and knee injuries, 657-658 Objective testing, 1173-1174, 1175f Oblique popliteal ligament (OPL), 10f, 29f, 32f, 34f anatomy of, 11, 12f Obturator nerve, 1129 Occupational activities, rating of, 1169-1172, 1172f form for, 1186, 1188f Occupational Rating Scale, 1170, 1172f reliability of, 1171-1172 OKC exercises see Open kinetic chain (OKC) exercises One- and two-strand graft reconstructions, 477-489 180-degree jump, 379t, 381-382, 382f, 396t Open kinetic chain (OKC) exercises, 274-275, 940 Open kinetic chain extension exercises, 308-310 Open tibial inlay approach, 467-468 Opening wedge osteotomy, 819b closing wedge osteotomy compared with, 794 complications of, technical pearls to avoid, 820t femoral, 811-812, 811b, 813f-815f distal, 824-825 height, 798t and tibial slope preservation, 794-797, 795f-797f, 798t Opening wedge tibial osteotomy, 798-805, 799b and anterior iliac crest bone graft harvest, 799-800, 800f and bone graft placement, 804 and desired limb alignment correction, 804 high, and clinical studies, 818-819 initial anteromedial tibial approach to, 800, 801f-803f initial operating room preparation for, 798 and internal fixation, 804 and knee arthroscopy, 799 and placement of tibial guide pins, 800-803, 804f and proximal osteotomy, 800-803, 804f and superficial medial collateral ligament management, 804-805 and tibial slope confirmation, 803 Operative limb, 886 Operative procedures, articular cartilage surfaces and, 1175, 1176f-1178f OPG see Osteoprotegerin (OPG) Opioids, complex regional pain syndrome (CRPS) and, 1146 OPL see Oblique popliteal ligament (OPL) Oral corticosteroid, arthrofibrosis and, 1076-1078, 1076b Osgood-Schlatter disease, 190-191 Osseous deformities, valgus knee and, 849 Osteoarthritis adduction moment and, 132-133, 135f unloading brace and, 945f Osteochondral autograft transplantation (OAT), 948-951, 949t-950t, 1004 Osteochondral grafts, 922-935 allograft indications of, 922-923 allograft outcomes, 932, 933t allograft planning, 925 allografting technique, 926-928, 926f autograft indications, 922 autograft outcomes, 931-932, 931t 1256 INDEX Osteochondral grafts (Continued) autograft planning, 925 autografting technique, 925-926 clinical evaluation of, 923-924, 924f clinical outcomes of, 929-932, 929t complications of, 934 contraindications of, 923 Dowel allograft, 926-927, 926f-927f imaging of, 923, 924f indications of, 922-923 intraoperative planning of, 925 operative technique of, 925-928 18-point scale and, 929t postoperative management of, 928 preoperative planning of, 924 press-fit plug technique, 926, 926f shell allograft, 927-928, 928f-929f shell-graft technique, 926 Osteoinductive agents, tendon-bone healing and, 115-116 Osteopenia, 1037 Osteophytes, removal of, 886-887 Osteoprotegerin (OPG), 117 Osteotome, distal realignment and, 983-984 Oswestry Arthroscopy Score (OAS), 1231 Outcome instruments global, 1211-1221, 1218b patellofemoral, 1239-1240, 1239b psychometric properties of analyses used for, 1165b general health, 1162-1164, 1164t knee-specific, 1163t for total knee arthroplasty, 1235-1239, 1236b Outerbridge, 1222, 1223b, 1223t Outside-in technique, 489, 490f-491f Overall rating assessment, 1179 Overpressure exercises, 270f Overpressure program for extension, 305f for flexion, 306f Oxford knee score, 1236-1239, 1238t-1239t P Pain see also Complex regional pain syndrome (CRPS) alpha-adrenergic antagonists and, 1145 articular cartilage procedure and, 940-941, 941f-942f corticosteroids and, 1141-1145 discoloration of skin and, 1122, 1123f in hyperextension gait abnormalities, 868-869 at iliac crest harvest site, 828 in medial retinaculum, 1023 meniscus transplantation and, 735t psychological issues and, 1137-1138 sensory abnormalities and, 1136-1137, 1137f sympathetic block and, 1148-1149, 1148f vasomotor measurement and, 1139 Parapatellar soft tissues, palpation of, 974-976 Parasympathetic nervous system, complex regional pain syndrome (CRPS) and, 1129 Paravertebral ganglion, 1128 blocks, 1150 Partial rupture, posterior cruciate ligament and, 462f Partial transphyseal reconstruction, 263, 264f Passive knee extension, full, 305 Passive knee flexion exercises, 590, 590f Passive range of motion (PROM), 939 Patella, 5f-6f, 8f, 13f-14f, 18f-20f, 26f, 32f anatomy of, 16, 16f Patella alta, 974, 1037, 1042b, 1043 correction of, 987-990, 987f-989f, 987t, 990t Patella infera, 1088-1089, 1088f-1090f, 1089b, 1089t Patellar chondropathy, 1016, 1017f-1018f Patellar crepitus, 990 Patellar dislocation cause of, 1016 clinical studies of, 993-1008 medial patellofemoral ligament reconstruction and, 993-999, 994t-998t patellofemoral articular cartilage lesions and, 999-1005, 1005f trochleoplasty procedures and, 1005-1008, 1007t complications of, 992-993, 993b contraindications of, 972, 972b, 973f Patellar dislocation (Continued) illustrative case of, 1008, 1008f indications of, 970-972, 971b operative options for, 970-1013, 970b postoperative management of, 991-992, 991b, 992t preoperative planning of, 974-976, 975b, 976f-977f surgical techniques of, 976-991, 978b, 979f distal realignment for, 983-985, 984f-985f iliotibial band Z-plasty release for contracture, 991, 991f lateral patellofemoral (iliopatellar tract) reconstruction for, 985-987, 986f lateral retinacular release for, 979 medial patellofemoral ligament reconstruction for, 980-983, 980f-983f, 982t patella alta correction for, 987-990, 987f-989f, 987t, 990t proximal realignment for, 979-980 trochleoplasty for, 990-991 Patellar glides, 307f Patellar height, published values for, 1089t Patellar instability, 1016, 1017f-1018f major factors for, 987 Patellar ligament insertion angle (PLIA), 127 Patellar malalignment, 970, 1015 Patellar medial subluxation test, 979 Patellar mobility limited, 1071f loss of, 942 methods used to, 972-974 Patellar mobilization, 305, 307f, 887-888, 1069f exercises, 764f and medial ligament injury rehabilitation, 647, 648f and PCL reconstruction, 590, 592f tibial and femoral osteotomy and, 862, 862f Patellar realignment, 1015 Patellar resection, component placement and, 1041 Patellar stability, factors influencing, 972-974 Patellar subluxation tests, 974-976 Patellar surface, 18f Patellar tendon, 3f, 29f, 34f anatomy of, 16 insertion of, 983-984 length of, 232 Patellar tendon rupture, acute, 1008, 1008f Patellar vertical-height ratio, 1072f-1073f radiographic methods of computing, 1073t Patellofemoral arthritis, 972 secondary, 