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Biomedical subjects

C O Tibesku

Publications and source records attributed to C O Tibesku.

17 recordsLinked to original sources
PubMed2006

Expression of the matrix receptor CD44v5 on chondrocytes changes with osteoarthritis: an experimental investigation in the rabbit.

OBJECTIVE: To evaluate the expression of CD44v5 on chondrocytes of hyaline cartilage during the course of osteoarthritis (OA). METHODS: In 12 white New Zealand rabbits the anterior cruciate ligament (ACL) was resected to create an anterior instability of the knee. In 12 control rabbits only a sham operation without resection of the ACL was done. Four animals of each group were killed at 3, 6, and 12 weeks. The loadbearing area was evaluated histologically according to Mankin and by immunostaining for CD44v5. RESULTS: In the trial group, histological grades of OA showed a positive linear correlation with the time after surgery. Immunostaining showed an increased expression of CD44v5 in the control group after 3 and 6 weeks, which dropped to normal after 12 weeks. There was no difference between control and trial groups after 3 and 6 weeks, but a difference was seen after 12 weeks. A significant positive correlation between CD44v5 expression and the histological grade of OA was found (r = 0.314). CONCLUSIONS: An in vivo increase of expression of the hyaluronan receptor CD44v5 occurs during the course of OA. Further studies are needed to evaluate whether this pattern applies to man and whether new treatment approaches might evolve from this knowledge.

Animals↗
PubMed2005

[Jumper's knee--a review].

Jumper's knee has been defined as painful chronic overuse injury of the extensor mechanism of the knee joint. The disease has a high incidence in jumping sports and depends on training frequency and level of performance. Its natural course is protracted, repetitive, and often bilaterally occurring. Its etiology is a chronic overload of the knee extensor mechanism which is triggered by jumping sports (volleyball, basketball etc.) as well as different intrinsic (ligamentous laxity, Q-angle, patella height, tenderness, pattern of force development) and extrinsic dispositions (frequency of training, level of performance, hardness of underground). The place of pathology most often is the osteo-tendinous transition zone of the proximal patellar tendon. Histologic evaluation of the tendon showed that the disease is rather degenerative than inflammatory. The diagnosis is primarily based on the typical sports history, physical examination, and ultrasound. MRI is helpful in operation planning. Plain radiography, CT, and bone scans are used to rule out differential diagnoses. Therapy should be chosen according to the stage of the disease and usually starts with a non-surgical approach. This includes rest from sports activities, immobilisation, non-steroid antiphlogistics, para-tendinous cortisone injections, massage, electric therapy, ultrasound and extracorporal shock waves. Afterwards an increase of activities is begun (moderate training, adequate warm-up, ice cooling after activity, muscle stretching, eccentric strengthening of the quadriceps). Patella straps and soft insoles are used as prevention. Up to 42 % of patients need surgical therapy after failure of long-lasting non-surgical measures, carried out either open or arthroscopically. Surgical principles include excision of the para-tendon, excision of the degenerative tissue, resection of the lower patella pole, and longitudinal incisions into the tendon. Most patients are pain-free after surgery but return to sports only at a lower level.

Arthroplasty↗
PubMed2004

Clinical and functional comparison of uni- and bicondylar sledge prostheses.

The aim of the present study was the evaluation of differences in clinical results, proprioceptive performance and gait in patients with unicondylar and bicondylar sledge prostheses of the knee. In a retrospective study, 17 patients with unicondylar sledge prostheses were compared with 15 patients with bicondylar sledge prostheses. Clinical examination was rated using HSS, Knee Society, and patellar scores and a visual analogue scale for pain. Proprioceptive performance was examined using sway measurements during single leg stance on a force platform. In addition, the patients underwent 3-D gait analysis including measurements of ground reaction forces and surface electromyographic (EMG) investigation of the lower extremity. Comparing both patient groups in clinical scores, gait, EMG and proprioception, no significant differences were found. Implantation of bicondylar sledge prostheses retaining both cruciate ligaments achieves functional results as good as unicompartmental arthroplasty. The presented results might encourage future research on new models of total joint replacement with preservation of both cruciate ligaments.

Aged↗
PubMed2004

Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement.

