I am grateful to all of the contributors to this book on Knee Disorders, which is appropriately subtitled “Surgery, Rehabilitation, Clinical Outcomes.” The chapters reflect the writings and teachings of the scientific and clinical disciplines required for the modern treatment of clinical afflictions of the knee joint. The goal of the writers of each chapter is to present rational evidence-based treatment programs based on published basic science and clinical outcomes to achieve the most optimal outcomes for our patients.
The “KEY” to understanding the different disorders of the knee joint encountered in clinical practice truly rests on a multiple disciplinarian approach and includes a comprehensive understanding of knee anatomy, biomechanics, kinematics, and biology of soft tissue healing. Restoration of knee function then requires a precise diagnosis of the functional abnormality of the involved knee structures, a surgical technique that is precise and successful, and a rehabilitation program directed by skilled professionals to restore function and avoid complications. Each chapter follows a concise outline of indications, contraindications, physical examination and diagnosis, step-by-step open and arthroscopic surgical procedures, clinical outcomes, and analysis of relevant published studies.
The first two chapters comprise an anatomic description of the structures of the knee joint. The photographs and illustrations represent the result of many cadaveric dissections to document knee anatomic structures. It was a pleasure to have four of our fellows (class of 2008-2009) involved in these dissections which resulted in two superb instructional anatomic videos that already have received awards and are included in the DVD. Numerous anatomic textbooks and publications were consulted during the course of these dissections to provide to the best of our ability accurate anatomic descriptions, realizing there is still ambiguity in the nomenclature used for certain knee structures. Special thanks to Joe Chovan who is a wonderful and highly talented professional medical illustrator. Joe attended anatomic dissections and worked hand-in-hand with us to produce the final anatomic illustrations. Joe and I held weekly to bi-monthly long working sessions for over two years that resulted in the anatomic and medical illustrations throughout this book that are unique, highly detailed, and believed to be anatomically accurate.
All surgeons appreciate that surgical procedures come and go, replaced by newer techniques that are more successful as techniques are discarded that may have proven inadequate by long-term clinical outcome studies. I am reminded that the basic knowledge of anatomy, biomechanics, kinematics, biology, statistics, and validated clinical outcome instruments always remain as our light-posts for patient treatment decisions. For this reason, there is ample space devoted in chapters to these scientific disciplines. Equally, the description of surgical techniques is presented in a step-by-step approach, with precise details by experienced surgeons on the critical points for each surgical technique to achieve a successful patient outcome. It is hoped that surgeons in training will appreciate the necessity for the basic science and anatomic approach that, combinaed with surgical and rehabilitation principles, is required to become a true “master of knee surgery and rehabilitation”.
There is a special emphasis placed in each of the major book sections on rehabilitation principles and techniques including pre-operative assessment, postoperative protocols, and functional progression programs to restore lower limb function. We have published comprehensive rehabilitation protocols in this book that have been used and continually modified over many years which direct the postoperative treatment of our patients. My co-author on these sections, Tim Heckmann, is a superb physical therapist. We have worked together treating patients in a wonderful harmonious relationship for nearly 30 years. In addition, there are special programs for the female athlete to reduce the risk of an ACL injury. Sportsmetrics, a non-profit neuromuscular training and conditioning program developed at our Foundation, is one of the largest women's knee injury prevention programs in the United States and has been in existence for over 15 years. A number of scientists, therapists, athletic trainers, and physicians at our Foundation have been involved in the research efforts and publications of this program. All centers treating knee injuries in athletes are reminded of the importance of preventive neuromuscular and conditioning programs whose need has been well established by many published studies.
The entire staff at Cincinnati Sportsmedicine and Orthopaedic Center and the Foundation functions in a team effort, working together in various clinical, research, and rehabilitation programs. The concept of a team approach is given a lot of attention; and those who have visited our Center have seen the actual programs in place. This team effort is appreciated by all including patients, staff, surgeons, physical therapists, athletic trainers, administrative staff, and clinical research staff. Our administrative staff, directed by a superb clinical operations manager Linda Raterman, manages five major MD-PT-ATC orthopedic centers. As the President and CEO, I have been freed of many of the operational administrative duties because of this excellent staff, allowing time required for clinical and research responsibilities. I have been blessed to be associated with a highly dedicated group of orthopedic partners who, besides providing excellent patient care and lively discussions at our academic meetings, have donated a defined income “tithing” every year for funding research and clinical education programs at our Foundation.