1036 Patellofemoral arthroplasty (PFA), 1036 Avon, clinical studies and, 1049-1052 clinical outcomes of second-generation, 1051t-1052t third-generation, 1053t contraindication to, 1037, 1037b, 1042 implants for, 1037, 1049 first-generation, 1037, 1038t second-generation, 1037 third-generation, 1037 indications for, 1036 operative technique for, 1038-1039 prostheses, 1038t rehabilitation for, 1044t-1048t survival/success rates of first-generation, 1049t second-generation, 1051t third-generation, 1052t Patellofemoral articular cartilage lesions, outcomes of procedures for, 999-1005, 1005f Patellofemoral disorders, 1014-1035 complications of, 1033 examination and, 530t-534t indications of, 1023, 1023f-1025f surgical strategy of, 1023-1025 surgical technique of, 1025-1033, 1025f-1034f Patellofemoral dysfunction, 1016t Patellofemoral (PF) joint biomechanic evidence relating limb torsion, with instability and pain, 1018-1019 clinical evidence relating limb torsion, with instability and pain, 1019-1021 long bone torsion affecting, 1016-1018, 1019f-1020f protection, 271-273, 273f Patellofemoral (PF) ligaments, 1014 Patellofemoral mechanism, realignment of, 970 Patellofemoral outcome instruments, 1239-1240, 1239b Anterior Knee Pain Scale in, 1240, 1241t Functional Index Questionnaire in, 1240 Saltzman Patellofemoral Score in, 1240, 1242t-1243t Samsung Medical Center (SMC) patellofemoral scoring system in, 1240, 1242t “Patellofemoral pain syndrome” (PFPS), 1239 Patellofemoral rating systems, 1235-1244 see also Patellofemoral outcome instruments Patellofemoral replacement, unicompartmental, 1036-1057 clinical examination and, 1037-1038, 1039f clinical studies and, 1049-1052, 1049t-1052t complications and, 1049 contraindications, 1037, 1037b correction of increased tibial tubercle-trochlear groove distance, 1042 trochlear dysplasia, 1041-1042 illustrative cases in, 1053-1055, 1053f-1056f implant design, 1037 indications of, 1036-1037, 1036b infrapatellar contracture and, 1043, 1043f lateral retinacular release and, 1043 medial patellofemoral ligament and, 1042-1043 patella alta and, 1043 postoperative management and, 1043-1049, 1044t-1048t preoperative planning and, 1038-1039, 1039f surgical decision making for, 1041-1043, 1042b surgical technique and, 1039-1041, 1040f cement, 1041, 1041f incision, 1040 patellar resection, component placement and, 1041 registration, 1040 trochlear component, implantation of, 1040-1041, 1040f-1041f valgus-aligned lower extremity and, 1042 Patellofemoral tracking, distal realignment and, 984-985 Patellotibial ligament, medial, Patient history, 1172, 1173f Patient perception, of knee condition, rating of, 1166b, 1168-1169, 1168f PCL see Posterior cruciate ligament (PCL) PCL meniscectomy, 680-682 Peak proximal tibia anterior shear force, 363f Pectoralis, biceps, 394 stretching, 395f Pedi-IKDC, 1193 Performance phase, 377-386 Periarticular fracture, 661f Peripheral nerve anatomy, 1104-1106, 1104b common peroneal nerve, 1105, 1105f deep peroneal nerve, 1105 innervation of the human knee joint, 1104, 1104f innervation of the proximal tibiofibular joint, 1104-1105, 1104f lateral femoral cutaneous nerve, 1106, 1106f proximal tibial nerve, 1105-1106 saphenous nerve, 1106 superficial peroneal nerve, 1105 Peroneal artery, 19f Peroneal nerve, 32f-33f common, 1105, 1105f neurolysis of, 1112, 1115f deep, 1105 superficial, 1105 neurolysis of, 1112-1115, 1116f and tibial and femoral osteotomy, 827-828 ultrasonography of, 668 Peroneus longus muscle, 12f, 29f, 33f Perturbation training ACL reconstruction and, 310-314, 314f, 332 and medial ligament injury rehabilitation, 650, 650f and PCL reconstruction rehabilitation, 593-595, 594f techniques, 310-314 tibial and femoral osteotomy and, 863-865, 866f Pes anserine flexion forces, 351f Pes anserine rotation forces, 351f PFA see Patellofemoral arthroplasty (PFA) PFL see Popliteofibular ligament (PFL) PFPS see “Patellofemoral pain syndrome” (PFPS) Phentolamine, complex regional pain syndrome (CRPS) and, 1148-1149 INDEX Physeal sparing intraarticular reconstruction, 261-262, 261f-262f Physiologic laxity, 417-418, 418f Pivot shift, in comprehensive knee testing, 535 Pivot shift test, 43, 50f, 143f, 145f, 616 bumper model of knee joint and, 75f drawer tests and, 44 grades, 47t, 51f internal rotation in, 73f procedure for, 69-70, 70f-73f study limitations and conclusions in, 72-75, 75f tibial translations and rotations in, 70f-71f Planned tibial tubercle osteotomy, 983-984 Plantaris, 12f, 29f Platelet-rich plasma, for ACL healing, 121 Playing surface conditions, ACL injury risk and, 346, 346b PLIA see Patellar ligament insertion angle (PLIA) PLS see Posterolateral ligament sectioning (PLS) PLT see Popliteus tendon (PLT) Pluripotent mesenchymal cells, 117 Plyometric training, 316-319, 316f-318f drills and, 332 and medial ligament injury rehabilitation, 651 and meniscus repair and transplantation rehabilitation, 770, 770b and PCL reconstruction, 595-596, 596f Plyometrics, 377-386 PMC see Posterior medial capsule (PMC) PMTL complex see Popliteus muscle-tendon-ligament (PMTL) complex Pool platform, articular cartilage procedures and, 938 Popliteal artery, 12f, 19f, 29f, 32f, 541-542 anatomic variations of, 458-460 anatomy of, 665f diffuse irregularity in, 665f and knee dislocations, 664 schematic diagram of, 668f traction injury to, 665f Popliteal vein, 12f, 29f Popliteofibular ligament (PFL), 12f, 29f, 31f-32f, 34f, 414f Popliteomeniscal fascicles, 29-31, 31f attachments, 427, 428b Popliteus muscle, 3f, 10f, 12f, 29-31, 29f, 31f-34f Popliteus muscle-tendon-ligament (PMTL) complex anatomic reconstruction of, 546-550, 547b fibular collateral ligament bone-patellar tendon bone reconstruction in, 548-549, 548b graft replacement in, 549-550, 550b, 551f-552f patient positioning and surgical approach to, 546-547 peroneal nerve dissection and visualization in, 547-548 anatomy of, 28-31, 31f-32f function and role of, 411-414, 412b, 412f-413f Popliteus tendon (PLT), 12f, 27f, 28-29, 29f, 31f, 34f, 414f lateral restraint and, 59 Porous-coated prosthesis, 883 Position, defined, 77t Position classification, 654-656, 656b, 657f limitation of, 656 Posterior bumpers, knee flexion effects on, 42f Posterior cruciate ligament (PCL), 3f, 12f, 29f, 34f Achilles tendon-bone allograft, 474-476, 476b preparation of, 474-476 acute rupture and, 463-464, 463b, 464f and allografts, 793 anatomy, anterior meniscofemoral