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Biomedical subjects

D Kohn

Publications and source records attributed to D Kohn.

At least 73 records · Page 4Linked to original sources
PubMed1999

Meniscus transplantation: preoperative planning.

Precise preoperative planning is mandatory to obtain good results of meniscus transplantation. Any pathology in addition to the missing meniscus should be detected, including malalignment, and ligament instability. A full status of the changes in the cartilage should be made. It is unknown how precisely the donor meniscus needs to fit the size of the original meniscus to allow healing and regeneration. The effect of incongruency and wrong insertion of the meniscal horns has been investigated in an animal experiment. The incongruous grafts did not entirely avoid chondromalacia after meniscectomy, but provided some chondroprotective effect. A wrong bony insertion of the meniscal horns leads to even more serious chondral damage than meniscectomy.

Animals↗
PubMed1999

Arthroscopic and open surgical techniques for meniscus replacement--meniscal allograft transplantation and tendon autograft transplantation.

Open, arthroscopically assisted and arthroscopic methods for lateral and medial meniscus allograft transplantation with bone plug fixation are described. An open technique for medial and lateral meniscus transplantation without bone plug fixation, as well as an open technique for autograft quadriceps tendon replacement of the medial meniscus are described.

Arthroscopy↗
PubMed1999

Postoperative follow-up and rehabilitation after meniscus replacement.

Even though basic scientific knowledge about the meniscal loading pattern may advocate restrictive rehabilitation after meniscus repair, experience and one controlled study favour accelerated rehabilitation. The current protocols for rehabilitation after meniscal substitution follow personal experience with parameters such as pain, effusion, locking, and gait pattern used as clinical guidance. Controlled clinical studies on rehabilitation should be encouraged. An example of a rehabilitation protocol is given. As meniscus replacement is a new treatment option, it is essential to document details about the graft, the knee status at operation and the surgical procedure. The goal of a postoperative follow-up is to control quality, to measure patient satisfaction and to show whether meniscus replacement is beneficial in relation to the natural history of meniscectomy cases. There is a need for a standard follow-up evaluation of patients after meniscus replacement, and the development of a meniscus transplantation score including subjective and objective data is suggested.

Humans↗
PubMed1999

Future research in meniscal replacement.

To study the remodelling process after meniscus replacement and to learn how to control it will be a key topic for future research. Not enough is known about the importance of precision in meniscal fixation and how to make the insertions as strong as in the normal meniscus. Methods to measure load-distribution, mechanical properties of the graft and status of the cartilage should be developed. A number of different auto- and allografts have been shown to heal and revascularize, but whether the grafts are functioning is not known. Meniscal scaffolds, which can be used for replacement of partial meniscal loss, need to be tested. Scaffolds and tissue engineering will be the subject of intensive research in the future.

Cryopreservation↗
PubMed1998

Drill hole position in endoscopic anterior cruciate ligament reconstruction. Results of an advanced arthroscopy course.

In 24 cadaver knees the anterior cruciate ligament (ACL) was replaced by a bone-tendon-bone patellar tendon autograft in an endoscopic technique. This was carried out during an advanced arthroscopy course after intensive instruction and practice on a plastic model. When the knees were opened and evaluated according to the recent orthopaedic literature, only four good results with correct tunnels and a non-impinging graft were found. In 12 knees the femoral tunnel was too far anterior (10) or had broken through the posterior femoral cortex (2). In 6 knees the tibial tunnel was too far anterior (2) or too far posterior (4). The notchplasty was insufficient in 6 knees. We conclude that endoscopic ACL reconstruction cannot be mastered after attending a course alone. Expert help is necessary during the first clinical cases.

Adolescent↗
PubMed1997

The subjective shoulder rating system.

We developed a subjective shoulder rating system (SSRS) and tested its reliability against a recognized system (Constant-Murley Score) and a four-point verbal rating scale in 200 patients (mean age 43 years, range 18-71 years; 83 women and 117 men; 48 anterior shoulder reconstructions, 123 subacromial decompressions, 29 manipulations under anesthesia). Within the study period of 1 year, patients completed the SSRS preoperatively and at 1 and 2 weeks, also at 3, 6, and 12 months. The examination according to the Constant-Murley Score was performed preoperatively and at 3 and 12 months. Linear regression showed a highly significant correlation between the SSRS and the Constant-Murley Score (r = 0.83, n = 592, P < 0.001). Ninety-seven percent of the SSRS forms were completed and returned. The average time to complete the SSRS form was 55 s (range 20-310 s) as compared with an experienced examiner requiring an average of 410 s (range 190-720 s) to complete the Constant-Murley Score. The time difference was highly significant (P < 0.001).

Adolescent↗
PubMed1997

[Shoulder arthrodesis in deltoid paralysis].

After loss of active glenohumeral motion the arm cannot be positioned in space and function is impaired. Fusion of the glenohumeral joint creates a new platform for the movement of elbow, hand and fingers and leads to an improvement of function. The use of the reconstructive plate makes the operation easier. Shoulder fusion is especially suited if the function of elbow and hand is well preserved and if the patient is physically active. But fusion is definite and the options of muscle transfer operations and above elbow amputation have to be considered.

Adolescent↗
PubMed1997

Medial meniscus replacement by a fat pad autograft. An experimental study in sheep.

The medial meniscus in 15 sheep was replaced by a pediculated infrapatellar fat pad graft and resulted in the development of a macroscopically meniscus-like structure within 6 months. Five additional sheep with a meniscectomy were controls. Degenerative changes in the fat pad autograft were visible after one year. Osteoarthritis of the weightbearing medial compartment was detected after 6 months. A temporary protective effect on the cartilage could be attributed to the autograft, but the long term results indicated that this was not permanent. Fat is not suitable as a meniscal substitute.

Adipose Tissue↗
PubMed1997

[Injuries during handball. A comparative, retrospective study between regional and upper league teams].

To evaluate the injuries in Team Handball 186 male players out of 16 teams were questioned retrospectively at the end of a season. An important difference between practice and competition injuries could be found with an injury rate of 0.8 injuries per 1000 training hours and 13.5 injuries per 1000 playing hours. Injuries were predominant at the lower extremities with ankle injuries being the most frequent injury type. 2/3 of the playing injuries occurred in offense. 1/3 of these offense injuries could be attributed to a counter-attack. These injuries were generally more severe which lead us to a proposition of changing the rules of the game in foul plays in this situation. Elbow injuries in goalkeepers and shoulder injuries in throwers were specific for these types of players. Prophylactic braces were used by nearly 2/3 of the players.

Adult↗