This thesis offers an overview of the length changes and isometry of the most frequently performed ligament reconstructions of the knee joint. The primary goal of this thesis was to improve our... Show moreThis thesis offers an overview of the length changes and isometry of the most frequently performed ligament reconstructions of the knee joint. The primary goal of this thesis was to improve our knowledge about the complex function of the anatomical ligaments of the knee. To study the length changes and isometry of the ligaments of the knee, we used a noninvasive imaging methodology to capture the in vivo biomechanics. Dual fluoroscopy was used to capture the in vivo joint motion and was combined with magnetic resonance (MR) or computed tomography (CT) imaging that were used to reconstruct the bony anatomy of the knee. To overcome the knee-to-knee differences, a quadrant method was used to apply the anatomical attachments of the ligaments to the 3-dimensional knee models. We studied the length changes and isometry of 1. anatomical anterior cruciate ligament and several locations on the medial aspect of the lateral femoral condyle to the anterior cruciate ligament attachment on the tibia; 2. the posterior cruciate ligament and several locations on the lateral aspect of the medial femoral condyle to the tibial attachment of the posterior cruciate ligament; 3. the anterolateral ligament and several locations on the lateral aspect of the lateral femoral condyle connected to the anatomic attachment of the anterolateral ligament on the tibia and Gerdy’s tubercle; and 4. The medial patellofemoral ligament and several locations on the medial aspect of the medial femoral condyle to the patellar medial patellofemoral ligament attachment. Optimal areas for the aforementioned ligaments of the knee were described. This newly gathered knowledge could improve the contemporary ligament reconstructions of the knee to reduce the amount of failed grafts related to tunnel malpositioning. Show less
In this thesis first we show that patients after total hip replacement are more satisfied than patients after total knee replacement (TKR). The indication to perform TKR is important. We studied... Show moreIn this thesis first we show that patients after total hip replacement are more satisfied than patients after total knee replacement (TKR). The indication to perform TKR is important. We studied the reason for orthopedic surgeons to recommend TKR. It seemed that the radiological osteoarthritis and age were most important. We compared Dutch orthopedic surgeons with those from other countries. Also we studied how well the oldest old patients (85+) perform with or without total joint replacement. In part 2 of the thesis more technical issues are addressed. A RCT studying the effect of fibrin sealant on postoperative knee function. No beneficial effect could be shown for the fibrin sealant. A Cochrane review and meta-analysis studying whether to sacrifice or retain the posterior cruciate ligament in TKR. It seemed there was no clinical difference between the two. Finally a RCT studying two different kinds of warming blankets applied during total joint replacement showed no evident difference between the two. Show less
