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Biomedical subjects

Amol Saxena

Publications and source records attributed to Amol Saxena.

17 recordsLinked to original sources
PubMed2006

Navicular stress fractures: a prospective study on athletes.

BACKGROUND: Navicular stress fractures of the foot often are difficult to diagnose and treat. METHODS: Nineteen athletic patients seen from 1999 to 2003, were compared to a previously treated group of 22 athletes with similar injuries treated from 1994 to 1998. Based on the frontal plane CT images, a previously described classification system was used to assess the injury: type I dorsal cortical break; type II fracture extending into the navicular body; and type III fracture breaches two cortices. Nonoperative treatment was recommended for patients with type I injuries and open reduction and internal fixation (ORIF) were recommended for those with type II and III injuries. The time to return to activity and ability to return to competition were assessed, along with differences between fracture type and gender. RESULTS: Return to activity (RTA) was 4.0 months for the entire group. RTA for type I (four injuries), type II (eight injuries), and type III (seven injuries) was 3.8, 3.7, and 4.2 months, respectively. Fifteen of 16 competitive athletes returned to full competition, including all who had ORIF. CONCLUSIONS: Navicular stress fractures can take 4 months to heal with nonoperative or operative treatment. Surgery should be considered for more severe injuries, which can be assessed by CT scan.

Adolescent↗
PubMed2004

Pigmented villonodular synovitis about the ankle: a review of the literature and presentation in 10 athletic patients.

BACKGROUND: Pigmented villonodular synovitis (PVNS) is relatively uncommon. The disorder results in increased proliferation of synovium causing villous or nodular changes of synovial-lined joints, bursae and tendon sheaths. This study examines the occurrence of PVNS about the ankle and its association with trauma. METHODS: Ten patients over a 10-year period were identified as having PVNS of the ankle. The average age was 40.2 (range 27 to 62) years. There were four women and six men. Average followup was 4.5 (range 1 to 11) years from the initial surgery. Four patients had bone involvement. All patients who were athletically active before symptoms arose complained of persistent pain and swelling in the lateral ankle. Their initial clinical symptoms were indistinguishable from commonly associated pathologies with persistent lateral ankle pain (i.e. tenosynovitis, osteochondral defects, os trigonum injury, and tendon tears). All patients had magnetic resonance imaging (MRI) revealing PVNS, which is represented by low-signal appearing masses on T1- and T2-weighted images. All patients' histopathology results revealed multinucleated giant cells and foam cells laden with hemosiderin deposits. All patients had synovectomy and tenosynovectomy. RESULTS: Eight patients were able to return to some sports (range 4 to 12 months); two had continued pain, disability, and inability to return to sports because of recurrence. CONCLUSIONS: PVNS should be considered in athletically active patients with persistent lateral ankle pain and swelling, particularly if bone erosions are visible on plain radiographs.

Adult↗
PubMed2004

Uniportal endoscopic plantar fasciotomy: a prospective study on athletic patients.

BACKGROUND: Endoscopic techniques have been described to surgically treat plantar fasciitis in the general patient population. A prospective, single-surgeon study was conducted to evaluate if a uniportal endoscopic plantar fasciotomy technique is effective in allowing athletic patients to return to their desired activities. METHODS: Sixteen patients with plantar fasciitis who were athletically active were compared to a control group that consisted of 10 patients who did not engage in sports. Most of the athletic patients were runners. Mean age at time of surgery was 39.8 +/- 13.1 years for the athletic group and 51.2 +/- 5.5 years for the control group (p < .01). All patients had conservative treatment for a minimum of 8 months (mean 19.4 months; range 8 to 50). All patients were rated for body mass index (BMI), and the Modified Plantar Fascia Score (MPFS) was obtained before and after endoscopic release. The preoperative MPFS was 42.0 +/- 2.5 for the athletic group and 23.6 +/- 15.7 for the control group (p < .01). All patients had uniportal endoscopic plantar fasciotomy with transection of the medial 50% of the plantar fascia. Postoperatively patients were kept in a low, below-knee, removable cast-boot for a total of 4 weeks, nonweightbearing for the first 2 weeks. RESULTS: The mean return-to-activity time after surgery was 2.6 +/- 0.7 months. The mean postoperative MPFS was 93.3 +/- 2.4, which was a significant improvement (p = .00001). Using this scoring system score, all results in athletes were excellent or good. The control group had a mean postoperative MPFS of 63.6 +/- 27.1, also significantly improved (p = .0006) but lower than the athletic group (p = .00001). All five poor results in the controls had a BMI of more than 27. Good or excellent results in the control group were obtained only in patients who walked for exercise. The BMI was statistically lower in the athletic group than in the control group (p = .00001). The average BMI in women was significantly higher (p = .02) than in men, and they required a longer time to return to activity (p = .01). CONCLUSION: Athletic patients undergoing uniportal endoscopic plantar fasciotomy can expect good to excellent results based on the MPFS. Fifty percent of the patients with a BMI of more than 27 had poor results.