OBJECTIVE: Comparison of different total knee replacements regarding clinical and functional differences with respect to gait and electromyographic analyses. DESIGN: Retrospective, comparative, clinical and functional study. METHODS: Three groups (control group of 11 healthy subjects, 15 patients with bicondylar sledge prostheses retaining all ligaments (cemented unicondylar prostheses in both the medial and lateral compartment), 15 patients with constrained total knee replacement sacrificing all cruciate and collateral ligaments (cemented total knee prosthesis with intramedullary stems and a large intercondylar tibial post) were compared by clinical evaluation using a number of clinical evaluation scores, a pain scale, surface electromyographic examinations of the lower limb, and gait analysis. RESULTS: Clinical scores revealed significantly worse results for patients with constrained prostheses. Both patient groups had significantly lower clinical scores compared to the control group. Gait analysis and electromyographic parameters revealed no significant differences between both patient groups. Compared to the control group, patients revealed significantly impaired parameters. Electromyography also demonstrated significant differences between patients and controls: mean electromyographic activities were reduced in vastus medialis and lateralis, semitendinosus, tibialis anterior and gastrocnemius. Peak activities were reduced in all muscles but rectus femoris. CONCLUSION: Clinical scores demonstrated significantly better results in bicondylar sledge than in constrained prostheses. Nevertheless, gait and electromyographic analyses did not reveal significant differences. RELEVANCE: Retaining of ligaments in bicondylar sledge prostheses apparently improved the activities of daily living but is not reflected in gait and electromyographic parameters.

Arthroplasty, Replacement, Knee↗
PubMed2004

Hyaline cartilage degenerates after autologous osteochondral transplantation.

OBJECTIVES: Autologous osteochondral grafting is a well-established clinical procedure to treat focal cartilage defects in patients, although basic research on this topic remains sparse. The aim of the current study was to evaluate (1) histological changes of transplanted hyaline cartilage of osteochondral grafts and (2) the tissue that connects the transplanted cartilage with the adjacent cartilage in a sheep model. METHOD: Both knee joints of four sheep were opened surgically and osteochondral grafts were harvested and simultaneously transplanted to the contralateral femoral condyle. The animals were sacrificed after three months and the received knee joints were evaluated histologically. RESULTS: Histological evaluation showed a complete ingrowth of the osseous part of the osteochondral grafts. A healing or ingrowth at the level of the cartilage could not be observed. Histological evaluation of the transplanted grafts according to Mankin revealed significantly more and more severe signs of degeneration than the adjacent cartilage, such as cloning of chondrocytes and irregularities of the articular surface. CONCLUSION: We found no connecting tissue between the transplanted and the adjacent cartilage and histological signs of degeneration of the transplanted hyaline cartilage. In the light of these findings, long-term results of autologous osteochondral grafts in human beings have to be followed critically.

Animals↗
PubMed2004

[MRI evaluation of meniscal movement and deformation in vivo under load bearing condition].

AIM: The aim of this experimental study was a quantitative evaluation of meniscal movement and deformation in vivo under load bearing conditions. METHODS: Sagittal T1-weighted MRI pictures of 15 healty knees were evaluated. The subjects were placed in an open MRI, that enabled measurements under load bearing and in different flexion grades. Series of pictures of the medial and lateral meniscus without load, with half and full body weight load and in full extension and 30 degrees flexion were taken. Two examiners measured twice the height of the posterior horn, and the inner and outer distance between the anterior and posterior horns of the menisci. RESULTS: The height of the posterior horns of the medial and lateral menisci decreased with increasing load. The inner and outer distance increased with load, the inner distance more than the outer, resulting in a compression of the periphery. Increase of flexion from 0 degrees to 30 degrees significantly influenced only the outer distance of both menisci. CONCLUSION: This method can be used in future to functionally evaluate the postoperative result after meniscus saving or replacing therapies. The compression of meniscal periphery from the inside to the outside under load in full extension allows early postoperative mobilisation after meniscal sutures.

Adult↗
PubMed2004

Muscle strength in patients with unicompartmental arthroplasty.

OBJECTIVE: The aim of the current study was to evaluate the isokinetic strength of the knee in patients with unicondylar prostheses, to compare these results with healthy control subjects of the same age, and to correlate these results with clinical scores. DESIGN: Seventeen patients were examined an average of 21.5 mos after surgery. Clinical examination was done using the Hospital for Special Surgery, Knee Society, and patellar scores and a visual analog scale for pain. Quality of life was assessed by the Short Form 36 Health Questionnaire. Isokinetic evaluation of knee extensor and flexor muscles was done using a Cybex 6000 dynamometer at angular velocities of 60 and 180 degrees/sec. Eleven healthy subjects of comparable age served as a control group. RESULTS: Clinical results differed significantly in all categories. Quality of life differed only in the items of physical functioning, role limitation because of physical problems, and bodily pain. Isokinetic strength in patients showed a loss of torque of approximately 30% in extension and flexion at 60 and 180 degrees/sec compared with the control group. The flexion and extension ratio and the angles of maximum torque did not differ between the groups. CONCLUSION: In comparison with healthy control subjects, persons with an implanted unilateral sledge prosthesis have strength deficits in extension and flexion. A deficit of the extensor muscles, as it has been described previously for patients with a total knee arthroplasty, could not be found.

