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Biomedical subjects

A F Anderson

Publications and source records attributed to A F Anderson.

28 records · Page 2Linked to original sources
PubMedDate not supplied

Preoperative instrumented testing of anterior and posterior knee laxity.

A prospective study was performed on 50 patients who were thought or suspected to have cruciate ligament tears. Each patient had a clinical examination preoperatively and under anesthesia and instrumented examination using the MedMetric KT-1000 arthrometer, Stryker knee laxity tester, and Genucom knee analysis. The diagnosis was confirmed by arthrotomy or arthroscopy. Thirty had acute knee injuries (within 2 weeks), 9 had subacute (2 weeks to 3 months), and 11 had chronic injuries. The surgical findings demonstrated that five had other maladies, but no cruciate ligament tears. Two had a partial ACL tear, and the remaining 43 patients had at least one cruciate tear. The preoperative clinical examination for cruciate ligament integrity was completely correct in 92%, correct but incomplete in 6%, and incorrect in 2%. Examination under anesthesia was correct in 98%, the KT-1000 was correct in 75% (involved knee minus noninvolved knee was greater than or equal to 3 mm laxity equal to ACL tear), the Stryker was correct in 75%, and Genucom in 70%. The average laxity of those with ACL tears was 4.4 mm with the KT-1000, 4.6 mm with the Stryker, and 2.0 mm with the Genucom. The methods of testing with the Stryker and the KT-1000 are similar and the laxity recorded in patients with a torn ACL were almost identical. However, the KT-1000 can be used to identify the quadriceps neutral position and therefore more accurately determine PCL instability. The Genucom has the most versatility, but the laxity recorded in patients with a torn ACL was significantly lower than the other devices.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

Antegrade curettement, bone grafting and pinning of osteochondritis dissecans in the skeletally mature knee.

In the period between 1981 and 1983, we treated 40 patients who had osteochondritis dissecans of the knee. Seventeen patients were skeletally mature and had large lesions (2 to 3 cm in diameter) of the medial femoral condyle that required surgery. Each of these patients, who underwent antegrade curettement, bone grafting, and pinning, had either failed a conservative program or had a loose or separated fragment. The average age at the time of surgery was 17. Followup ranged from 5 to 7 years. Postoperative evaluation included the criteria of the Hughston et al. rating scale, subjective assessment, clinical examination, and AP, lateral, and tunnel radiographs. According to the osteochondritis dissecans rating scale described by Hughston et al., there were two excellent, nine good, five fair, no poor results, and one failure. Additional evaluation, not included in the Hughston rating scale, consisted of Cybex II muscle strength testing, strict grading of preoperative and postoperative roentgenograms for degenerative changes, and magnetic resonance imaging. Roentgenograms demonstrated that 16 of the 17 lesions healed. The average healing time was 8 months. Preoperative degenerative changes occurred frequently; postoperatively, there was some progression of these changes in the majority of cases. Magnetic resonance imaging demonstrated that the articular surface was smooth in 57% of the knees and in 43% there was some degree of irregularity. Although the integrity of the articular cartilage could be documented, magnetic resonance imaging is of questionable value in the postoperative evaluation of this condition, because the status of the articular cartilage could not be correlated with the degree of degenerative changes or results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Instrumented evaluation of knee laxity: a comparison of five arthrometers.

We performed a prospective study on 50 subjects with normal knees and 50 patients with chronic unilateral disruption of the anterior cruciate ligament. In a randomized testing sequence, both groups were examined with five arthrometers: the MEDmetric KT-1000, the Stryker Knee Laxity Tester, the Acufex Knee Signature System, the Dyonics Dynamic Cruciate Tester, and the Genucom Knee Analysis System. Each examination was performed according to protocol with the knee at 30 degrees of flexion. The total anterior laxity measurements of the normal subjects using the Dyonics Dynamic Cruciate Tester and Acufex Knee Signature System were approximately half of the KT-1000, Stryker, and Genucom values. A comparison of the side-to-side measurements revealed no statistically significant difference in the values of the five arthrometers. However, the Genucom showed an unacceptably high number of normal subjects with laxity values that suggested an anterior cruciate ligament tear. Total anterior laxity measurements of the anterior cruciate ligament deficient knees were almost twice those of normal knees with each device except the Genucom. Comparison of the mean side-to-side difference in the patients with ACL deficiency demonstrated statistically significant differences in the values recorded with the five arthrometers. The side-to-side difference was greatest with the KT-1000 and least for the KSS. In the 89 N Lachman test, the KT-1000 and Stryker demonstrated the highest diagnostic accuracy. The maximum manual test improved the accuracy of each device. This study establishes the total anterior laxity measurements cannot be generalized from one device to another in either group of subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Isolated posterior cruciate ligament reconstruction. Long-term results.