ligament and, 425f anatomy of, 449-458, 449b, 450f-451f, 452t-454t anterior meniscofemoral ligament, 450-451, 455f arthroscopic-assisted open tibial inlay technique and, 493-497, 493b, 493f attachment, 495-496, 495f-497f augmentation, preservation of remnant, 509-513, 514t-515t augmentation approaches and techniques, 499, 499b avulsion fractures and, 497-499, 498b causes of failure, 501-502, 501b, 502t chronic injuries and, 463b chronic ruptures and, 448f, 465-466, 465f Cincinnati knee rating system, 461b clinical evaluation and, 461-463, 461b composite of the shapes of, 455f contraindications of, 449, 449b cyclic fatigue testing and, 442-443, 442b, 443f Posterior cruciate ligament (PCL) (Continued) deficiency, in vivo effects of, 423t-424t diagnosis, operative techniques, and clinic outcomes, 447-526, 448b diagnostic clinical tests and, 461-462, 461b femoral and tibial attachments, 449f femoral attachment measurements, 457t, 459f fiber function, 428-442, 428b, 429f-440f forces generated in, 411f function of, 406-446 graft based on biomechanical properties, 472-473, 474t graft constructs, single-strand versus two-strand, 469-472 illustrative cases of, 515-520, 516f-520f indications of, 448-449, 448b and intact knee dislocations, 654, 656f intraoperative evaluation of, 466, 466b isolated reconstruction, 418-421 lateral stress radiography and, 462f measurement lines, 456f measurement lines parallel to intercondylar roof, 457t measurement lines radial to intercondylar roof, 457t medial femoral condyle, 449-458 multiligament injuries and, 463b, 464-465 normal knee motion restoration and, 418-422, 418b, 419t-420t, 420f one- and two strand graft reconstructions and, 477-489 operative techniques and, 466-499, 467b, 467t, 477b our clinical studies, 499-504 partial, 461f partial rupture and, 462f physical examination and, 461, 461b posterior stress radiograph and, 473f posteromedial approach, 494-495, 494f-495f preoperative planning and, 463-466, 463b preparation of quadriceps tendon-patellar bone autograft, 473-474, 473b QT-PB autograft preparation, 477 radiographic assessment and, 461b, 462-463 reconstruction with associated ligament instabilities, 509, 510t-513t reference line at 12 o’clock position, 456, 457f results from clinical studies, 504-513 revision reconstruction, 513 rule of thirds and, 458f severe posterior tibial subluxation and, 408f single-strand allograft reconstruction, 503-504, 503b, 504f single-strand reconstruction results, 508-509, 508t-509t single-strand versus two-strand graft constructs and, 467t single-versus two-strand reconstruction, 472t surgical reconstruction, application to, 413-414 tibial attachment techniques and, 459f, 467-468, 468b tibiofemoral, grafts, 428-442, 429f-440f two-strand QT-PB autograft reconstruction revision, 502-503, 502b, 503t two-strand quadriceps tendon-patellar bone autograft tibial inlay, 499-500, 499b, 500f two-strand quadriceps tendon-patellar bone autograft tibial tunnel, 500-501, 501b, 501t two-strand reconstruction results and, 508-509, 508t-509t vascular anatomy and variations, 458-460, 458b, 460f Posterior cruciate ligament (PCL) all-inside techniques, 477-489, 478t-479t femoral graft technique, 483-484, 483b femoral placement of rectangular tunnel for bone plug, 489-491, 491b, 492f femoral placement of single tunnel, 467t, 489, 490f-491f femoral placement of two tunnels and graft passage, 467t, 484-487, 485b, 486f-487f graft tensioning and fixation and, 487-489, 488b, 488f patient positioning and setup, 477-480, 479f-480f, 480b tibial tunnel drilling, 482-483, 482f, 485f tibial tunnel preparation, 480-482, 480b, 481f Posterior cruciate ligament-posterolateral reconstructions, combined, 421-422, 421f 1257 Posterior cruciate ligament procedure, rehabilitation of, 578-606 clinical biomechanics, 579-581, 579b, 580f-581f clinical concepts of, 578-579, 579b partial or acute isolated ruptures of, protocol for, 581-582, 581f reconstruction postoperative protocol, 582-596, 583t-589t balance, proprioceptive, and perturbation training in, 593-595, 594f brace support, 582 and conditioning, 595 flexibility in, 590-591 immediate postoperative management, 582, 583t-589t modalities in, 582 patellar mobilization, 590, 592f and plyometric training, 595-596, 596f range of knee motion, 582-590, 590f-592f and return to sports activities, 596, 597t and running and agility programs, 595 strengthening in, 591-593, 593f weight bearing in, 590 Posterior cruciate ligament (PCL) sectioning adduction-abduction rotation limits and, 409-410, 410f-411f anteroposterior translation limits, 407-408, 407f, 408t extension limits, 406-407 knee motion limits and, 406-410, 407b Posterior displacement, secondary structures and, 56t Posterior draw, in neutral tibial rotation, 56f Posterior drawer test, 530t-534t ligamentous restraints of knee joint in, 50t for posterior cruciate ligament rupture, 65-66 Posterior intercondylar area, 24f-25f Posterior knee bony landmarks, 24f-25f Posterior lateral capsule, 12f Posterior medial capsule (PMC), 65 sectioning effect on posterior tibial translation, 66-67 Posterior medial-lateral capsulotomy, 1079, 1084f-1086f Posterior meniscofemoral ligament, 3f, 34f Posterior oblique ligament, 3f, 9f-10f anatomy of, 5-11, 7f, 10f role of, 67, 410-411 Posterior stress radiographs, 462-463, 1174 Posterior subluxations, medial and lateral tibiofemoral compartments, 414b Posterior tibial artery, 19f Posterior tibial subluxation, of PCL-deficient knee, 422-425, 422b Posterior tibial translation (PTT), 41, 42f, 411f, 415, 415f-416f MCL and PMC sectioning effect on, 66-67 quantification of, 223-224 Posterior translation, limits of knee joint motion in, 41t Posterolateral bundles, 144-154, 147f robotic studies on, 158, 158f-161f Posterolateral capsule reconstruction, for severe varus recurvatum, 550-552, 553b, 553f-555f Posterolateral dislocation, 656, 657f Posterolateral injuries, 868 Posterolateral ligament injuries, 527-577 and anatomic posterolateral reconstruction, 560-561, 561f, 562b anatomic relationships and, 528f associated cruciate ligament ruptures and, 564t author’s clinical studies and, 559-564 clinical evaluation for, 528-535, 529b clinical outcome data for, 565t-567t comprehensive knee examination and, 530t-534t contraindications to, 528, 528b and femoral-fibular allograft reconstruction, 560-561 illustrative cases for, 569-574, 570f-575f indications of, 527-528, 527b intraoperative