Adult↗
PubMed2003

Return to activity after sesamoidectomy in athletically active individuals.

Sesamoidectomy of the first metatarsophalangeal joint in athletically active patients may be indicated in cases of chronic sesamoiditis resistant to nonsurgical care or symptomatic displaced fractures or nonunion. Painful scar, hallux deviation, and delayed return to activity are all potential complications. These need to be considered especially when performing surgery in the athletically active individual. Twenty-six sesamoidectomies in 24 patients (21 females and 3 males) were reviewed for type of sesamoidectomy, incision location, time to return to activity, and complications. Mean age was 35.4 years (range, 16-68 years) with mean follow-up 86.4 months. Eleven athletes (defined as professional or varsity level sports) operated on had a mean return to activity of 7.5 weeks (range, 4-10 weeks), while 13 "active" patients had a mean return to activity of 12.0 weeks. This difference was statistically significant using the t-test, (p < .02). There were 10 fibular and 16 tibial sesamoids excised. Complications included one hallux varus and two cases of postoperative scarring with neuroma-like symptoms, all associated with fibular sesamoidectomy; there was one case of hallux valgus deformity with tibial sesamoidectomy. Despite the functional importance of tibial and fibular sesamoids, athletically active individuals can return to sports after a sesamoidectomy as early as 7.5 weeks.

Adolescent↗
PubMed2003

Results of chronic Achilles tendinopathy surgery on elite and nonelite track athletes.

Twenty-seven track athletes/runners with chronic Achilles tendinopathy underwent a retrospective review of 37 surgical Achilles procedures performed between 1990 and 1999. There were 22 males and 5 females. Average age of the group was 36.6 years (range, 16-75 years). The mean "return to activity" (RTA) was 10.6 +/- 6.3 weeks. For elite athletes, RTA was 7.9 = 4.8 weeks. For nonelite athletes, RTA was 15.0 +/- 6.2 weeks, and was statistically higher (p = .003). There was no significant difference between males' and females' RTA. Average follow-up for the group was 4.7 years (range, 1-10 years). Runners on average ran more than 60 miles a week. There were 14 elite and 13 nonelite athletes, including four Olympians, five sub-4-minute milers, and four National Champions. Return to competition and "100%" were 25.0 and 25.4 weeks, respectively, for the elite group. Return to competition for the nonelite group was 27.0 +/- 11.0 weeks. Eighteen patients underwent peritenolysis with a mean RTA of 7.7 weeks. Of this group, four patients with concomitant bony procedures had significantly slower RTA as opposed to the 14 patients who had peritenolysis only (mean, 4.5 weeks). Four patients had Achilles debridement for mucoid degeneration, and a mean RTA of 12.8 weeks. Eleven patients had Haglund-type procedure (retrocalcaneal exostectomy) had a mean RTA of 15.1 weeks. Six Achilles tendocalcinosis repair patients had a mean RTA of 12.0 weeks. There were three reoperations, two of which were performed by the author. Using the Testa Achilles tendon surgery rating scale, this group of patients had 34 "excellent" and 3 "good" results. The patients who underwent a reoperation were able to achieve "good" or better results.

Achilles Tendon↗
PubMedDate not supplied

Peroneal tendon injuries: an evaluation of 49 tears in 41 patients.