Aged↗
PubMed2003

CD44H and the isoforms CD44v5 and CD44v6 in the synovial fluid of the osteoarthritic human knee joint.

OBJECTIVE: To determine whether the concentrations of CD44H and v5 and v6 in the synovial fluid are correlated with the presence of accompanying synovitis in the osteoarthritic joint and with the grade of osteoarthritis. DESIGN: Using antero-posterior and lateral X-rays of the knee joint and patellar view of 46 patients were graded with the Kellgren & Lawrence scale. Synovial fluid from these patients with different grades of primary osteoarthritis of the knee joint with and without synovial inflammation (synovitis) was collected during surgical procedures. A horseradish peroxidase conjugated anti-CD44H-, anti-sCD44v5- or anti-sCD44v6-antibody was added and labeled with tetramethylbenzidine. The absorbance was measured at wavelengths of 450/620 nm. Regression analysis was performed and the statistical significance was assessed, using the Student t-test for unequal variance. RESULTS: CD44H and v5 and v6 were detected in the synovial fluid of all 46 patients. Osteoarthritic patients with synovial inflammation showed significantly higher levels of CD44H and v6, but not v5, than osteoarthritic patients without synovial inflammation. With progression of osteoarthritis from Kellgren grade II to III, CD44v5 decreased significantly. All other isoform concentrations remained statistically unchanged. CONCLUSIONS: CD44H and the isoforms v5 and v6 were present in the synovial fluid of osteoarthritic patients. Their concentrations do not reflect the osteoarthritic stage in the Kellgren grading scale. CD44H and CD44v6, but not CD44v5, are significantly up-regulated in osteoarthritic synovial inflammation.

Adult↗
PubMed2003

[Internal rotational strength of the thigh after ACL reconstruction. Prospective comparison of harvesting of the semitendinosus and gracilis tendons and the patella tendon].

AIM: The aim of the present study was the prospective, randomized evaluation of the internal rotation strength in patients, undergoing ACL reconstruction using either semitendinosus and gracilis tendon autografts (ST/G) or the central third of the patella tendon (BPT). METHOD: 40 patients (20 male, 20 female, average age 32 years [16 - 49]) underwent reconstruction of the ACL. In 20 patients ST/G was used, in 20 matched patients the central third of the patella tendon (BPT) was used. Rehabilitation was identical for both groups. The isometric strength of internal tibial rotation in neutral position was measured preoperatively, 3, 6 and 12 months postoperatively. RESULTS: After 3 months no difference to the preoperative data was found. After six months the internal tibial torque was significantly higher (p < 0.05) than preoperatively. No additional increase was found after 12 months. There was no statistically significant difference between both groups at any time. CONCLUSION: The internal tibial torque, which is predominantly a function of the pes anserinus, recovers shortly after operation and is, due to postoperative rehabilitation, significantly elevated after 6 months. The randomized comparison with the harvesting of the central third of the patellar tendon showed no significant difference.

Adolescent↗
PubMed2003

Quality of life and gait after unicondylar knee prosthesis are inferior to age-matched control subjects.

OBJECTIVE: Evaluation of quality of life, gait pattern, and muscle activity after implantation of unicondylar sledge prostheses in comparison with control group. DESIGN: A total of 17 patients were examined at an average follow-up of 21.5 mo after implantation of unicondylar sledge prostheses. In addition to clinical evaluation with different scores, our patients underwent three-dimensional gait analysis and surface electromyographic investigation of the lower limb and quality-of-life assessment using the Short Form-36 health questionnaire. The control group consisted of 11 healthy subjects. RESULTS: Statistical analysis showed significantly lower results for the patient group in the Hospital for Special Surgery score, the Knee Society score, the patella score, and the Visual Analog Scale for pain. In quality of life, significant differences could be found for the following items: physical functioning, role limitation because of physical problems, and bodily pain. Electromyographic activities during gait were significantly lower in the patient group, except for the rectus femoris and the tibialis anterior. Regarding gait analysis, the variables for ground reaction forces and stride length differed significantly, whereas maximum knee extension and flexion did not. CONCLUSIONS: Unicondylar knee replacement has failed to restore functional capabilities, quality of life, gait pattern, and muscle activity compared with healthy subjects of the same age. The assumption that unicondylar sledge prostheses preserve normal joint function must be questioned.