evaluation and, 538, 538b and operative procedures, failure of, 563-564, 563f, 563t-564t, 564b and operative treatment of acute PL ruptures, 538-544, 539b and operative treatment of chronic PL ruptures, 544-559 other operative techniques and results in, 564-569, 568f 1258 INDEX Posterolateral ligament injuries (Continued) partial to complete, classification and treatment of, 535, 536t preoperative planning, 535-538, 536b for acute injuries, 535-536, 536t, 537f for chronic injuries, 536, 537f for cruciate graft reconstruction, 538, 538f proximal advancement of the posterolateral structures and, 556-559, 558f-561f, 559b, 562, 562b and varus malalignment, 564t Posterolateral ligament reconstruction and double and triple varus knees, 816-818, 817b, 817f-818f restoring normal knee motion and, 418-422, 418b, 419t-420t, 420f Posterolateral ligament sectioning (PLS), adductionabduction rotation limits and, 409-410, 410f-411f Posterolateral ligament structures, 406-446 Posterolateral reconstructive procedure, rehabilitation of, 578-606, 597t-604t clinical concepts of, 578-579, 579b discharge rehabilitation criteria for, 605t Posterolateral tissues, pain in, 868-869 Posteromedial ligament ruptures repairs for, 621-625, 623t treatment rules and planning for, 617-618 Posteromedial ligaments, in ACL-deficient knees, 61-66, 61b, 62t-63t, 63f-68f Posteromedial posterior cruciate ligament (PPCL), 441f Posterosuperior popliteomeniscal fascicle, 31f Postoperative bracing, B-PT-B reconstruction and, 304 Postoperative complications, 1175, 1178f Postoperative long-leg hinged knee brace, 319 Postural stability, ACL reconstruction and, 276-279 “Pounds carried,” factor of, 1170-1171 Power training, American College of Sports Medicine (ACSM) during, 312t PPCL see Posteromedial posterior cruciate ligament (PPCL) Pregabalin, 1145 Prepatellar anatomy, 15-16, 17f Prepatellar subaponeurotic bursa, 16 Prepatellar subcutaneous bursa, 16 Prepatellar subfascial bursa, 16 Press-fit plug technique, 926, 926f Primary arthrofibrosis, 1059, 1060b initial phase of, 1070 Primary varus knees, 777, 777f Procardia see Nifedipine Proliferative scar tissue, 1059, 1060f PROM see Passive range of motion (PROM) Prone hamstrings with partner resistance, 387 Proprioception, 330 ACL reconstruction and, 276-279 articular cartilage procedure and, 943, 944f-945f injury effects on, 331 and medial ligament injury rehabilitation, 650, 650f and meniscus repair and transplantation rehabilitation, 764-766, 765b training, 310-314 Proprioceptive training and PCL reconstruction rehabilitation, 593-595, 594f tibial and femoral osteotomy and, 863-865 Prosthesis-related bone loss, as factors leading to failure, 1049 Proximal popliteus capsular expansion, 31 Proximal realignment, 979-980 Proximal tibial anatomic axis (PTAA), 788 Proximal tibial nerve anatomy of, 1105-1106 neurolysis of, 1115-1116, 1117f Proximal tibiofibular joint, 24f-25f denervation of, 1112, 1115f innervation of, 1104-1105, 1104f Psychological factors, in complex regional pain syndrome (CRPS), 1133-1134 Psychological issues, complex regional pain syndrome (CRPS) and, 1137-1138 Psychotherapy, complex regional pain syndrome (CRPS) and, 1141 PTAA see Proximal tibial anatomic axis (PTAA) PTT see Posterior tibial translation (PTT) Q Q-angle, 974-975 in ACL injury, 348 Q-angle arc, 975 QSART see Quantitative sudomotor axon reflex test (QSART) QT-PB see Quadriceps tendon-patellar bone (QT-PB) Quadriceps, 319, 392 active test and, 530t-534t anatomy and, 13-14, 13f-14f stretching, 306, 307f-308f, 393f, 396t Quadriceps control, 874 Quadriceps inhibition, 129, 129f Quadriceps tendon (QT), medial patellofemoral ligament reconstruction using, 971 Quadriceps tendon-patellar bone (QT-PB), 475f allograft, 478f-479f autografts, 467, 476f, 477-489, 478f-479f preparation of, 473-474, 473b Quadriceps tendon-patellar bone (QT-PB) autograft ACL reconstruction and, 173, 174f for ACL revision reconstruction, 224, 241-242, 241b, 242f-243f, 243t-244t failure in, 250 Quality of life, visual analogue scales for, 1218b, 1219 Quantitative sudomotor axon reflex test (QSART), 1139 Quick feet exercise, 396t R Radial tears, meniscus, 694, 695f Radiofrequency cartilage debridement devices, 976-979 Radiographs complex regional pain syndrome (CRPS) and, 1138 revision knees and, 223-224 Radiography, lateral stress, 462f Range of motion (ROM) articular cartilage procedures and, 938 defined, 78t-79t knee, bone-patellar tendon-bone (B-PT-B) reconstruction and, 296t-303t, 304-305, 304f and medial ligament injury rehabilitation, 646-647, 647f-648f and meniscus repair and transplantation, 763-764, 763b, 763t testing of, 530t-534t RANKL see Receptor activator of nuclear factor κB ligand (RANKL) Rating systems, 1162 Receptor activator of nuclear factor κB ligand (RANKL), 117 Reconstructed knees, cyclical data for, 443t Recruitment patterns, muscle, 349t Rectus femoris muscle, 13f Red-red tears, meniscus, 678 Red-white tears, meniscus, 678-679 Reduction, for acute knee dislocation, 669, 669b Reflected arm, 540 Registration, surgical technique, for patellofemoral arthroplasty, 1040 Rehabilitation exercises, 940 Rehabilitation program for ACL reconstruction, 199-200, 199t in primary anterior cruciate ligament reconstruction clinical studies, 201t Reliability, 1164 our study in, 1179-1180, 1179b, 1180t Resection infrapatellar branch of the saphenous nerve, 1112, 1113f medial cutaneous nerve of the thigh, 1112, 1114f Responsiveness, 1165 testing, our study in, 1179-1180, 1179b, 1181t Restraining joint moment, 57f Resurfacing implants, in varus or valgus malalignment, 883 Retro eminence ridge, 24f-25f Return to play, sportsmetrics training, 402 Return to sports activities after meniscus repair and transplantation rehabilitation, 770-771, 771b PCL reconstruction and, 596, 597t Reverse pivot shift test, 530t-534t Revision ACL reconstruction and, 140 ACL rehabilitation protocol and, 319-327, 320t-327t of anterior cruciate ligament reconstruction, 221-257 Achilles tendon-bone allograft for, 224-225 anterolateral ligament reconstruction in, 236-241, 239f-240f B-PT-B allograft for, 245, 245f, 246t B-PT-B autograft for, 224-225, 241b, 242-245, 244f, 244t-245t bone grafting procedure and, 228-230, 228b, 230t, 231f-232f bone-patellar tendon-bone graft anatomic tibial and femoral technique, 230-235, 233f, 234b clinical evaluation of, 223-224, 223b clinical studies on, 241-251, 241b