PubMed Health⌕ Search

Biomedical subjects

D M Daniel

Publications and source records attributed to D M Daniel.

At least 19 recordsLinked to original sources
PubMed1996

Equal effectiveness of electrical and volitional strength training for quadriceps femoris muscles after anterior cruciate ligament surgery.

Neuromuscular electrical stimulation and voluntary muscle contraction are two exercise modes widely used in rehabilitation to strengthen skeletal muscle. Since there is no debate as to which mode is most effective, we compared electrical stimulation with voluntary contraction performed at matched intensities following reconstructive surgery of the anterior cruciate ligament. Forty men and women, aged 15-44, were randomly assigned to either an electrical stimulation or a voluntary contraction group. None of the subjects had a previous history of neuromuscular injury. The subjects received treatment for 30 minutes a day, 5 days a week, for 4 weeks. Knee extension torque was monitored during treatment to try to match the absolute muscular tensions (quantified as "activity") achieved during therapy. To match the activity of the subjects in the electrical stimulation group, who were treated at the highest stimulation intensity they could tolerate, the subjects in the voluntary contraction group were paced at progressively increasing intensities corresponding to 15, 25, 35, and 45% of the injured limb's maximum voluntary torque during weeks 1, 2, 3, and 4, respectively. We found no significant difference between the groups in terms of maximum voluntary knee extension torque throughout the study period. In addition, 1 year after surgery, there was still no significant difference between groups with regard to knee extension torque (p > 0.4). These data suggest that neuromuscular electrical stimulation and voluntary muscle contraction treatments, when performed at the same intensity, are equally effective in strengthening skeletal muscle that has been weakened by surgical repair of the anterior cruciate ligament.

Adolescent↗
PubMed1996

Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint.

We performed a retrospective study of sixty-six patients (forty-one male and twenty-five female) who had a combined injury of the anterior cruciate and medial collateral ligaments. Our purpose was to determine the prevalence of late valgus instability of the knee. The mean age of the patients was thirty-five years (range, sixteen to sixty-three years). The mean follow-up interval was forty-five months (range, twenty-one to 108 months). Twenty patients had been injured while snow-skiing; twenty-four, during other sports activities; seven, in a motor-vehicle accident; and the remaining fifteen, during activities of daily living. Eleven patients had reconstruction of the anterior cruciate ligament and repair of the medial collateral ligament, thirty-three had reconstruction of only the anterior cruciate ligament, and twenty-two were managed non-operatively. There was no evidence of valgus instability on clinical examination at the most recent follow-up visit. However, there was evidence of instability on stress roentgenograms of the knee in eight (13 per cent) of sixty patients. With the numbers available, we could detect no relationship between the presence of valgus instability and the method of treatment of the ligamentous tears ( p > 0.4). We also compared the results for twenty-one of the thirty-three patients who had a combined ligamentous injury and reconstruction of only the anterior cruciate ligament with those for thirty-seven patients who had reconstruction of an isolated tear of the anterior cruciate ligament. After a mean follow-up interval of thirty-five months (range, twenty-one to sixty-six months), there was no difference in the anterior displacement, impairment of function, level of participation in sports activities, results of the one-leg-hop for distance test, or strength as determined by testing on a Cybex machine. On the basis of the findings in this study, we believe that, when there is mild or moderate valgus instability, an injury of the medial collateral ligament does not need to be repaired when the anterior cruciate ligament is repaired after a combined ligamentous injury.

Adolescent↗
PubMed1995

Effects of tourniquet use in anterior cruciate ligament reconstruction.

Although tourniquets are used commonly during anterior cruciate ligament (ACL) surgery, little data are available regarding their effects on postoperative function. This retrospective study evaluated 94 patients who had an arthroscopically assisted, autogenous bone-patellar ligament-bone ACL reconstruction between 1988 and 1991 at the San Diego Kaiser Hospital. A tourniquet was used in 48 patients (T+ group). No tourniquet was used in 46 patients (T- group). The surgical and postoperative protocols were identical for the two groups. There were no bleeding complications. There was no significant difference in anesthesia time between the two groups. This study has shown that ACL surgery can be performed expeditiously without a pneumatic tourniquet. Quadriceps strength recovery after surgery was less in the T+ group at 12 weeks after surgery, but there was no significant difference between the groups 52 weeks after surgery. Difference in thigh girth was greater in T+ group 6 and 12 weeks after surgery, but there was no significant difference between the groups 52 weeks after surgery.