Aged↗
PubMed2002

Proprioceptive function, clinical results, and quality of life after unicondylar sledge prostheses.

OBJECTIVE: Evaluation of proprioceptive performance and quality of life after implantation of unicondylar sledge knee prostheses in comparison with normal control subjects. DESIGN: A total of 17 patients were examined after implantation of unicondylar sledge prostheses. Clinical examination was performed, quality of life was assessed, and proprioceptive performance was examined. A total of 11 healthy subjects of comparable age served as a control group. RESULTS: Clinical results of both groups differed significantly in all categories. Quality-of-life assessment differed only in the following items: physical functioning, role limitation caused by physical problems, and bodily pain. Other than angle reproduction at 15 degrees, no significant differences in proprioceptive testing, neither sway measurement nor angle reproduction, were found. Statistical analysis revealed no correlation between clinical scores and proprioceptive results. CONCLUSIONS: In comparison with normal control subjects of comparable age, the implantation of unicondylar sledge prostheses does not result in proprioceptive deficits. Except for physical functioning, role limitations caused by physical problems and bodily pain, most aspects of quality of life do not differ between patients and control subjects, although the patients' clinical results were significantly lower than the controls.

Aged↗
PubMed2001

Computed tomography-guided endoscopic removal of an osteoid osteoma from the femur.

The case of a 19-year-old male patient who complained of dull pain in his right knee for more than 18 months and was finally diagnosed with intracortical osteoid osteoma in the femoral diaphysis is presented. A new operative method was used to locate and remove the tumor. Under spinal anesthesia with the patient in the prone position, a lateral and a posterior approach were marked with special bone cutting tubes under computed tomographic control. The usual arthroscopic instruments (punch, retrograde suction stamp) were used to remove the nidus under arthroscopic visualization, thereby avoiding the disadvantages of open excisions, such as large incisions, bone loss, long hospitalization, and risk of infection. The advantages and disadvantages are thoroughly discussed and compared with conventional surgical procedures.

Adult↗
PubMed2000

Interdependence of clinical and isokinetic results after bicondylar knee prostheses with special emphasis on quality of life results.

Nineteen patients were examined at an average follow-up of 2 years after total knee joint replacement without patella resurfacing. They were compared with 22 healthy subjects of the same age. Using the Hospital for Special Surgery (HSS) score the operated knee joints scored an average of 77 points, the contralateral side scored 87 points and the control group 97 points. In the SF-36 health questionnaire the patients showed highly significant deviations. Isokinetic measurements revealed a clear loss of isokinetic strength of more than 50% on average in flexion as in extension when compared to the control group and there were considerable asymmetries between the operated and the contralateral legs.

Aged↗
PubMed1999

[Gangrene of the fingers caused by accidental intra-arterial injection of diazepam].

HISTORY: A 51-year-old woman was accidentally given an intra-arterial injection of 10 mg diazepam to control an acute claustrophobic anxiety attack. She complained of severe knocking pain in the entire left arm during the injection. On the second day the hand and lower arm were red an swollen and she complained of increasingly feeling cold and having paraesthesias. On the fifth day the radial half of the palm as well as the first to third digits showed livid discoloration. In the further course necrotic areas developed in the palmar aspect of the distal phalanx of the thumb and of the index finger proximal to the middle phalanx. INVESTIGATION: Angiography on the tenth day after the injection revealed very poor perfusion of the radial artery as far as the wrist, occlusion of the superficial palmar arterial arch and occlusions of the digital arteries of the five fingers. TREATMENT AND COURSE: Infusion of 25,000 IU heparin over 24 h brought no improvement. On the 24th day after the diazepam injection the palmar aspect of the distal phalanx of the thumb and the index finger became necrotic, requiring amputation of the latter and, after removal of necrotic tissue, flap-plasty using subcutaneous soft tissue of the extensor surface of the index finger to cover the defect on the thumb. The patient was without symptoms on discharge and the wounds were healing well. CONCLUSION: Every doctor should be aware of the dangers of accidental intra-arterial injection. The slightest suspicion and symptoms require immediate and adequate treatment to save the limb.

Amputation, Surgical↗