Nearly all of the patients treated at the Knee Institute are entered into prospective clinical studies by a dedicated clinical research group directed by Sue Barber-Westin and Cassie Fleckenstein. The staff meticulously tracks patients over many years to obtain in published studies a 90 to 100% follow-up. I invite you to read the forward of Sue Barber-Westin who has performed such an admirable and dedicated job in bringing our clinical outcome studies to publication. It is only through her efforts that we have been successful in large prospective clinical outcome studies. In each chapter, the results of these outcome studies are rigorously compared with other authors' publications. The research and educational staff work with fellows and students from many different disciplines including physicians, therapists, trainers and biomedical students. There have been 125 Orthopedic and Sportsmedicine Fellows who have received training at our Center. The scientific contribution of fellowship research projects are acknowledged numerous times in the chapters. Our staff enjoys the mentoring process and from a personal note, this has been one of my greatest professional joys.
In regard to mentoring, one might ask where the specialty of orthopedics (or any medical specialty) would be today without the professional mentoring “system” that trains new surgeons and advances our specialty, providing for a continuum of patient treatment approaches and advances. The informal dedication of the teacher to the student, often providing wisdom and guidance over many years, is actually contrary to capitalistic principles as the hours of dedication are rarely if ever compensated. It is the gift from one generation to another and I mention this specifically as I hope that I have been able to repay in part the mentors who provided this instruction and added time and interest for my career. I graduated from the University of Utah with a philosophy degree which provided an understanding of the writings and wisdom of the great scientists and “thinkers” of our times, taught by superb educators in premedical courses and philosophy. I received an M.D. degree from George Washington University and am thankful to the dedicated teachers who laid a solid medical foundation for their students and taught the serious dedication and obligation that physicians have in treating patients. I was fortunate to be accepted for internship and residency at the University of Michigan and remember the opportunity to be associated with truly outstanding clinicians and surgeons. Under the mentorship of the chairman William S. Smith, M.D., I and my fellow residents knew one of the finest orthopedic surgeons and dedicated teachers one could be associated with who was a truly humble man that inspired decades of orthopedic residents. Many graduates of this program have continued as orthopedic educators and researchers, which is a great tribute to Bill Smith and his mentorship. My fellow residents remember one of his many favorite sayings provided to remind residents of the need for humility. After a particularly enthusiastic lecture or presentation by a prominent surgeon and glowing statements of admiration, Bill Smith would say with a wink and smile, “He puts his pants on one leg at a time just like you do”.
After orthopedic residency, I accepted a four-year combined clinical and research biomechanics position at the Aerospace Medical Research Laboratories with the United States Air Force in Dayton, Ohio. The facilities and veterinary support for biomechanical knee studies were unheralded and it was here that some of the first high strain-rate experiments on mechanical properties of knee ligaments were performed using the unique laboratory testing equipment available. I am indebted to Victor Frankel and Albert Burstein, the true fathers of biomechanics in the United States, as they guided me in these formative years of my career. I was particularly fortunate to have a close association with Al Burstein who mentored me in the discipline of orthopedic biomechanics. This research effort also included professors and students at the Air Force Institute of Technology. I am grateful to all of them for instructing me in the early years of my research training. As biomechanics was just in its infancy, it was obvious that substantive research was only possible with a combined MD-PhD team approach.