Adult↗
PubMed1994

The healed Segond fracture: a characteristic residual bone excrescence.

This report describes the natural history of the Segond fracture and documents the radiographic appearance of the healed Segond fracture. The clinical and radiographic records of 129 patients with acute anterior cruciate ligament (ACL) injuries were reviewed. Four (3.1%) of these patients had Segond fractures. On follow-up radiographic examination, seven patients demonstrated a characteristic bone excrescence arising 3-6 mm inferior to the lateral tibial plateau. In four of the five patients for whom acute injury films were available this excrescence arose at the site of the earlier Segond fracture. Healing of such fractures is associated with a characteristic bone excrescence distinct from an osteophyte. This excrescence implies significant internal derangement of the knee.

Adolescent↗
PubMed1994

The effect of cold therapy on pain, swelling, and range of motion after anterior cruciate ligament reconstructive surgery.

This prospective study assessed the effect of cold therapy on pain, pain medication use, limb swelling, and knee range of motion in 131 patients who had an arthroscopically assisted anterior cruciate ligament reconstruction. Patients were randomized into five treatment groups. Cooling pads were incorporated into the dressing in 89 patients, and no cooling pads were used in 42 patients. There were four cooling-pad temperature groups: 40 degrees F, 45 degrees F, 55 degrees F, and 70 degrees F. The cooling pads lowered the skin temperature. There was no difference between groups with respect to hospital stay, pain medication use, pain scale, knee girth, or range of motion.

Adult↗
PubMed1994

[Instrumented measurement of ruptures of the anterior cruciate ligament].

The KT-1000 arthrometer was used to measure anterior tibial displacement in patients with acute unilateral anterior cruciate ligament (ACL) disruptions. Measurement revealed 11.5 mm absolute displacement on the injured side and 3.6 mm side-to-side difference with the 89 N test, 15.2 mm absolute displacement and 6.1 mm side-to-side difference with the manual maximum displacement test, and 8.5 mm displacement and 2.0 mm side-to-side difference with the active quadriceps test. Chronic anterior instabilities measured 13.0 mm absolute displacement on the involved side and 5.4 mm side-to-side difference with the 89N test, 17.7 mm displacement and 8.6 mm side-to-side difference with the manual maximum displacement test, 10.8 mm displacement and 4.4 mm side-to-side difference with the active quadriceps test. Testing technique, measurements in control subjects without previous knee injuries, and displacement measurements of other authors and other instrumented testing devices are described.

Adult↗
PubMed1993

Bone imaging after acute knee hemarthrosis.

Follow-up evaluations were carried out in 84 patients examined 5-8 years after sustaining an acute traumatic hemarthrosis of the knee. The initial examination performed within 2 weeks of injury had revealed 18 patients with a stable knee and 66 with anterior instability. Twelve of the patients underwent anterior cruciate ligament reconstruction within 3 months of injury and 11 more did so between 1 and 3 years after injury. To document joint deterioration at follow-up, bone scintigraphy and conventional anteroposterior, lateral, and tunnel X-rays were taken. Medial, lateral, patellofemoral and patellar uptake in bone scintigraphy was graded from 0 to 4. Six radiological variables were graded at eight different sites. Sixty-three patients (75%) had a positive bone scan and 69 patients (82%) showed radiological changes. Bone scan and X-ray scores were both significantly higher in the reconstructed knees.

Acute Disease↗
PubMed1993

Diagnosis of an ACL disruption with KT-1000 arthrometer measurements.

