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Biomedical subjects

B Zarins

Publications and source records attributed to B Zarins.

At least 37 records · Page 2Linked to original sources
PubMed1985

Knee rehabilitation following arthroscopic meniscectomy.

Guidelines for knee rehabilitation after conventional open meniscectomy are generally well known. Less agreement exists on rehabilitation following arthroscopic meniscectomy. The program is sometimes arbitrary. Rehabilitation should follow a logical progression regardless of the type of surgery performed. Rehabilitation following knee surgery can be divided into four phases: immediate post-operative period, early healing phase, late healing phase, and conditioning for return to preinjury activity. Following arthroscopic surgery, the overall recovery time can be significantly shortened compared to conventional arthrotomy, primarily by decreasing the length of the early postoperative phases. A smaller incision causes less soft-tissue injury to skin, capsule, synovium, and other periarticular structures, resulting in less quadriceps inhibition and a more rapid recovery. The rate of tissue healing is not altered, however, and the knee must still heal completely before the patient can return to a full functional level. Not all patients are rehabilitated uniformly, and a great deal of variability exists following arthroscopic surgery. Factors that affect the speed of rehabilitation and return to normal function are the extent of meniscectomy performed, the coexistence of additional intra- or extra-articular pathology, and individual patient differences. Therefore, an arbitrary time frame for rehabilitation following arthroscopic meniscectomy is not recommended. Rather, each patient should progress from one stage of rehabilitation to the next, based on objective knee findings.

Arthroscopy↗
PubMed1985

Combined intra-articular and extra-articular reconstructions for anterior tibial subluxation.

This article describes several procedures that combine intra-articular techniques with extra-articular techniques to stabilize the knee with anterior tibial subluxation. The procedures detailed are reconstruction using the semitendinosus tendon and the iliotibial tract; tenodesis using a strip of iliotibial tract combined with intra-articular reconstruction of the anterior cruciate ligament with the central third of the patellar tendon; "mini-reconstruction"; and a procedure utilizing a vascularized patellar tendon graft plus "dynamic" augmentation.

Humans↗
PubMed1984

Current concepts in the diagnosis and treatment of shoulder instability in athletes.

Glenohumeral joint instability is a fairly common clinical disorder in athletes, especially in sports that involve the throwing motion. The direction of shoulder instability can be anterior, inferior, posterior, or multidirectional. The cause can be trauma, congenital laxity, or voluntary muscle action. Normal shoulders that have been disrupted by injury respond well to surgical correction. Shoulders that have inherently lax supporting structures, as found in patients with atraumatic and voluntary dislocation, have less consistent success with surgical repair. A common condition encountered in the shoulder of a throwing arm is anterior subluxation, which can be diagnosed by the positive apprehension sign and confirmed by arthroscopy. A torn glenoid labrum is a common injury also. Improvement in the diagnosis and treatment of shoulder disorders has been made recently by arthroscopy which allows direct visualization of the joint; many conditions can now be corrected by means of arthroscopic surgery. Radiographic techniques have also been improved.

Arthroscopy↗
PubMed1984

Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment.

We analyzed the cases of thirty-nine patients who were treated for recurrent anterior dislocation of the shoulder after unsuccessful surgical repair for the same condition in order to identify factors responsible for failure of the earlier operations and to determine the results of treatment of the post-surgical recurrence. The prior operations included nineteen Bankart, seven Putti-Platt, five Magnuson, three duToit, two Bristow, and three Nicola procedures. Thirty-two shoulders were treated by reoperation. At reoperation the most common pathological lesion associated with recurrence of the dislocation after the prior repair was a Bankart lesion (avulsion of the capsule and labrum from the anterior glenoid rim). This was present in 84 per cent of the thirty-two shoulders that were treated by reoperation. Excessive laxity of the capsule was found in 83 per cent of the twenty-nine shoulders in which laxity was assessed, and was considered to be the primary cause of instability in four shoulders. A Hill-Sachs lesion of the humeral head was found in 76 per cent of the twenty-nine shoulders that were evaluated for this lesion and was large in three of the shoulders. Other factors that were associated with recurrent instability were scarring of the subscapularis muscle, generalized ligament laxity, technical errors at surgery, and severe reinjury. The success rate of reoperation after previous failure was very encouraging. Of the twenty-four shoulders that were reoperated on and were followed for two years or longer, ten were graded excellent; twelve, good; and two, poor. One (4 per cent) of the twenty-four shoulders that were reoperated on continued to dislocate and another shoulder continued to subluxate, making the incidence of recurrent instability after reoperation 8 per cent. Seven of the thirty-nine shoulders did not have a reoperation but were treated with specific resistive exercises. The results in these were one excellent, four good, one fair, and one poor. Eight patients were lost to follow-up.