contraindications for, 222-223, 223b endoscopic, 241 graft options and clinical outcomes of, 221-257 graft selection for, 224-225, 224b iliotibial band extraarticular reconstruction in, 235-236, 235b, 237f-238f illustrative cases for, 251-255, 251f-254f indications for, 221-222, 222b operative techniques for, 225-241, 225b patient setup in, 225, 225b preoperative planning for, 224, 224b prevalence of nonanatomic graft placement in, 241b, 245-246 prior femoral tunnel and, 226-228, 229f QT-PB graft for, 224, 241-242, 241b, 242f-243f, 243t-244t staged bone grafting and, 225-226, 226b STG autograft for, 224 tibial tunnel problems and, 225-226, 226b, 227f-228f two-incision technique with STG graft and, 235 PCL reconstruction and, 502-503, 502b, 503t two-strand QT-PB autografts and, 502-503, 502b, 503t “Ring” sign, 139f Risser sign, 260, 260f Robotic surgery systems, 883-884 Robotic-assisted surgical navigation, 883-884 ROM articular cartilage procedures and see Range of motion (ROM) Rotation, defined, 78t-79t Rotation axes abduction-adduction, 40, 40f location of, 59-60, 60f Rotation windup forces, 351f Rotational malalignment, 1014-1016, 1015f, 1016t Rotational osteotomy, of tibia, 1030-1032 Rotatory subluxations, 46-49, 48f Routine diagnostic arthroscopy, 976-979 Rule of thirds, 458f Running and agility program ACL reconstruction and, 316 and medial ligament rehabilitation, 651 PCL reconstruction and, 595 Running program ACL reconstruction and, 316 meniscus repair and transplantation rehabilitation, 770, 770b Rupture(s) acute medial ligament, 617-618 with knee dislocations, 618 anterior cruciate ligament, 138-139 chronic medial, 618 defined, 80t isolated PCL, 467t PCL combined other ligament, 467t posterior cruciate ligament, 463-464, 463b, 464f posteromedial, 618 posteromedial ligament, 617-618 Russian twists, 389, 389f S Saltzman Patellofemoral Score, 1240, 1242t-1243t Samsung Medical Center (SMC) patellofemoral scoring system, 1240, 1242t INDEX Saphenous nerve, 20f anatomy of, 1106 in Hunter’s canal, 1109f neurolysis of, 1116, 1119f in medial side of knee, 18 resection of, 1112, 1113f Sartorial branch, of saphenous nerve, 18 Sartorial fascia, 4f Sartorius fascia, 20f Sartorius muscle, 3f-4f, 5, 20f Sartorius tendon, 4f Scales, 1162 Scar tissue, 272f, 1059, 1060f, 1062 Scientific rationale, 373-375, 374f Scissors jump, 379t, 384-385, 384f, 396t Scleraxis, 118 SEBT see Star Excursion Balance Test (SEBT) Second-generation implants, for patellofemoral arthroplasty, 1037 Secondary arthrofibrosis, 1060 Secondary patellofemoral arthritis, 1036 Secondary sterilization, for allografts, in primary anterior cruciate ligament reconstruction clinical studies, 201t Segond fracture, 32-34, 670, 671f-672f Self-efficacy, 284 Semimembranosus muscle, 3f, 9f-10f, 20f attachments, 610f groove for, 24f-25f Semimembranosus tendon, 3f, 9f-10f, 29f anatomy of, 10-11, 11f-12f Semitendinosus-gracilis (STG) autograft, 173-176, 175f-176f, 177t, 178f-180f, 556 versus bone-patellar tendon-bone autograft, 201 Semitendinosus-gracilis (STG) tendon autograft, for ACL revision reconstruction, 224 failure in, 250 Semitendinosus tendon, 3f-4f, 20f Sensory abnormalities, complex regional pain syndrome (CRPS) and, 1136-1137, 1137f Seto Sports Participation Survey, 1212b, 1214-1215 Sex hormones, 348-349, 349b Shell allograft, 927-928, 928f-929f Shell-graft technique, 926 Short Form 36 (SF-36) Health Survey, 1162-1164, 1235 Short lateral ligament, 26-28 Single and double longitudinal tears, meniscus, 690-694, 692f-694f Single-hinged braces, 873 Single-leg hop, 379t tasks, 375, 376f, 385, 385f tests, 319 Single-leg landing, 356t-357t Single-leg squat test, 875f Single-strand allograft reconstruction, PCL, 503-504, 503b, 504f Single-strand PCL graft constructs, 469-472, 472b Single-strand PCL reconstruction, 472t, 504-508, 504t-507t Single tunnel, femoral placement of, PCL, 467t, 489, 490f-491f Single-tunnel femoral attachment techniques, 468-469, 468b SIT see Sports injury test (SIT) Six degrees of freedom knee kinematics, 433f Skeletal alignment, optimal, 1023 Skeletally immature patients, anterior cruciate ligament reconstruction in, 258-267 associated intraarticular pathology and, 260-261 clinical evaluation of, 259-260, 259b clinical outcomes and, 261-265, 261b contraindications for, 259 diagnostic tests for, 260 graft selection for, 265 history and, 259 indications for, 258-259, 258b injury prevention for, 266 intraoperative evaluation and, 261 neuromuscular training for, 266 operative techniques and, 261-265, 261b partial transphyseal reconstruction and, 263, 264f physeal sparing techniques and, 261-262, 261f-262f physical examination and, 260 preoperative planning and, 260-261, 260b primary repair and, 261 Skeletally immature patients, anterior cruciate ligament reconstruction in (Continued) recommendations for, 265, 265b risk factors for, 259 skeletal maturity and, 260-261, 260f transepiphyseal reconstruction and, 262-263, 263f transphyseal reconstruction and, 263-265, 265f α-smooth muscle actin (ASMA), 1067 Soccer training program, 397t results of, 401t Soft tissue balance, articular cartilage procedure and, 941-942, 942f Soft tissue flexibility, 942 Soft tissue graft, tibial fixation options for, 471t Soft tissue pliability, 942 Soleal line, 5f-6f Soleus muscle, 12f, 29f, 33f, 393 Soleus stretch, 394f Sox-9, 118 Species, anterior cruciate ligament changes and, 97b Sports, knee low-energy injuries from, 656-657 Sports activities, return to, bone-patellar tendon-bone (B-PT-B) reconstruction and, 319 Sports Activity Scale, 1169, 1170f, 1211-1215, 1212b published, 1213t-1214t Sports and daily activities, rating of, 1169, 1169b, 1170f-1171f, 1170t form for, 1186, 1186f Sports injury test (SIT), 375 Sports training, after ACL reconstruction, 279-282, 279b Sportsmetrics program, 333 Sportsmetrics training basketball and, 395-402, 398t dynamic warmup and, 376-377 essential components and, 375-394 flexibility and, 391-394 neuromuscular retraining program and, 373-375, 374f plyometrics/jump training and, 377-386 problems encountered and, 403 program options and, 394-402 return to play, 402 soccer and, 395-402, 397t sports injury test and, 375 strength training and, 386-391 suggested solutions and, 403 tennis and, 395-402, 400t volleyball and, 395-402, 399t warmup and, 396t WIPP training and, 394-395 Sprain, defined, 77, 80t Squat jump exercise, 378, 379t, 380f, 396t “Squatting,” factor of, 1170-1171 Stability, 331-332 Staged bone grafting, 225-226, 226b failure in, 250 Stair-climbing machines, 315 Standing frontal alignment, 530t-534t Standing recurvatum test, 530t-534t “Standing/walking,” factor of, 1170-1171 Star Excursion Balance Test (SEBT), 277-278 Static test, 277-278 Stationary bicycling, 315, 595 Steamboats (hip flexion), 391, 396t Stellate ganglion, 1128 Stem cells, tissue stimulation and, 117 Step-up exercise, 309f Sterilization process(es), 723 secondary, for allografts, 193-195 Steroid injection, into ligament direct, 102 intraarticular, 102, 103f Stiffness, gender differences in, 352-353, 352t, 353f Straight-leg march, 376, 396t Straight leg plus raise exercise, 874f Straight-leg raise plus exercise, 863f Straight leg raises, 306-307 for meniscus repair and transplantation rehabilitation, 766f Strain, in vivo ACL, 274, 275t Strain rate, ligament mechanical properties and, 92-93, 92f-93f, 93t Strain shielding, as factors leading to failure, 1049 Straub and Hunter’s sports performance index, 1212b, 1215 1259 Strength program B-PT-B reconstruction and, 316 bone-patellar tendon-bone (B-PT-B) reconstruction and, 296t-303t Strength training American College of Sports Medicine (ACSM) during, 312t sportsmetrics and, 386-391 Strengthening in medial ligament injury rehabilitation, 647-650, 649f for meniscus repair and transplantation, 766-768, 766b, 767t and PCL reconstruction, 591-593, 593f Strengthening exercises, aquatic therapy and, 961 Strengthening program, tibial and femoral osteotomy and, 863, 863f, 864t, 865f Stress-shielding, ACL healing and, 104-105, 104b, 105f, 105t Stride out exercise, 376-377 Subcutaneous tissues, distal realignment and, 983-984 Subjective Knee Evaluation Form, of 2000 International Knee Documentations Committee, 1193, 1194f-1196f AOSSM online scoring system for, 1209 limitations of, 1208b Subjective knee symptoms, visual analogue scales for, 1218b, 1219 Subluxation, defined, 77t Subperiosteal dissection distal realignment and, 983-984 of patellar attachment, 982 Sudomotor measurement, complex regional pain syndrome (CRPS) and, 1139 Superficial iliotibial band, 26f Superficial layer, of anterior knee, 15 Superficial medial collateral ligament (SMCL), 3f-4f, 8f-10f, 29f, 64 anatomy of, 5-11, 7f distal advancement of, 623f and opening wedge osteotomy, 804-805 Superficial nerves, 20f Superficial neurovascular structures, of anterior knee, 18, 19f-20f Superficial oblique retinaculum, 14f-15f anatomy of, 15 Superficial peroneal nerve anatomy of, 1105 neurolysis of, 1112-1115, 1116f Superior medial genicular artery, 19f-20f Superior tibiofibular joint, 24f-25f Superman (alternating arms and legs), 389 Supervised clinic-based physical therapy, 281-282 Supine hamstring bridge, 387, 388f, 396t Supine straight leg raises, 306-307 Supporting investigations, for sportsmetrics, 373-375, 374f Supracondylar line, 24f-25f Supracondylar process, 24f-25f Surgical Documentation Form, of 2000 International Knee Documentations Committee, 1199, 1204f-1207f Surgical sympathectomy, complex regional pain syndrome (CRPS) and, 1149 Sympathetic block, complex regional pain syndrome (CRPS) and, 1148-1149, 1148f Sympathetic nervous system, complex regional pain syndrome (CRPS) and, 1128-1129 Symptomatic medial patellar subluxation, diagnosis of, 985 Symptomatic patellofemoral arthritis, 139 Symptomatic tibiofemoral arthritis, 139 Symptoms modified rating scale for, 1167-1168, 1167f rating of, 1165-1168, 1166b, 1166f-1167f form for, 1186, 1187f subjective knee, visual analogue scales for, 1218b, 1219 Synapses, complex regional pain syndrome (CRPS) and, 1126-1128, 1128f T Tampa Scale of Kinesiophobia, 284, 284t Tandem balance, 764 Team communication, 943 1260 INDEX Tear patterns, meniscus, 679, 679f Technique development phase, 377 Teeter effect, 825-826 Tegner activity scales, 1211-1214, 1212b, 1212t Tendon-bone insertion, after ACL reconstruction, 112, 112b, 113f biologic factors of, 114-118 biologic mediators and, 118 bone ingrowth modulation and, 115-117, 116f-117f healing challenges in, 112 healing modulation in, 112-118, 114b hyperbaric oxygen and, 118 inflammatory response and, 114-115, 115f-116f insertion site histology of, 113f mechanical factors of, 112-114, 114f MMP modulation and, 117-118, 118f nitric oxide modulation and, 118 pull-out strength and, 113f stem cells and, 117 technical factors of, 112 vascularity modulation and, 117 Tendon sizers, 262 Tennis, sportsmetrics training, 395-402, 400t results of, 401t TGF-β see Transforming growth factor-β (TGF-β) Thigh, resection of the medial cutaneous nerve of, 1112, 1114f Third-degree injuries medial ligament injury rehabilitation weeks to 3, 637-638 weeks to 6, 638 weeks to 9, 638-645 weeks 10 to 12, 645 Third-generation implants, for patellofemoral arthroplasty, 1037 Three stop-jump tasks, 362f Tibia, 5f-6f, 18f rotational osteotomy of, 1030-1032 Tibial and femoral osteotomy, 773-847, 774f, 858-867 balance and proprioceptive training and, 863-865 and body weight, 775-776, 775f bracing and weight bearing and, 859-860, 859f, 861f clinical concepts of, 858-859, 859t computerized navigation in, role of, 809-811, 810f, 811b conditioning and, 865-867, 867t contraindications for, 775-776, 775b deep venous thrombosis and, 858 flexibility and, 862-863 illustrative cases, 829-839, 829f-830f, 832f-841f indications, 774-775, 774b, 785f modalities of, 859, 860t patellar mobilization and, 862, 862f perturbation training and, 863-865, 866f postoperative signs and symptoms requiring treatment, 859t preoperative planning for, 783-797, 784b angular correction in, calculations to determine, 783-787, 784f, 786f-787f coronal and slope alignment, final recommendations to obtain correct, 797 tibial slope calculations in, 787-791 timing of procedures, 791-793, 792t, 793f prevention and management of complications of, 825-839, 826b arterial injury, 827 arthrofibrosis and patella infera, 828 bony instability, 825-826 deep vein thrombosis, 828-829 delayed union or nonunion, 825-839 iliac crest harvest site pain, 828 inadequate or loss of axial correction, 826-827 peroneal nerve injury or palsy, 827-828 tibial plateau fracture, 827 range of knee motion and, 860-861, 861f-862f, 861t rehabilitation protocol of, 859-867, 860t return to activities and, 865-867 strengthening and, 863, 863f, 864t, 865f Tibial anterior cruciate ligament graft locations, 162-165, 163f-166f