Forty-one patients sustaining 49 tears of the peroneal tendons were evaluated prospectively a minimum of 1 year after surgical treatment. Preoperative and postoperative function and activity were assessed by using the American Orthopedic Foot and Ankle (AOFAS) score. Mean age at the time of surgery was 44.0 +/- 11.7 years. Mean follow-up after the index surgery was 35.5 +/- 22.2 months. There were 17 women and 24 men. One woman had bilateral surgery 1 year apart. There were a total of 18 tears of the peroneus longus tendon; 11 of these were isolated, whereas 7 had a combined tear with peroneus brevis. There 31 peroneus brevis tears; 24 of these were isolated and 7 were combined. Using 3-way analysis of variance, there were no significant differences in return to activity or postoperative AOFAS scores among those with a longus, brevis, or combined tear. The mean return to activity for peroneus longus, peroneus brevis, and combined tears were 3.2, 3.6, and 3.7 months, respectively. The mean postoperative AOFAS scores were 90.6, 90.8, and 84.3 respectively. The mean preoperative AOFAS score was 52.0 +/- 16.8. The mean postoperative score was 89.7 +/- 10.3 (P <.00001). Using this scoring system, there were 24 excellent, 12 good, 4 fair, and 2 poor scores. Three patients underwent additional surgery. Fourteen of 16 athletes returned to full sporting level. The average return to activity for the entire group was 3.49 +/- 1.15 months.

Adult↗
PubMedDate not supplied

Endoscopic gastrocnemius recession: preliminary report on 18 cases.

A technique of endoscopic gastrocnemius recession was evaluated. Fifteen patients undergoing 18 procedures were prospectively studied with a minimum follow-up of 1 year. There were 9 women and 6 men (mean age, 44.1 +/- 22.6 years). One patient had an isolated recession; the others had various adjunctive flatfoot or reconstructive procedures. Pre- and postoperative ankle dorsiflexion was evaluated, as was the amount of time before patients could perform a single-leg heel raise postoperatively. The mean preoperative ankle dorsiflexion with the knee extended was -8.7 degrees +/- 3.5 degrees , which improved from a mean 14.9 degrees at 3 months postoperatively to a mean 6.2 degrees +/- 2.6 degrees . At 12 months postoperatively, this value was 3.6 degrees +/- 1.8 degrees , a net postoperative improvement of 12.6 degrees (P < .00001). Patients were able to perform a single-leg heel raise on an average of 13.0 +/- 6.0 weeks. Complications were mostly related to lateral foot dysesthesia in the distribution of the sural nerve (N = 3). Furrowing of the medial leg was noted in 1 patient. No hematomas or neuromas associated with the portal sites were found. These results show endoscopic gastrocnemius recession to be an acceptable method of lengthening the gastrocnemius complex.

Adolescent↗
PubMedDate not supplied

Implantable electrical bone stimulation for arthrodeses of the foot and ankle in high-risk patients: a multicenter study.

This study assessed arthrodesis procedures performed in the foot and ankle of high-risk patients following implantation of an internal electrical bone stimulator. Criteria defining patients as "high risk" included diabetes, obesity, habitual tobacco and/or alcohol use, immunosuppressive therapy, and previous history of nonunion. Standard arthrodesis protocol of bone graft and internal fixation was supplemented with the implantable electrical bone stimulator. A retrospective, multicenter review was conducted of 26 patients (28 cases) who underwent 28 forefoot and hindfoot arthrodeses from 1998 to 2002. Complete fusion was defined as bony trabeculation across the joint, lack of motion across the joint, maintenance of hardware/fixation, and absence of radiographic signs of nonunion or pseudoarthrosis. Radiographic consolidation was achieved in 24 of the 28 cases at an average 10.3+/-4.0 weeks. Followup averaged 27.2 months. Complications included 2 patients who sustained breakage of the cables to the bone stimulator. Five patients underwent additional surgery. Four of the 5 patients had additional surgery in order to achieve arthrodesis. All 4 went on to subsequent arthrodesis. This study demonstrates how arthrodesis of the foot and ankle may be enhanced by the use of implantable electrical bone stimulation.

Adult↗
PubMedDate not supplied

Bioabsorbable screws for reduction of Lisfranc's diastasis in athletes.