Adolescent↗
PubMed1983

Effect of patellectomy on the function of the quadriceps and hamstrings.

The Cybex-II isokinetic dynamometer was used to measure quadriceps and hamstrings function after unilateral patellectomy in twelve patients. The interval between surgery and testing averaged twenty-six months (range, fourteen to forty-two months). Data on isokinetic and isometric performance were compared with those of the untreated limb and with those of subjects who had not been operated on but who had been matched by age, sex, and weight. On the side that had been operated on, the peak torque of the quadriceps was significantly decreased whereas the peak torque of the hamstrings was preserved. Deficits in time factors related to the development of tension and high-speed performance were documented, revealing abnormalities in both muscle groups. Although patellectomy was successful in achieving relief of pain in these patients, the results of the study confirmed that the function of the knee muscles was compromised postoperatively. The objective findings documented alterations in muscle function that correlated well with the functional limitations described by the patients.

Adult↗
PubMed1983

Irrigating solutions for arthroscopy. A metabolic study.

UNLABELLED: In an effort to determine the optimum solution for irrigation during arthroscopic procedures, an in vitro metabolic experiment was performed in which cartilage slices were incubated with 35SO4 in various commercially available solutions, harvested at regular intervals, and assayed for incorporated radioactivity. The solutions were compared with Ham F12 medium, a complex, ionically balanced salt and amino-acid solution that is used for tissue culture. The data show that neither normal saline or phosphate-buffered saline supports metabolic activity as well as Ringer lactate or acetate, both of which approximate the values for the control, Ham F12 solution. CLINICAL RELEVANCE: Arthroscopy and arthroscopic surgical procedures have become commonplace in orthopaedic practice. Normal saline solution, commonly used in large quantities as an irrigating solution, is in fact not physiological, and we showed that it inhibits normal synthesis of proteoglycan by the chondrocytes. Ringer lactate seemed to support cartilage metabolism as well as an "ideal" tissue-culture medium (Ham F12 solution). Since Ringer solution and normal saline cost the same in our hospital, we strongly recommend that this more physiological solution be used for arthroscopic procedures.

Animals↗
PubMed1982

Soft tissue injury and repair--biomechanical aspects.

The main force which muscles, tendons and ligaments resist is tension. A single maximal tensile force will cause disruption of the tissue and an acute injury. Cyclic submaximal forces will cause adaptation if sufficient time is given for healing, and breakdown in the forces are applied over too short a period of time. The adaptive response is rate-limited. It is affected by the magnitude of the force and other factors.

Aging↗
PubMed1982

Chronic unreduced dislocations of the shoulder.

We evaluated the results of treatment in twenty-three patients with twenty-four shoulder dislocations that had gone unreduced for at least three weeks. Fourteen dislocations were posterior, eight were anterior, and one each was superior and inferior. Seventy-nine per cent of the posterior dislocations had not been recognized by the initial treating physician. Fourteen shoulders (58 per cent) were operated on. Of seven that were treated by open reduction with preservation of the humeral head, the results in two were graded as excellent; in three, as good; and in two, as fair. A Neer total shoulder-replacement prosthesis was used in one patient with an excellent result, and a Neer humeral-head prosthesis was used in two patients with a good and a fair result. In four patients, the humeral head was removed and a Jones procedure was performed, with one good and three fair results. There were no poor results after surgical treatment and it was not necessary to arthrodese any shoulder. We did not find it necessary to transfix the shoulder joint by screws or pins, or to use plaster spica casts to maintain stability of the shoulder following open reduction. Supporting the arm at the side in a position posterior to the coronal plane for a posterior dislocation, and anterior to the coronal plane for an anterior dislocation, proved to be comfortable and effective. There were no postoperative dislocations using this simple method. These results show that the over-all prognosis for surgical treatment of the chronic unreduced dislocation shoulder is more favorable than has previously been reported. A rating system based on 100 units was used to evaluate our final results, and is recommended as a standard system for future comparative studies.

Adult↗
PubMed1982

Arthroscopic surgery in a sports medicine practice.

