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In some groups of polytrauma patients, particularly those with chest injuries, head injuries, and those with mangled extremities, early total care of major bone fractures may be potentially harmful. Delaying all orthopaedic surgery, however, is also not always the best approach. In these situations, damage control orthopaedics, which emphasizes the stabilization and control of the injury rather than repair will add little additional physiologic insult to the patient and is a treatment option that should be considered.

A prospective study was done of the use of allogeneic tissue to reconstruct the anterior cruciate ligament in knees in which an intra-articular or an extra-articular operation had failed. Sixty-six consecutive patients (sixty-six knees) had such an operation with use of bone-patellar ligament-bone allografts; all but one returned for follow-up evaluation twenty-three to seventy-eight months (mean, forty-two months) after the operation. A total of 235 previous operations had been performed in these sixty-six knees, including eighty-one procedures for rupture of the anterior cruciate ligament. The results of the allograft procedure were evaluated with a subjective and objective system that rated twenty factors. The anterior-posterior displacement was substantially improved in most of the patients. According to data derived from arthrometric studies and pivot-shift tests of the fifty-seven patients who were so evaluated and in whom the condition was unilateral, 53 per cent (thirty) of the reconstructed ligaments were determined to be functional; 21 per cent (twelve ligaments), partially functional; and 26 per cent (fifteen ligaments), a failure. When we calculated the rate of failure by including ten failures that had occurred within two years after the operation with the fifteen that occurred in patients who had been followed for at least two years, the over-all rate of failure was 33 per cent (twenty-five of seventy-five operations). There was significant improvement in the subjective ratings of functional limitations and symptoms (p < 0.01) and in the over-all rating score (p < 0.0001). However, there was a significant difference between the scores of the patients in whom the surfaces of the articular cartilage had appeared normal at the index operation and those of the patients in whom there had been noteworthy fissuring and fragmentation or exposure of subchondral bone. After the program of rehabilitation, which included immediate motion of the knee, a range of motion of 0 to 135 degrees was restored in all but five knees, four of which lacked only 5 degrees of this extent of flexion or extension. The results demonstrate that bone-patellar ligament-bone allografts may be used when proper autogenous tissues are not available and that symptoms and abnormal displacement were reduced in most of our patients.

Foreword.- Preface.- SECTION I: ETIOPATHOGENIC BASES AND THERAPEUTIC IMPLICATIONS.- Background. Patellofemoral malaligment vs Tissue homeostasis. Myths and truths about patellofemoral disease.- Pathogenesis of anterior knee pain and patellar instability. What have we learned from realignment surgery?.- Biological causes of anterior knee pain.- In search of the etiology of anterior knee pain.- Biomechanics of the patellofemoral joint. Implications in the genesis of pain and instability.- Anatomy of patellar dislocation.- Evaluation of the patient with anterior knee pain and patellar instability.- Influence of psycological factors on pain and dissability in patellofemoral pain syndrome.- Uncommon causes of anterior knee pain.- Risk factors and prevention of anterior knee pain.- Conservative treatment of athletes with anterior knee pain: science, classical and new ideas.- Conservative management of anterior knee pain: the McConnell program.- Squeletal malalignment and anterior knee pain. Rationale, diagnosis and management.- Patellar tendinopathy: Where does the pain come from?.- Pathophysiology of patellofemoral arthritis.- Prevention of anterior knee pain after anterior cruciate ligament reconstruction.- Donor-site morbidity after anterior cruciate ligament reconstruction using autografts.- SECTION II: EMERGING TECHNOLOGIES FOR INVESTIGATING PATELLOFEMORAL JOINT.- Computational modeling for investigating patellofemoral joint. Clinical relevance.- Kinetic and kinematic analysis in evaluating patellofemoral disorders.- SECTION III: CLINICAL CASES COMMENTED.- Complicated cases studies.- Failure of patellofemoral surgery. Analysis of clinical cases.- Neuromatous knee pain: Evaluation and management.- Posterior knee pain referred from the patellofemoral joint.- SECTION IV: SURGICAL TECHNIQUES.- Reconstruction of the medial patellofemoral ligament.- Reconstruction of the medial patellofemoral ligament.- Reconstruction of the lateral patellofemoral ligament.- Reconstruction of the lateral patellofemoral ligament.- Rotational osteotomy.- Trochleoplasty.- Osteotomies in patella baja / patella alta.- Arthroscopic patellar release for the treatment of patellar tendinopathy.- Anteromedial tibial tubercle osteotomy (Fulkerson osteotomy).- Autologous chondrocyte implantation.-Patellofemoral arthroplasty: Pearls and pitfalls.- EPILOGUE.

The new edition of this popular two-volume text, which was first published in 1992, is more than just an improved second edition; it is an ambitious new work. The structure is similar to that of the first edition, but it has been expanded to include 447 more pages, five more chapters, and thirty-two additional contributors (111 compared with the previous seventy-nine). The new chapters cover the evaluation of outcomes, the enhancement of fracture-healing, orthopaedic decision-making, gunshot wounds …