This was a study of 15 athletes who sustained Lisfranc's diastasis and were treated with surgical reduction and fixation with 3.5mm bioabsorbable poly-L lactic acid screws. Patients were prospectively evaluated for their ability to return to activity, maintenance of reduction, and need for implant removal. The average patient age was 28 years; there were 9 females and 6 males. Average followup was 36 months (range: 12-62). The mean return to activity time was 4.2 months (range: 3-6), with a significant difference between males and females (P=.02), 3.4 versus 4.7 months, respectively. The mean preoperative American Orthopedic Foot and Ankle Society midfoot score was 35.4+/-25.0, which increased postoperatively to 92.7+/-7.7 (P=.00001). Overall there were 10 "excellent," 4 "good," and 1 "poor" result. Patients were statistically more likely to have less than an excellent result when diagnosis was delayed by more than 6 weeks (P=0.01). One patient demonstrated a radiographic loss of reduction but returned to full sports activities. The patient with the longest delay in diagnosis demonstrated anatomic reduction but exhibited radiographic degenerative changes and scored a poor result. Three patients required a second surgery for screw or screw head removal. Bioabsorbable screws appear sufficient for treating Lisfranc's diastasis but do not necessarily obviate fixation removal.

Absorbable Implants↗
PubMedDate not supplied

Plantar fascia ruptures in athletes.

OBJECTIVE: To educate sports medicine practitioners as to length of time for an athlete to return to activity after sustaining a rupture of the plantar fascia. METHODS: Athletic patients sustaining plantar fascia ruptures and subsequent treatment were reviewed. Diagnosis was based on clinical findings, although radiographic studies were done. Patients were treated for 2 to 3 weeks with a below-knee or high-top boot, nonweightbearing, with an additional 2 to 3 weeks of weightbearing in the boot. Patients used physical therapy. RESULTS: Eighteen athletes, including 6 elite athletes, were evaluated. Mean age was 40.9 +/- 13.2 years. There were 12 males and 6 females. Mean postinjury follow-up was 42 months. Duration of prior plantar fascia symptoms ranged from 0 to 52 weeks. All but 2 ruptures were of the medial portion. Four patients had injections prior to rupture. Five patients wore orthoses preinjury; 14 wore orthoses postinjury. All patients returned to activity after 2 to 26 weeks (mean, 9.1 +/- 6.0 weeks). Running athletes predominantly composed the cohort; others played tennis, volleyball, and basketball. CONCLUSION: Using the treatment protocol, patients sustaining plantar fascia rupture can achieve favorable results with complete return to activity. None of the 18 patients sustained reinjury, had postinjury sequelae, or necessitated surgery, contrary to other studies.

Adult↗
PubMedDate not supplied

Tarsal coalitions. Activity levels with and without surgery.

This study compares activity levels of patients with tarsal coalitions who did and did not have surgery and quantifies the return-to-activity time after tarsal coalition surgery. Thirty-one patients (mean +/- SD age, 22.1 +/- 11.6 years) with 39 coalitions (28 talocalcaneal, 1 complete talonavicular, and 10 calcaneonavicular) were included. The mean postoperative review time was 3 years. Fifteen patients (17 feet) who underwent resection had a mean +/- SD return-to-activity time of 10.3 +/- 5.8 weeks. There was no statistically significant difference in the return-to-activity time between talocalcaneal and calcaneonavicular coalitions. Thirteen patients (21 feet) quit sports; 11 (17 feet) were from the nonsurgical group. Three nonsurgical patients continued playing sports. The Fisher exact test was used to determine whether those forgoing surgery had a decreased ability to achieve desired activity levels. The correlation of surgery and failure to achieve the desired activity level was low (-0.69). Therefore, tarsal coalition excision is not correlated with failure of patients to reach desired activity levels. Patients forgoing surgery could not reach desired activity levels. Surgical excision of tarsal coalitions has a favorable outcome.

Adolescent↗
PubMedDate not supplied

The effect of foot orthoses on patellofemoral pain syndrome.

In a retrospective review of 102 patients treated for chondromalacia pa-tellae and patellofemoral pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthoses was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved and 2% were asymptomatic, showing a significant decrease in the level of pain with orthoses intervention (chi-square P <.001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD.

Adolescent↗
PubMedDate not supplied

Peroneal tendon abnormalities. A review of 40 surgical cases.

