Der Orthopäde
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Review
[Patellofemoral pain after total knee arthroplasty: clinical pathway and review of the literature].
Total knee arthroplasty (TKA) is an operation with a high gain in quality of life. However, some patients suffer from pain, limited range of motion, instability, infections or other postoperative complications. Patellofemoral pain (PFP) in particular is a common complication after TKA and is often responsible for revision surgery. ⋯ Diagnostics and therapy of patellofemoral pain is not easy to handle and should be treated following a clinical pathway. We suggest that patients with patellofemoral pain should be classified into four groups according to the suspected diagnosis after basic diagnostic measures as 1) tenidinosis, 2) mechanical reasons, 3) intraarticular non-mechanical reasons and 4) neurogenic psychogenic reasons. Efficient application of special diagnostic measures and further therapy is facilitated by this classification.
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This case report describes an acute postoperative compartment syndrome of the lower leg following simple arthroscopy of the knee. The diagnostics as well as the time course of further therapeutic procedures are considered critically. ⋯ In summary, even with an optimal perioperative management the subsequent compartment syndrome due to knee arthroscopy cannot be avoided with any certainty. However, immediate causal therapy lies in the urgent dermatofasciotomy to prevent irreversible neuromuscular damage.
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To address recurrent patellar instability in children and young adolescents a variety of therapeutic options exist either as non-operative or operative treatment. Recent options, such as reconstruction of the medial patellofemoral ligament have evoked a new focus of attention on this topic. The intention of this article is to present diverse therapeutic options and to evaluate them by reference to the current literature.