One of the most fortunate blessings in my professional life is the relationship I have had with Edward S. Grood, Ph.D. I established a close working relationship with Ed nd we currently have the longest MD-PhD (or PhD-MD) team that I know of which is still active today as we conduct the next round of knee ligament function studies using sophisticated three-dimensional robotic methodologies. We worked together in establishing one of the first Biomechanical and Bioengineering programs in the country at the University of Cincinnati College of Engineering, and I greatly appreciated that it was named the Noyes Biomechanics and Tissue Engineering Laboratory. This initial effort expanded with leadership and dedicated faculty and resulted in a separate Bioengineering Department within the College of Engineering with a complete program for undergraduate and graduate students. Dr. Grood pioneered this effort with other faculty and developed the educational curriculum for the five-year undergraduate program. Many students of this program have completed important research advances that are referenced in this book. David Butler, Ph.D. joined this effort in its early years and contributed important and unique research works that are also credited throughout the chapters. This collaborative effort of many scientists and physicians resulted in three Kappa Delta awards, the Orthopedic Research and Education Clinical Research award, AOSSM Research Awards, and the support of numerous grants from NIH, NSF, and other organizations. Thomas Andriacchi, Ph.D. collaborated on important clinical studies that provided an understanding of joint kinematics and gait abnormalities. It has been an honor to have Tom associated with our efforts throughout the years.
My finest mentors were my parents, a dedicated and loving father, Marion B. Noyes, M.D. who was a true renaissance surgeon entirely comfortable doing thoracic, general surgery, and orthopedics and who, as Chief Surgeon, trained decades of surgical residents. Early in my life, I read through classic Sobotta anatomic textbooks and orthopedic textbooks which remain in my library with his writings and notations along side. Later in my training, I was fortunate to scrub with him on surgical cases. My loving mother, a nurse by training, was truly God's gift to our family for many generations as she provided unqualified love and sage and expert advice to our entire family with knowledge, wisdom, and the admiration of all of us living into her nineties. She expected excellence, performance, and adherence to a rigorous value system. These are also the attributes of the most wonderful gift of all, the opportunity to go through life with a loving and true soul mate, my wife JoAnne Noyes that I remain eternally grateful and devoted. Our family includes a fabulous daughter and son-in-law, two wonderful grandchildren, my devoted son who graduated in Physics and mentors me in nuclear and atomic matters outside my reach, and a third wonderful and dedicated son and daughter-in-law with three additional grand-children. Together, with JoAnne and all our brothers and sisters, we enjoy wonderful family events together. As I look back on my career, it is the closeness of family and friends that has provided the greatest enrichment.
In closing I wish to specially thank Kim Murphy, the Publishing Director of Elsevier and their staff who are true professionals and were a joy to work with in completing this textbook. Given all the decisions that must be made in bringing a textbook to publication, at the end of the process the Elsevier team made everything work in a harmonious manner always striving for the highest quality possible.
-- Author --
Key Features
- Presents step-by-step descriptions on the full range of complex soft tissue knee repair and reconstruction for anterior cruciate ligament reconstruction, meniscus repair, soft tissue transplants, osseous malalignments, articular cartilage restoration, posterior cruciate ligament reconstruction, and more to provide you with guidance for the management of any patient.
- Relies on Dr. Noyes’ meticulous clinical studies and outcomes data from peer-reviewed publications as a scientifically valid foundation for patient care.
- Features detailed post-operative rehabilitation programs and protocols so that you can apply proven techniques and ease your patients’ progression from one phase to the next.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
- Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation.
- Videos: View video clips illustrating a variety of conditions.