From 1973 to 1987, 28 patients seen at our institution sustained isolated posterior cruciate ligament tears. Of these 28 patients, 25 were reevaluated at an average followup of 7 years and 1 month after secondary reconstruction of the posterior cruciate ligament using the semitendinosus and gracilis tendons alone or with an extraarticular procedure. Subjectively, 22 of 25 patients related no restrictions regarding activities of daily living, with 14 of 25 patients being able to return to their previous competitive level in sports. Objective evaluation after reconstruction revealed no change in the preoperative and postoperative posterior drawer examination in 13 of 25 patients, a finding confirmed by KT-1000 arthrometer measurements. Radiographic evaluation revealed degenerative changes predominantly involving the medial and patellofemoral compartments in 15 of 25 patients. Despite optimistic subjective reporting, this long-term retrospective study reveals that this procedure inconsistently limits posterior instability and therefore cannot be recommended.

Adult↗
PubMedDate not supplied

Anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons augmented by the losee iliotibial band tenodesis. A long-term study.

Seventy patients were evaluated after combined intra- and extraarticular reconstruction of the anterior cruciate ligament. Semitendinosus and gracilis tendons were used for the intraarticular reconstruction and Losee iliotibial band tenodesis for the extraarticular procedure. Minimum followup was 5 years (average, 7). Clinical examination and instrumented ligament examination with the KT-1000 arthrometer and the Cybex II dynamometer were used to evaluate results. Subjectively, patients had no complaints of instability with daily activities; 93% had no complaints of instability with athletic participation. Clinical examination demonstrated that 81% had less than a 1 + Lachman test; 98% had a negative pivot shift. Instrumented examination of the anteroposterior limits of motion revealed that only 57% had less than 3-mm side-to-side difference; 30% had 3- to 5-mm; and 13% had 6- to 9-mm. Mean hamstring muscle strength measured with the Cybex II dynamometer was 94% at 60 and 96% at 100 deg/sec. When evaluated with the Zarins scale, 90% were rated good or excellent, 6% fair, and 4% poor. This reconstructive procedure restores functional, but not necessarily normal, stability in most anterior cruciate ligament-deficient knees. It allows patients to increase activity levels without significant risk of additional injuries.

Adult↗
PubMedDate not supplied

Arthroscopic shoulder stabilization using transglenoid sutures. A four-year minimum followup.

Thirty-seven of 41 consecutive patients with recurrent anterior instability of the shoulder were retrospectively observed for a mean of 5.6 years (range, 4 to 10) after an arthroscopic stabilization procedure had been performed. The operative technique involved the use of transglenoid sutures to repair the capsule and labrum. According to the criteria established by Rowe, 27 patients (74%) had good or excellent results, and 3 patients (7%) were graded as fair. Seven patients (19%) developed recurrent instability after the procedure and had failed results. Failure rates were equal in patients with a history of recurrent dislocation and those with recurrent subluxation. Absence of a Bankart lesion at operation was associated with postoperative instability (P = 0.03). The presence or size of humeral head defects did not influence the result. Eight of 12 athletes who engaged in sports requiring repetitive overhead shoulder motion returned to full activity, and none of the 12 developed instability after operation. Four of the 13 patients who participated in contact sports or recreational skiing developed postoperative instability (P = 0.21). All failures occurred within 2 years of the procedure.

Adolescent↗
PubMedDate not supplied

Osteochondritis dissecans of the femoral condyles. Long-term results of excision of the fragment.

Nineteen patients with 20 osteochondritis dissecans lesions were evaluated between 2 and 20 years after excision of a partially detached (grade III) or loose (grade IV) fragment from the femoral condyles. Evaluation with the Hughston rating scale for osteochondritis dissecans revealed one excellent result, four good, four fair, six poor, and five failure results. Eleven patients had developed osteochondritis dissecans before skeletal maturity. In contrast to what has been stated in the literature, the results in these patients were no better than in those who developed osteochondritis dissecans as adults. The short-term results of excision are good, but the long-term results are extremely poor. Consequently, we recommend bone grafting and replacement of the fragment when it is technically possible because the long-term results are better than those after excision.

Adolescent↗
PubMedDate not supplied

Anterior calcaneal osteotomy for symptomatic juvenile pes planus.

Five patients with symptomatic flexible pes planus unresponsive to conservative therapy underwent nine open wedge anterior calcaneal osteotomies and advancement of the posterior tibial tendon. The average follow-up was 6 years, 8 months. Three patients exhibited medial and plantar talonavicular subluxation and naviculocuneiform sag. There were three excellent results, three very good, two good, and one poor. The patient with a poor rating was asymptomatic, had normal foot motion, and was satisfied with the procedure.

Adolescent↗