The authors reviewed data from 40 peroneal tendon surgeries performed on 39 patients (25 males and 14 females) between 1991 and 1999. Patients underwent tendon repair, subluxation repair, and/or accessory ossicle and muscle excisions. Some patients underwent more than one procedure, including eight undergoing ankle stabilizations. Preoperatively and postoperatively, the American Orthopaedic Foot and Ankle Society ankle-hindfoot score was assessed. Average preoperative and postoperative ankle-hindfoot scores were 61.6 (range, 19 to 72) and 91.4 (range, 63 to 100), respectively. Mean group return-to-activity time, defined as initiation of regular activity, including sports, was 3.2 months (range, 1 to 6 months). There were 17 athletes and 22 active patients; no patients were sedentary. Magnetic resonance imaging was used to evaluate peroneal tendon pathology in 29 patients. Sensitivity was 82.7%; specificity, 50%; and positive predictive value, 100%. Overall results were excellent in 25 cases, good in 12, fair in 1, and poor in 2. A paired t-test showed that patients with previous steroid injections had statistically poorer results. Patients with symptoms for more than 12 months also had poorer outcomes.

Adolescent↗
PubMedDate not supplied

Surgery for chronic Achilles tendinopathy. Review of 91 procedures over 10 years.

The authors reviewed 91 surgical procedures in 87 patients with chronic Achilles tendinopathy. There were 62 males and 25 females (mean age, 44.9 years). The average interval between surgery and review for the group was 4.2 years (range, 1 to 10 years). Twenty patients underwent peritenolysis, with a mean return-to-activity time of 7.7 weeks. Four patients with concomitant bony procedures had significantly longer return-to-activity times than 16 patients who underwent peritenolysis only. The mean return-to-activity time was 13.2 weeks in 15 patients who had Achilles debridement for mucoid degeneration, 14.4 weeks in 32 Achilles tendocalcinosis repair patients, 18.6 weeks in 24 patients who had retrocalcaneal exostectomy procedures, and 34.0 weeks in 5 patients who had chronic Achilles rupture repair. Athletic patients (n = 47) had significantly shorter return-to-activity times than active (n = 38) and sedentary (n = 6) patients. Males returned to activity faster than females. Runners returned to activity faster than other patients.

Achilles Tendon↗
PubMedDate not supplied

Ankle dorsiflexion in adolescent athletes.

Ankle equinus has been proposed to be associated with lower-extremity pathology. Physiologically normal measurements have been quantified in various populations. Forty high-school athletes (16 girls and 24 boys) without a history of ankle injury had ankle dorsiflexion measured with the knee extended and flexed by an experienced evaluator using a goniometer with the subjects supine. The group mean +/- SD dorsiflexion for the right ankle was 0.35 degrees +/- 2.2 degrees with the knee extended and 4.88 degrees +/- 3.23 degrees with the knee flexed. The values for the left ankle were -0.6 degrees +/- 2.09 degrees and 4.68 degrees +/- 3.33 degrees, respectively. There were no statistically significant differences between limbs using the Student t-test. In girls, values for right and left ankle dorsiflexion were 0.19 degrees +/- 2.1 degrees and -0.7 degrees +/- 2.3 degrees, respectively, with the knee extended and 4.88 degrees +/- 3.59 degrees and 4.88 degrees +/- 3.07 degrees, respectively, with the knee flexed. In boys, these values were 0.46 degrees +/- 2.3 degrees and -0.5 degrees +/- 1.98 degrees with the knee extended and 4.88 degrees +/- 3.04 degrees and 4.54 degrees +/- 3.55 degrees with the knee flexed. There were no statistically significant differences between boys and girls. Ankle dorsiflexion in asymptomatic adolescent athletes is approximately 0 degrees with the knee extended and just less than 5 degrees with the knee flexed.

Adolescent↗
PubMedDate not supplied

Fluoroquinolone therapy and Achilles tendon rupture.

Fluoroquinolones have been associated with tendinopathies. The authors present three cases of Achilles tendinopathy in which the patients' symptoms were preceded by treatment for unrelated bacterial infections with ciprofloxacin. Although the exact mechanism of the relationship is not understood, those who engage in sports or exercise should be advised of the risk of quinolone-induced tendinopathy.

Achilles Tendon↗