Contents
Section I - Knee Anatomy
- Chapter 1 - Medial and Anterior Knee Anatomy
- Chapter 2 - Lateral, Posterior, and Cruciate Knee Anatomy
Section II - Classification and Biomechanics
- Chapter 3 - The Scientific Basis for Examination and Classification of Knee Ligament Injuries
- Chapter 4 - Knee Ligament Function and Failure
Section III - Anterior Cruciate Ligament
- Chapter 5 - Biology of Anterior Cruciate Ligament Graft Healing
- Chapter 6 - Human Movement and Anterior Cruciate Ligament Function: Anterior Cruciate Ligament Deficiency and Gait Mechanics
- Chapter 7 - Anterior Cruciate Ligament Primary and Revision Reconstruction: Diagnosis, Operative Techniques, and Clinical Outcomes
- Chapter 8 - Graft Options for Anterior Cruciate Ligament Revision Reconstruction
- Chapter 9 - Allografts: Graft Sterilization and Tissue Banking Safety Issues
- Chapter 10 - Scientific and Clinical Basis for Double-Bundle Anterior Cruciate Ligament Reconstruction in Primary and Revision Knees
- Chapter 11 - Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients
- Chapter 12 - Scientific Basis of Rehabilitation after Anterior Cruciate Ligament Autogenous Reconstruction
- Chapter 13 - Rehabilitation of Primary and Revision Anterior Cruciate Ligament Reconstructions
- Chapter 14 - Neuromuscular Retraining after Anterior Cruciate Ligament Reconstruction
Section IV - Gender Disparity in Anterior Cruciate Ligament Injuries
- Chapter 15 - Risk Factors for Anterior Cruciate Ligament Injuries in the Female Athlete
- Chapter 16 - Lower Limb Neuromuscular Control and Strength in Prepubescent and Adolescent Male and Female Athletes
- Chapter 17 - Differences in Neuromuscular Characteristics between Male and Female Athletes
- Chapter 18 - Gender Differences in Muscular Protection of the Knee
- Chapter 19 - Decreasing the Risk of Anterior Cruciate Ligament Injuries in Female Athletes
Section V - Posterior Cruciate Ligament and Posterolateral Ligament Structures
- Chapter 20 - Function of the Posterior Cruciate Ligament and Posterolateral Ligament Structures
- Chapter 21 - Posterior Cruciate Ligament: Diagnosis, Operative Techniques, and Clinical Outcomes
- Chapter 22 - Posterolateral Ligament Injuries: Diagnosis, Operative Techniques, and Clinical Outcomes
- Chapter 23 - Rehabilitation of Posterior Cruciate Ligament and Posterolateral Reconstructive Procedures
Section VI - Medial Collateral Ligament
- Chapter 24 - Medial and Posteromedial Ligament Injuries: Diagnosis, Operative Techniques, and Clinical Outcomes
- Chapter 25 - Rehabilitation of Medial Ligament Injuries
Section VII - Dislocated Knees and Multiple Ligament Injuries
- Chapter 26 - Classification of Knee Dislocations
- Chapter 27 - Management of Acute Knee Dislocation before Surgical Intervention
Section VIII - Meniscus
- Chapter 28 - Meniscus Tears: Diagnosis, Repair Techniques, and Clinical Outcomes
- Chapter 29 - Meniscus Transplantation: Diagnosis, Operative Techniques, and Clinical Outcomes
- Chapter 30 - Rehabilitation of Meniscus Repair and Transplantation Procedures
Section IX - Lower Extremity Osseous Malalignment
- Chapter 31 - Primary, Double, and Triple Varus Knee Syndromes: Diagnosis, Osteotomy Techniques, and Clinical Outcomes
- Chapter 32 - Valgus Malalignment: Diagnosis, Osteotomy Techniques, and Clinical Outcomes
- Chapter 33 - Rehabilitation after Tibial and Femoral Osteotomy
- Chapter 34 - Correction of Hyperextension Gait Abnormalities: Preoperative and Postoperative Techniques
Section X - Articular Cartilage Procedures and Rehabilitation of the Arthritic Knee
- Chapter 35 - Autologous Chondrocyte Implantation
- Chapter 36 - Osteochondral Grafts: Diagnosis, Operative Techniques, and Clinical Outcomes
- Chapter 37 - Rehabilitation after Articular Cartilage Procedures
- Chapter 38 - Aquatic Therapy for the Arthritic Knee
Section XI - Patellofemoral Disorders
- Chapter 39 - Operative Options for Extensor Mechanism Malalignment and Patellar Dislocation
- Chapter 40 - Patellofemoral Disorders: Correction of Rotational Malalignment of the Lower Extremity
Section XII - Postoperative Complications
- Chapter 41 - Prevention and Treatment of Knee Arthrofibrosis
- Chapter 42 - Knee Pain of Neural Origin
- Chapter 43 - Diagnosis and Treatment of Complex Regional Pain Syndrome
Section XIII - Knee Rating Outcome Instruments
- Chapter 44 - The Cincinnati Knee Rating System
- Chapter 45 - The International Knee Documentations Committee Rating System
- Chapter 46 - Rating of Athletic and Daily Functional Activities after Knee Injuries and Operative Procedures
- Chapter 47 - Articular Cartilage Rating Systems
About the Author
- Frank R. Noyes, MD, President, Cincinnati Sportsmedicine Research and Education Foundation, Chairman and Medical Director, Cincinnati Sportsmedicine and Orthopaedic Center; Clinical Professor, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine; Adjunct Professor, Noyes Tissue Engineering and Biomechanics Laboratory, Department of Biomedical Engineering, University of Cincinnati College of Engineering, Cincinnati, Ohio.