Tibial attachment of ACL, 148f fiber-length patterns and, 88-90, 89f posterior cruciate ligament, 449f Tibial avulsion fracture, 92, 95 photomicrograph of, 93f Tibial fixation anterior cruciate ligament and, 187f options for bone graft, 470t options for soft tissue graft, 471t Tibial footprint, 146-154, 146f-147f, 148t-149t, 150f landmarks for identifying, 151t Tibial insertions, of ACL, 148t, 149f, 156f Tibial nerve, 12f, 29f, 1129-1130 Tibial plateau fracture, 827 Tibial plateau geometry, 347 Tibial positioning, 72f Tibial reduction phenomenon, 69-70 Tibial rotation, 39, 40f, 44f abnormalities in, 46 external, 415-417, 417f internal-external limits, 408-409, 408f-409f internal limits of, 65f medial-lateral compartment translations during external, 70-72, 75f pivot shift test and, 70f-71f Tibial slope, 790f-792f appropriate wedge angle and, 796f calculations to determine, 787-791, 789f increase in, effect of, 789f and literature review, 788t preservation of, and opening wedge osteotomy, 794-797, 795f-797f and vertical gap height, 797t Tibial slot technique, 727f Tibial subluxation, posterior, 422-425, 422b Tibial torsion measurement of, 975-976 measurements lack standards, 1021-1023, 1021f-1023f Tibial translations, 70f-71f anterior and posterior limits of, 71f internal and external limits of, 72f posterior, 415, 415f-416f Tibial tubercle, 4f-6f, 18f, 20f Tibial tubercle/trochlear groove (TT/TG), 976 distance, increased, correction of, 1042 role of, 976 Tibial tunnel in ACL revision reconstruction bone grafting procedure for, 228-230, 228b, 230t, 231f-232f misplaced, 222 placement of, 230-234, 234b problems, 225-226, 226b, 227f-228f drilling and, 482-483, 482f, 483b, 484f-485f malposition of, 190 placement of, 177-180 preparation, 480-482, 481f Tibiofemoral joint arthritis, 139 as complication, 1049 patellofemoral arthroplasty and, 1037 Tibiofemoral joint symptoms, and meniscus tears, 700t Tibiofemoral motions, 38-39 Tibiofemoral PCL grafts, 428-442, 429f-440f Tibiofemoral rotation test (Dial test), 223, 616, 781-783 Tibiofemoral unicompartmental knee arthroplasty (UKA), 882 contraindications of, 883 implant design of, 883, 883t-884t Tibiofemoral valgus, 850 TightRope devices, 189, 189f-192f Tinel’s sign, 1107, 1109f Tissue homeostasis, 1066-1067 Tissue integrity, and meniscus tears, 679-680 TKA see Total knee arthroplasty (TKA) Toe walk, 376 Torsional realignment, results of, 1033-1034 Total knee arthroplasty (TKA), 1037, 1235 see also Knee arthroplasty unicompartmental knee arthroplasty versus, 899-901, 900t Tourniquet, distal realignment and, 984-985 TPBS see Triple phase bone scintigraphy (TPBS) Traction injury, to popliteal artery, 665f Transepiphyseal reconstruction, 262-263, 263f Transforming growth factor-β (TGF-β), 1066-1067 Translations, 40, 40f-41f abnormalities in, 46 defined, 76, 78t-79t Transphyseal reconstruction, 263-265, 265f Transverse ligament, 3f, 34f Trendelenburg gait, 916-917 Triceps, 393-394, 395f Triple phase bone scintigraphy (TPBS), 1138, 1138f Triple varus knee, 528-529, 777, 777f, 816-818, 817b, 817f-818f, 868 Trochlear component, implantation of, 1040-1041, 1040f-1041f Trochlear dysplasia, correction of, 1041-1042, 1042b Trochlear implant(s), 1037 preoperative planning steps for, 1038-1039, 1039f Trochlear morphology, abnormality in, 1042 Trochleoplasty, 990-991 outcomes of, 1005-1008, 1007t TT/TG see Tibial tubercle/trochlear groove (TT/TG) Tuberculum tendinis, 5f-6f, 10-11, 24f-25f Tuck jump, 377-378, 379t, 380f, 396t Tumor necrosis factors-α inhibitors (TNF-α), complex regional pain syndrome (CRPS) and, 1148 Tunneled epidural catheter, 1086 Two-incision technique with STG graft, 182, 235 Two-strand PCL graft constructs, 469-472, 472b Two-strand PCL reconstruction, 472t Two-strand QT-PB autograft reconstruction revision, 502-503, 502b, 503t Two-strand quadriceps tendon-patellar bone autograft tibial inlay, 499-500, 499b, 500f Two-strand quadriceps tendon-patellar bone autograft tibial tunnel, PCL, 500-501, 501b, 501t 2000 International Knee Documentations Committee Knee Evaluation Form, 1193, 1197f Knee History Form, 1199, 1202f-1203f Subjective Knee Evaluation Form, 1193, 1194f-1196f AOSSM online scoring system for, 1209 limitations of, 1208b Surgical Documentation Form, 1199, 1204f-1207f Two-tunnel femoral attachment technique, 468-469 U Ultra-low-velocity (ULV) knee dislocation, 657-658 Ultrashort echo-time (UTE) techniques, after ACL grafts implantation, 166-167 Ultrasonography, of peroneal nerve, 668 Unicam machine, 940f Unicompartmental arthroplasty effect of factors on failure of, 894t versus high tibial osteotomy, 894-899, 899t Noyes Knee Institute rehabilitation for, 889t-893t versus total knee arthroplasty, 899-901, 900t Unicompartmental arthroplasty prostheses modern, 883t modern lateral, 884t Unicompartmental knee replacement clinical examination of, 884 clinical studies of, 894-901 lateral unicompartmental knee arthroplasty, 901, 901t-903t medial unicompartmental knee arthroplasty, 894, 895t-898t unicompartmental knee arthroplasty versus high tibial osteotomy, 894-899, 899t unicompartmental knee arthroplasty versus total knee arthroplasty, 899-901, 900t complications and factors leading to failure of, 888-894, 894t contraindications of, 883 versus high tibial osteotomy, 824 illustrative cases of, 903, 904f-905f implant design in, 883, 883t-884t indications of, 882-883 postoperative management of, 887-888, 889t-893t robotic technology of, 883-884, 885t surgical technique of, 884-887, 886f-888f for varus or valgus malalignment, 882-910 University of California Los Angeles (UCLA) Activity-Level Rating Score, 1235, 1236t Unloading braces, types of, 873 Unstable platform, 310 INDEX V Valgus knee, common characteristics of, 850b Valgus malalignment, 848-857 clinical biomechanics and, 849-850 clinical evaluation of, 850 clinical examination of, 884 clinical outcomes of, 854-856 clinical studies of, 894-901 lateral unicompartmental knee arthroplasty, 901, 901t-903t medial unicompartmental knee arthroplasty, 894, 895t-898t unicompartmental knee arthroplasty versus high tibial osteotomy, 894-899, 899t unicompartmental knee arthroplasty versus total knee arthroplasty, 899-901, 900t complications and factors leading to failure of, 888-894, 894t complications of, 856 contraindications of, 883 distal femoral osteotomy contraindications and, 849, 849b distal femoral osteotomy indications and, 848-849, 