Biomedical subjects

G C Terry

Publications and source records attributed to G C Terry.

27 records · Page 2Linked to original sources

PubMedDate not supplied

Analysis of subjective knee complaints using visual analog scales.

A questionnaire using a system of visual analog scales was developed for analyzing subjective knee complaints. This system was tested on 117 consecutive patients who had undergone knee surgery and 65 patients at their initial office evaluation of a knee disorder. The validity of and patient affinity for this type of questionnaire was compared with that of three other established subjective evaluation methods. The visual analog scale system was shown to be valid and comparable to other methods while offering several advantages. It brought greater sensitivity and greater statistical power to data collection and analysis by allowing a broader range of responses than did traditional categorical responses. It removed bias that was introduced by examiner questioning, and it allowed graphic temporal comparisons. Most importantly, patient affinity was higher for this type of subjective evaluation than for other methods.

Data Interpretation, Statistical↗

PubMedDate not supplied

How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement.

A knowledge of the patterns of injury to the components of the iliotibial tract allows a clearer interpretation of motion limits testing in patients with abnormal anterior tibial translation of the knee (anterior cruciate ligament-deficient knees). Eighty-two consecutive patients with acute knee injuries were classified as anteromedial-anterolateral rotatory instability (anterior cruciate ligament-deficient) based on the abnormal motion demonstrated by clinical examination tests for instability. At surgery, injuries to the intraarticular and extraarticular anatomic structures were identified and correlated to the abnormal grades of motion demonstrated by the knee motion limits examination. Tears of the anterior cruciate ligament occurred in 80 (98%) of the knees. However, the grade of abnormal motion demonstrated by the Lachman and pivot shift tests was quite variable. This variation did not correlate statistically with anterior cruciate ligament tears. Injuries to the anatomic components of the iliotibial tract were confirmed in 76 (93%) of the knees. These injuries correlated highly with variations in grades of abnormal motion detected by the following tests: lateral joint line opening at 30 degrees (r2 = 0.05); Lachman test (r2 = 0.08); pivot shift (r2 = 0.16); and anterior translation at 90 degrees of flexion (r2 = 0.34). Thus, injuries to the components of the iliotibial tract are thought to contribute to the variation in grades of abnormal motion observed in this complex subgroup of anterior tibial translation instabilities.

Acute Disease↗

PubMedDate not supplied

The quantitative measurement of normal passive medial and lateral patellar motion limits.

To quantify normal motion, medial and lateral passive patellar motion limits were measured in 67 high school athletes randomly selected from a group of 1340 athletes undergoing preseason physical examinations. Patellar displacement was measured at knee flexion angles of 0 degree and 35 degrees, using both a Patella Pusher (a hand-held force gauge) and a manual technique, and the results were compared. Demographic data and physical examination of the deceleration mechanism (Q angle, vastus medialis obliquus dysplasia, patella alta and baja, and valgus and varus alignment) were correlated with patellar motion limits. With the knee in extension, passive displacement of the patella averaged 9.6 mm medially and 5.4 mm laterally. In flexion, medial displacement averaged 9.4 mm and lateral displacement averaged 10.0 mm. No positive correlations were found between demographic data or deceleration mechanism examination parameters and patellar motion limits, suggesting that motion produced by the displacement force was limited by ligamentous restraints only. The clinical assessment of the passive limits of patellar motion should include examination at knee flexion angles of 0 degree and 35 degrees. The manually produced displacement was found to be more reproducible than displacement by the Patella Pusher (P < 0.05).

Adolescent↗

PubMedDate not supplied

Arthroscopically treated tears of the glenoid labrum. Factors influencing outcome.

Labral tears and associated glenohumeral ligament injuries were classified and treated arthroscopically in 83 patients. Transverse labral tears were the most common. Subtle increased glenohumeral translation was noted in 24% of patients. Glenohumeral ligament injury was present in 58% of the shoulders, with the middle and superior ligaments or middle ligaments alone most commonly involved. These ligament injuries were classified into different groups based on severity. Partial excision of the torn labrum was the primary treatment in all patients and was combined with glenohumeral ligament repair in 9 patients. Seventy-eight patients were available for subjective follow-up evaluation (average, 3.2 years), while 53 patients were objectively evaluated (average followup, 2.8 years). There were 14% excellent, 71% satisfactory, and 15% poor results. The main factor associated with poor results was a grade III glenohumeral ligament injury in which only partial excision of the torn labrum was performed. There was a positive correlation between injury to both the superior and middle glenohumeral ligaments and increased anterior translation demonstrated by preoperative stability testing at 60 degrees of humeral abduction in neutral rotation. We believe glenohumeral ligament injury is often associated with labral tears and arthroscopic partial labral excision is only effective in those patients who have grade I or II (less severe) glenohumeral ligament injuries.

Adolescent↗

PubMedDate not supplied

The biceps femoris muscle complex at the knee. Its anatomy and injury patterns associated with acute anterolateral-anteromedial rotatory instability.