The KT-1000 was used to measure anterior tibial displacement in three populations: normal subjects (n = 120), patients with unilateral acute anterior cruciate ligament (ACL) disruptions (n = 105), and patients with chronic unilateral ACL disruptions who were scheduled for ACL reconstructions (n = 159). All patients with ACL disruptions were measured with and without anesthesia. Tibial displacement under three loading conditions was measured: 89-N anterior displacement force, manual maximum displacement force, and quadriceps contraction to lift the leg. The measurements of the normal knee in the injured populations were not significantly different from those of the knees in the normal population on any test. The injured knee tested with and without anesthesia was significantly different from the normal knee on all tests. The right-left difference in the normal population as less than 3 mm in 98% of patients in the 89-N test, 97% in the manual maximum test, and 99% in the quadriceps active test. The largest amount of displacement and the greatest difference in displacement between the injured and the normal knee was produced by the manual maximum test. The manual maximum injured-minus-normal knee displacement was 3 mm or more in 99% of patients with chronic ACL disruptions and in 95% of patients with acute ACL disruptions.

Adolescent↗
PubMed1993

Quadriceps/anterior cruciate graft interaction. An in vitro study of joint kinematics and anterior cruciate ligament graft tension.

The Oxford Rig, a device that simulates active knee extension during stance, was used to study the effects of quadriceps force on AP tibial displacement and axial tibial rotation in vitro. Human anatomic specimen knees were tested with the anterior cruciate ligament (ACL) intact, sectioned, and reconstructed. Patellar tendon grafts used in the ACL-reconstructed state were attached distally to a load cell, allowing direct measurement of graft tension. Both ACL status and quadriceps force had significant effects on anterior tibial displacement, limits of AP displacement, axial tibial rotation, and graft tension, as shown by analysis of variance. Anterior cruciate ligament sectioning led to anterior tibial displacement in the absence of quadriceps force, whereas ACL reconstruction led to posterior tibial displacement. In the ACL-intact, quadriceps-stabilized state, anterior displacement of the tibia was observed between 95 degrees flexion and full extension, with a maximum displacement (3.5 +/- 0.2 mm) between 30 degrees and 45 degrees flexion. After ACL sectioning, anterior tibial displacement resulting from quadriceps force was accentuated relative to the intact state by as much as 4.5 mm +/- 0.9 mm at 20 degrees and 25 degrees flexion. Anterior tibial displacement in the ACL-intact and reconstructed specimens was similar when quadriceps force was present. In the quadriceps-stabilized state, graft tension increased between 5 degrees and 80 degrees flexion. The maximum increase in graft tension due to quadriceps force was at 35 degrees flexion.

Aged↗
PubMed1989

The use of functional knee braces in the control of pathologic anterior knee laxity.

Four designs of knee braces, Don-Joy 4 Point, RKS, Lenox Hill, and CTi, were evaluated in 42 patients with a unilateral knee brace. Brace migration was the predominant complaint, as noted in patient questionnaires. All braces tested reduced giving-way episodes (34 of 42 patients reported no giving way during brace usage). All four brands of braces reduced the grade of pivot shift (mean reduction = 0.8 grade). Instrumented laxity testing with the KT-1000 arthrometer was performed with an 89-N passive anterior displacement, high load passive anterior displacement, and a quadriceps contraction active displacement. Brace use decreased the measured pathologic anterior displacement on all tests. During functional testing with one-legged hop and 40-yard shuttle run, the mean values were not significantly changed by brace usage.

Adolescent↗
PubMed1988

Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee.

Orthopaedic surgeons routinely use passive tests, in which the displacing force is applied externally, to evaluate the integrity of the ligaments of the knee. Using a quadriceps active test, in which the muscle contractures of the subject served as the displacing force, tibial displacement was measured with an arthrometer in ninety-two subjects: sixty-seven who had an acute or chronic rupture of the posterior or anterior cruciate ligament and twenty-five who had normal knees. With the knee joint in 90 degrees of flexion, contraction of the quadriceps resulted in anterior translation of the tibia in forty-one of forty-two knees that had a documented disruption of the posterior cruciate ligament. This anterior translation did not occur in the contralateral, normal knee of the same subjects; in the knees of the twenty-five normal subjects; or in twenty-five knees that had a known unilateral anterior cruciate-ligament disruption.

