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Part3　RECONSTRUCTIVE PROCEDURES OF THEKNEE IN ADULTS > Chapter 9　Soft-Tissue Procedures and Osteotomies About the Knee

著者：Andrew H. Crenshaw Jr.
 
This chapter discusses the surgical treatment of nontraumatic abnormalities involving the bone, muscles, tendons, tendon sheaths, fascia, and bursae of the knee. The cause of these disorders may be degenerative, developmental, related to repetitive use, or a combination of these factors. Many of these disorders are encountered frequently in office practice, but few require surgery. Most respond favorably to treatment such as rest, application of ice or heat, elevation, and local or systemic antiinflammatory medication.

Muscle Contractures  
    Contractures can develop in almost any muscle group. The cause can be obscure, as in congenital contractures, or obvious, as in infection, ischemia, trauma, or injection myositis. Injection fibrosis most commonly occurs in the quadriceps muscle but also has been described in the gluteal, deltoid, and triceps muscles. Contractures in infants often follow intramuscular antibiotic injections. We have seen several adults with multiple areas of fibrosis and contracture after the addictive intramuscular use of the opioid pentazocine (Talwin). Oral pentazocine now comes compounded with naloxone (Talwin NX), which will cause opioid withdrawal symptoms if the pills are crushed and injected. Chronic intramuscular use of other opioid analgesics also can induce muscular fibrosis and contracture.
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