We dissected 30 cadaveric knees to provide a detailed anatomic description of the biceps femoris muscle complex at the knee. The main components of the long head of the muscle are a reflected arm, a direct arm, an anterior arm, and a lateral and an anterior aponeurosis. The main components of the short head of the biceps femoris muscle are a proximal attachment to the long head's tendon, a capsular arm, a confluens of the biceps and the capsuloosseous layer of the iliotibial tract, a direct arm, an anterior arm, and a lateral aponeurosis. We examined 82 consecutive, acutely injured knees with clinical signs of anterolateral-anteromedial rotatory instability for the incidence and anatomic location of injuries to the biceps femoris muscle. Injuries to components of that muscle were identified in 59 (72%) of these knees; 29 knees (35.4%) had multiple components injured. There were 3 injuries to the long head of the biceps femoris muscle (all in the reflected arm) and 89 to the short head. A statistically significant correlation (P = 0.01) was found between increased anterior translation with the knee at 25 degrees of flexion as demonstrated by the Lachman test and injury to the biceps-capsuloosseous iliotibial tract confluens. Additionally, adduction laxity at 30 degrees of flexion correlated with a Segond fracture (P = 0.04). These data establish, in part, the relationship of the biceps femoris complex injury to anterior translation instability.

Adolescent↗

PubMedDate not supplied

Surgical correction of medial subluxation of the patella.

We evaluated the results of a surgical procedure to correct medial subluxation of the patella in 63 patients (65 knees), most of whom had undergone a lateral retinacular release. We performed a direct repair or a reconstruction of the lateral patellotibial ligament using locally available tissue such as strips of iliotibial band or patellar tendon. Followup averaged 53.7 months (range, 24 to 99). Outcome was based on the examiner's inability to clinically reproduce the patient's painful medial subluxation and on the patient's general impression of his or her improved functional status. Forty-four patients (68%) reported improvement in their functional levels and 49 (75%) reported that they were subjectively improved by the procedure. Overall, 50 patients (80%) had a rating of good or excellent. Six knees required a second surgical reconstruction because of failure to improve or because of a reinjury. Analysis of overall clinical outcome revealed no significant relationships based on the patient's age at the time of the initial procedure, sex, or length of followup (P > 0.10). Reconstitution of the lateral patellotibial ligament effectively corrected medial subluxation of the patella and long-term results of this salvage procedure were satisfactory.

Adolescent↗

PubMedDate not supplied

The posterolateral aspect of the knee. Anatomy and surgical approach.

Thirty cadaveric knees were dissected to obtain a detailed understanding of the anatomic structures of the posterolateral aspect of the knee, and a dependable surgical approach to evaluate injuries to these structures was developed and used on 71 consecutive patients who were operated on for posterolateral knee injuries. Three fascial incisions and one lateral midcapsular incision were used to provide surgical access. The following individual anatomic structures were identified: the layers of the iliotibial tract, long and short heads of the biceps femoris muscle, fibular collateral ligament, midthird lateral capsular ligament, fabello-fibular ligament, posterior arcuate ligament, popliteus muscle complex, lateral coronary ligament, and posterior capsule. This study increased our understanding of the individual anatomic structures and the relationships between these components. The surgical approach provided for the evaluation of these anatomic structures should aid the surgeon in properly assessing the injuries before surgical repair. This information should also stimulate more anatomic, biomechanical, and clinical studies of the posterolateral aspect of the knee.

Cadaver↗

PubMedDate not supplied

Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability.

Seventy-one consecutive patients with posterolateral knee injuries had clinical stability testing abnormalities documented prospectively. We compared these findings with the incidence and patterns of their injuries documented at surgery. An abnormal reverse pivot shift test was associated with injury to the fibular collateral ligament (P = 0.01), popliteal components (P = 0.01), and midthird lateral capsular ligament (P = 0.02). An abnormal posterolateral external-rotation test at 30 degrees of flexion was associated with injury to the fibular collateral ligament (P = 0.0001) and lateral gastrocnemius tendon (P = 0.01). An abnormal adduction test at 30 degrees of flexion was associated with injury to the posterior arcuate ligament (P = 0.02). The results of this study should alert the clinician to the possibility of injury to a specific anatomic structure when the corresponding clinical stability test is abnormal. Because the fibular collateral ligament was injured in only 23% of the knees in this large series of patients, we recommend that an injury to the fibular collateral ligament not be the sole determining factor in making the diagnosis of posterolateral injuries. The wide array of injuries to many individual anatomic components that we found indicates the complexity of injuries to the posterolateral aspect of the knee.

Acute Disease↗

PubMedDate not supplied

Winner of the AlbertTrillat Young Investigator Award. The effects of aggressive notchplasty on the normal knee in dogs.

We assessed the possible association between an aggressive intercondylar notchplasty and histopathologic, radiographic, and gait changes to the knee. Three groups of six adult greyhounds were observed for 6 months. Group I dogs had a sham operation. Group II dogs had a 4-mm notchplasty of the lateral femoral condyle where it articulates with the lateral tibial spine. Group III dogs had a 7- to 8-mm notchplasty of the lateral femoral condyle to simulate the long-term effects of an overly aggressive notchplasty. Force plate gait analyses were not significantly different for any dogs at 3 and 6 months. Histopathologic studies (hematoxylin and eosin and safranin O stains) revealed notchplasty area remodeling with a thin layer of lamellar bone covered by fibrous connective tissue. Both Group II and III dogs had significant loss of lateral femoral condyle and trochlear groove articular surface proteoglycans. The radiographic notch width index remained unchanged throughout the study for Group I; the indexes increased immediately after surgery in Groups II and III because of the notchplasty, but after 6 months these values returned to near-preoperative measurements. An aggressive intercondylar notchplasty caused articular cartilage histopathologic changes at 6 months consistent with those found in knees with early degenerative arthritis. Significant refilling of a non-impinged notchplasty occurred by 6 months after surgery. Our results raise concern about the effects of aggressive intercondylar notch widening in humans.

Analysis of Variance↗