Book Reviews
This book details the approaches Dr. Noyes has developed to the diagnosis and treatment of knee disorders, along with the scientific foundations on which his approaches are based. The result is a valuable reference book for both physicians and physical therapists who care for patients with knee disorders. The inclusion of supporting basic science data also makes this book an excellent reference for any investigator or student who is interested in improving the care provided patients with knee disorders by further advancing knowledge of the normal and pathologic knee.
Although the title is “Noyes' Knee Disorders”, and the content in large part reflects his clinical approaches and research, it also includes the clinical approaches and research results of other leading surgeons and physical therapists. There is, however, a common thread in that the clinical approaches presented include the scientific foundations on which they are based. Further, the reader will find that the chapters that present the research of Dr. Noyes and his colleagues also include results of other leading scientific investigators. The studies included were selected to fill in gaps and provide a broader perspective in areas where a consensus has not yet been developed.
The quality of the content of this book is complimented by the quality of its production. Each chapter has “Critical Points” sections that focus the reader's attention on the main walk-away messages. There has been extensive use of color to enhance readability, particularly in the presentation of data. Great care has been taken to make the anatomical drawings and medical illustrations accurate and to carefully label all illustrations and photographs. The care put into the production by the publisher reflects the high standard and care Dr. Noyes brings to those projects he undertakes, including the care delivered to his patients and his dedication to advancing care through carefully conducted basic science and clinical research studies. While one result of the publisher's and Dr. Noyes' efforts is the book's visual appeal, it was not the goal. Rather, the visual appeal is a by-product of their efforts to provide the reader a useful text in which the content is easily understood and accessible to the reader.
This book presents much of the research conducted by Dr. Noyes and his collaborators, including much of my own research. I would like to take this opportunity to express my appreciation and gratitude to Frank Noyes for the opportunity of collaboration, for the time and energy he has devoted to our collaboration, and to the significant financial support he and his partners have provided our research. I first met Frank in 1973 when he was stationed with the 6570th Aerospace Medical Research Laboratory, located at Wright Patterson Air Force base just outside Dayton, OH. I had recently received my PhD and was working at the University of Dayton Research Institute. It was there we met thanks to the efforts of a mutual friend and colleague George “Bud” Graves. It was also in Dayton we did our first collaborations that led to our paper on the age-related strength of the anterior cruciate ligament. In 1975 we moved to the University of Cincinnati, thanks to the encouragement of Edward Miller, M.D., then Head of the Division of Orthopaedics at the University of Cincinnati. This move was made possible by the generosity of Nicholas Giannestras, M.D. and many other orthopaedic surgeons in the community who provided support to initiate a Biomechanics Laboratory. It was in Cincinnati where we initiated our first study on whole knee biomechanics and designed and initiated our studies on primary and secondary ligamentous restraints. We were fortunate to have David Butler join our group in late 1976 and complete the study in progress on the ACL and PCL restraints, a study for which he later received the Kappa Delta Award.
In addition to working with excellent colleagues, I have been fortunate to work with many engineering students, orthopaedic residents, post-doctoral students, sports medicine fellows, and visiting professors. Without their combined intellectual contribution and hard work, I would not have been able to have completed many of the studies which are included in this text. They all have my sincerest appreciation for their support and contributions.
-- By Edward S. Grood, PhD, Director, Biomechanics Research, Cincinnati Sportsmedicine Research and Education Foundation; Professor Emeritus, Department of Biomedical Engineering, Colleges of Medicine and Engineering, University of Cincinnati, Cincinnati, Ohio.
Product Details
- Hardcover: 1176 pages
- Publisher: Saunders; 1 Har/DVD/ edition (September 18, 2009)
- Language: English
- ISBN-10: 141605474X
- ISBN-13: 978-1416054740
- Product Dimensions: 11.2 x 8.8 x 2.1 inches
List Price: $330.00