849b history and physical examination of, 850 illustrative cases of, 903, 904f-905f implant design in, 883, 883t-884t indications of, 882-883 operative technique of, 851-854, 851f-854f postoperative management of, 887-888, 889t-893t postoperative regimen for, 853b preoperative planning and, 850-851, 850f radiographic evaluation of, 850, 850b robotic technology of, 883-884, 885t surgical technique of, 851b, 884-887, 886f-888f unicompartmental knee replacement for, 882-910 Valgus rotation, 66f Valgus test, ligamentous restraints of knee joint in, 50t Validity, 1165 our study in, 1179-1180, 1179b, 1180t Varus angulation, in ACL-deficient knees, 776t Varus knee syndromes clinical algorithm for, 785f clinical evaluation of, 779-783, 780b diagnostic clinical tests in, 781 physical examination in, 780-781 radiographic assessment in, 783, 783f subjective and functional outcome of, 779 tibiofemoral rotation test in, 781-783 clinical studies, 812-825, 812b, 820b closing wedge tibial osteotomy, 805-809, 805b diagnosis of abnormalities in, 782t double varus, 776, 777f, 816-818, 817b, 817f-818f and dynamic muscle forces, 780f and external adducting moment, 781f intraoperative evaluation for, 797-798, 798b, 799f knee adduction moment and, 778f-779f, 781f and lower limb alignment, 776-778, 777b, 778f gait analysis in, 778-779, 779b manual knee tests for, 782f and opening wedge tibial osteotomy, 798-805, 799b preoperative planning for, 783-797, 784b and angular correction calculations, 783-787, 784f, 786f-787f coronal and slope alignment, final recommendations to obtain correct, 797 Varus knee syndromes (Continued) cruciate graft options in, 793 opening versus closing wedge osteotomy in, 794 and preservation of tibial slope, 794-797, 797f and tibial slope, 787-791, 788t, 789f-792f timing of procedures in, 791-793, 792t, 793f prevention and management of complications of, 825-839, 826b arterial injury, 827 arthrofibrosis and patella infera, 828 bony instability, 825-826 deep vein thrombosis, 828-829 delayed union or nonunion, 825-839 iliac crest harvest site pain, 828 inadequate or loss of axial correction, 826-827 peroneal nerve injury or palsy, 827-828 tibial plateau fracture, 827 primary varus, 777, 777f and tibial and femoral osteotomy contraindications, 775-776, 775b and tibial and femoral osteotomy indications, 774-775, 774b triple varus, 777, 777f, 816-818, 817b, 817f-818f and varus angulation, 776t Varus malalignment, 564t clinical examination of, 884 clinical studies of, 894-901 lateral unicompartmental knee arthroplasty, 901, 901t-903t medial unicompartmental knee arthroplasty, 894, 895t-898t unicompartmental knee arthroplasty versus high tibial osteotomy, 894-899, 899t unicompartmental knee arthroplasty versus total knee arthroplasty, 899-901, 900t complications and factors leading to failure of, 888-894, 894t contraindications of, 883 illustrative cases of, 903, 904f-905f implant design in, 883, 883t-884t indications of, 882-883 osseous and ACL reconstruction, 199 in primary anterior cruciate ligament reconstruction clinical studies, 201t postoperative management of, 887-888, 889t-893t robotic technology of, 883-884, 885t surgical technique of, 884-887, 886f-888f unicompartmental knee replacement for, 882-910 Varus recurvatum, 535, 868, 879f severe, posterolateral capsule reconstruction for, 550-552, 553b, 553f-555f Varus stress testing, 530t-534t Varus test, ligamentous restraints of knee joint in, 50t Vascular anatomy, posterior cruciate ligament, 458-460, 458b Vascular injuries, 664-666, 664b, 666f Vascularity modulation, tissue healing and, 117 Vascularized ACL grafts, 103-104, 103b, 104f Vasomotor, complex regional pain syndrome (CRPS) and abnormalities, 1136 measurement, 1139 Vasopneumatic devices, 295-304 Vastus intermedius, 14 Vastus lateralis longus, 13f Vastus lateralis muscle, 12f, 14, 14f, 26f, 29f, 33f 1261 Vastus lateralis obliquus, 13f Vastus medialis, 9f, 20f Vastus medialis longus, 13-14, 13f Vastus medialis obliquus (VMO), 3f, 5-7, 8f, 13-14, 13f Vastus medialis obliquus (VMO) approach, 494 VersiTomic Flexible reaming system, 189, 193f Video drop-jump, 319 Video plant-and-cut drill, 319 Viscosity, aquatic therapy and, 958-959, 958f, 962-963, 964f-965f, 965t Visual analogue scales, for quality of life and subjective knee symptoms, 1218b, 1219 Visual motor imagery (VMI), 276 VMI see Visual motor imagery (VMI) VMO see Vastus medialis obliquus (VMO) Volleyball, sportsmetrics training and, 395-402, 399t results of, 401t Voluntary muscle, control of, 873-874 W Walking, knee kinematics during, 130-132, 130b, 131f Walking lunges forward, 387 Wall jump exercise, 377, 379f, 379t Wall-sit exercises, for meniscus repair and transplantation rehabilitation, 768f Wall-sitting isometrics, 308 Wall-sitting to muscle exhaustion, 309f Warm up for Injury Prevention and Performance (WIPP), 375-376 Water, buoyancy of, 938 Water walking, for meniscus repair and transplantation rehabilitation, 768-770 Weight bearing articular cartilage procedures and, 938 and bone-patellar tendon-bone (B-PT-B) reconstruction, 304f, 305 early, after ACL reconstruction, 269-271, 269b, 272f and medial ligament injury rehabilitation, 646 and PCL reconstruction, 590 tibial and femoral osteotomy and, 859-860, 859f, 861f Weight machines, 308 Weight shift exercise, 939f Weight-bearing line (WBL), of lower extremity, 849-850 Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 1218, 1218b, 1235 White-white tears, meniscus, 678-679 Widespread implementation, of neuromuscular training, 402 WIPP see Warm up for Injury Prevention and Performance (WIPP) WOMAC see Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Workers’ compensation, 200, 200f Y Young’s modulus, Mankin scoring system and, 1231, 1232f Z Z-plasty, arthrofibrosis and, 1079, 1083f ... Ligament Injuries 565 N 46 26 /29 70 32 54 21 Study Kim et al19 (20 11) Geeslin & LaPrade 12 (20 11) Lee et al31 (20 11) Yoon et al67 (20 11) LaPrade et al25 (20 10) Rios et al56 (20 10) Chronic Acute and... allograft Arthroscopy 20 04 ;20 (suppl 2) :195 -20 0 22 LaPrade RF Anatomic reconstruction of the posterolateral aspect of the knee J Knee Surg 20 05;18 (2) :167-171 23 LaPrade RF Posterolateral Knee Injuries... chronic 2. 7 (2- 4.9) 2- 4 2. 9 (25 .8) 4.1 (25 .7) 3.8 (2- 7 .2) Follow-up (yr [Range]) Primary repair PL (35), allograft (tibialis anterior or tibialis posterior) reconstruction of FCL, PFL, popliteus (22 )