Adolescent↗
PubMed1985

The measurement of anterior knee laxity after ACL reconstructive surgery.

An objective clinical instrument known as a knee ligament Arthrometer was developed. The instrumentation system was applied to measurements of knee ligament laxity in the operating room with the patients under anesthesia. Prereconstruction and immediate postreconstruction measurements were made with the patient still on the operating table. The change in laxity of the patient's operated knee as compared to the opposite nonoperated control knee was documented for 19 chronic and 24 acute patients. Four separate reconstruction types were studied in the operating room. The immediate postreconstruction measurements documented that all four of the reconstruction types were equally effective in the immediate restoration of normal laxity in the ACL-deficient knees. The Arthrometer proved to be a useful tool for confirming that each patient's normal knee laxity was reestablished in the O.R. by its reconstruction.

Humans↗
PubMed1985

Instrumented measurement of anterior laxity of the knee.

We performed instrumented measurement of anterior-posterior laxity of the knee in thirty-three cadaver specimens, 338 normal subjects, and eighty-nine patients with unilateral disruption of the anterior cruciate ligament. The test instrument was the Medmetric knee arthrometer, model KT-2000. We measured total anterior-posterior laxity, produced by anterior and posterior loads of eighty-nine newtons (twenty pounds), and the anterior compliance index. The total anterior-posterior laxity is composed of an anterior displacement and a posterior displacement; these are measured from a testing reference position, defined as the resting position of the knee after applying and then releasing a posterior load of eighty-nine newtons. The anterior compliance index is defined as the anterior displacement between an anterior load of sixty-seven newtons and one of eighty-nine newtons. All tests were performed with the knee held on a thigh support that placed the knee in 20 +/- 5 degrees of flexion. The mean anterior displacement at eighty-nine newtons was 5.7 millimeters in a group of normal subjects and 13.0 millimeters in a group of patients with a disrupted anterior cruciate ligament. Ninety-two per cent of the normal subjects had a left knee-right knee difference in anterior displacement of no more than two millimeters, while 96 per cent of the patients with a unilateral disruption of the anterior cruciate ligament had an injured knee-normal knee difference in anterior displacement of more than two millimeters. Ninety-three per cent of the normal subjects had a difference in the left-right compliance index of no more than 0.5 millimeter, and 85 per cent of the patients with unilateral disruption of the anterior cruciate ligament had a difference in the compliance index of the injured and normal sides of more than 0.5 millimeter.

Adolescent↗
PubMedDate not supplied

Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption.

Instrumented anterior/posterior laxity measurements were performed on 138 patients evaluated within 2 weeks of injury with their first traumatic knee hemarthrosis. All patients were tested with the MEDmetric Arthrometer model KT-1000 in a knee injury clinic. Seventy-five of the patients had knee arthroscopy. Thirty-three had arthrometer laxity tests under anesthesia. Eighty-seven percent of patients arthroscoped had anterior cruciate ligament (ACL) tears and 41% had meniscus tears. One hundred twenty normal subjects were tested to establish normal anterior laxity values. Three tests were used to evaluate anterior laxity: anterior displacement between a 15 and 20 pound force (compliance index), anterior displacement with a 20 pound force, and anterior displacement with a high manually applied force. Displacement measurements in normal subjects revealed a wide range of normal laxity with a small right knee-left knee difference. For example, the 20 pound anterior displacement range was 3 to 13.5 mm with a right knee-left knee difference (mean +/- SD, 0.8 +/- 0.7 mm). Eighty-eight percent of the normals had a right-left difference of less than 2 mm. In the 53 patients arthroscoped who had complete ACL tears, the anterior laxity measurements performed in the clinic were suggestive or diagnostic of pathologic anterior laxity in 50 patients.

Acute Disease↗