The arthroscope has dramatically changed the approach of the orthopedist to the diagnosis and treatment of joint injuries. A thorough history and physical examination, complemented by careful arthroscopic visualization, allow for a high degree of diagnostic accuracy. The ability to perform arthroscopic surgery has eliminated the need for open arthrotomy in most internal derangements of the knee. Used properly, the arthroscope is an essential tool in the practice of sports medicine.

Age Factors↗
PubMed1970

Surgic grand rounds.

Explore the source record for details and available documents.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMedDate not supplied

Rotational motion of the knee.

This study deals with the quantitation of axial rotation at the knee. Passive rotation of the knee was measured at various degrees of flexion on 17 subjects with normal knees and 19 patients with unilateral anterolateral rotatory instability. Normal subjects were found to have bilateral symmetric rotational knee motion at each angle of flexion tested. When the knee is in a position of flexion between 30 and 90 degrees, there are approximately 45 degrees external and 25 degrees internal rotation. Rotatory motion decreases with further extension and, at 5 degrees of flexion, the knee has 23 degrees external and 10 degrees internal rotation. The knee with a torn anterior cruciate ligament and anterolateral rotatory instability was found to have an arc of rotation similar to the contralateral knee and to the control knees between 30 and 90 degrees flexion. At 15 degrees of flexion, a slightly greater arc of rotation was measured compared to normal knees. At 5 degrees of flexion, a significantly greater range of external (to 41 degrees) as well as internal (to 14 degrees) rotation was measured.

Adolescent↗
PubMedDate not supplied

Strain measurement in lateral ankle ligaments.

We measured strain in the lateral ligaments of 10 human cadaver ankles while moving the ankle joint and applying stress in a variety of ways. We studied the anterior talofibular, calcaneofibular, posterior talofibular, anterior tibiofibular, and posterior tibiofibular ligaments. Strain measurements in the ligaments were recorded continuously while the ankle was moved from dorsiflexion into plantar flexion. We then repeated measurements while applying inversion, eversion, internal rotation, and external rotation forces. Strain in the anterior talofibular ligament increased when the ankle was moved into greater degrees of plantar flexion, internal rotation, and inversion. Strain in the calcaneofibular ligament increased as the talus was dorsiflexed and inverted. These findings support the concept that the anterior talofibular and calcaneofibular ligaments function together at all positions of ankle flexion to provide lateral ankle stability. We measured maximum strain in the posterior talofibular ligament when the ankle was dorsiflexed and externally rotated. The strain in the anterior and posterior tibiofibular ligaments increased when the ankle was dorsiflexed. External rotation increased strain in the anterior tibiofibular ligament and decreased strain in the posterior tibiofibular ligament. Based upon strain measurements in the lateral ankle ligaments in various ankle joint positions, we believe the anterior talofibular ligament is most likely to tear if the ankle is inverted in plantar flexion and internally rotated. Theoretically, the calcaneofibular ligament tears primarily in inversion if the ankle is dorsiflexed; the anterior tibiofibular ligament tears in dorsiflexion, especially if combined with external rotation; and the posterior tibiofibular ligament tears with extreme dorsiflexion.

Adult↗
PubMedDate not supplied

Reconstruction of the lateral ankle ligaments. A biomechanical analysis.

UNLABELLED: The purpose of this study was to perform a biomechanical analysis of several commonly performed operative procedures used to stabilize the lateral ankle. We performed the Evans, Watson-Jones, and Chrisman-Snook procedures on 15 cadaveric ankles and tested the ankles for stability, motion, and isometry of graft placement. The Evans procedure allowed increased anterior displacement, internal rotation, and tilt of the talus when compared to ankles with intact ligaments. Subtalar joint motion was restricted by the Evans procedure. The Watson-Jones procedure controlled internal rotation and anterior displacement of the talus, but was less effective in controlling talar tilt and also restricted subtalar joint motion. The Chrisman-Snook procedure allowed increased internal rotation and anterior displacement of the talus when compared to ankles with intact ligaments. The procedure was effective in limiting talar tilt, but restricted subtalar joint motion. Based on the biomechanical data obtained, we devised a lateral ankle reconstruction with bone tunnels that reproduce the anatomic orientation of both the anterior talofibular and calcaneofibular ligaments. This ankle ligament reconstruction resists anterior displacement, internal rotation, and talar tilt without restricting subtalar joint motion. CLINICAL RELEVANCE: We found considerable mechanical differences among the more commonly performed lateral ankle reconstructions. It is possible to locate bone tunnels and graft placement so that a more anatomic configuration is achieved.

Adult↗