Viable meniscal transplantation.
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Adult↗
Biomedical subjects
H Claessens
Publications and source records attributed to H Claessens.
Treatment of unstable fractures, dislocations and fracture-dislocations of the cervical spine with Senegas plate fixation.
The results of the anterior approach to the cervical spine for the treatment of fractures and dislocations by arthrodesis and Senegas plate fixation are described. Twenty-two patients underwent a one- or two-level arthrodesis of the cervical spine. Their mean age was 42 years. The injuries were subdivided using the radiological classification described by Harris. In the group of patients who presented with a complete neurological deficit below the level of injury, there was only one patient who deteriorated. X ray examination 1 year after surgery showed fusion in 17 patients (100%). In contrast to some recent cadaveric and animal studies in which the anterior approach and fixation were found to be less stable than posterior fusion, our results obtained with this method are excellent, despite the fact that post-operative immobilization was limited. Problems with the anterior approach did not arise in these 22 patients. Alignment was always acceptable and fusion was achieved within one year in all cases.
Adolescent↗
[Viable meniscus transplantation].
The integrity of the semilunar cartilages has proved to be the best safeguard against mechanical degenerative changes. One can postulate that restoring normal congruency between the femur and tibia with intact menisci would be the ideal solution to many mechanical knee problems. Several semilunar cartilages have been transplanted with good functional results in medial and lateral compartmental meniscal disease. However, this form of chondroprotection in the load-bearing area of the femur and tibia can only be properly evaluated after 10 to 20 years of follow-up. In order to obtain functional results, meniscal allografts have to be incorporated in the knee joint by intimate meniscofemoral synovial bonding. The synovial fibroblasts must grow into the collagen meshwork of the meniscal allograft. Such ingrowth has been shown in freeze-dried and deep-frozen meniscal allografts. However, in a small number of transplants shrinking has been observed on repeat arthroscopy at 6 months. Satisfactory incorporation of meniscal allografts has been obtained with fresh allografts, but availability remains a problem when this method is used for meniscal substitution. For this reason viable meniscal allograft implantation was initiated in a series of 25 patients and the value of this method studied. The meniscal allograft can be kept in an adequate semisynthetic nutrient medium for approximately 2-3 weeks without apparent loss of viability, during which period the appropriate recipient can be selected and prepared, a thorough laboratory screening can be conducted, and the culture results and disease transmission factors can be evaluated. In this way, live transplant hazards can be avoided, resulting in a higher success rate.
Adult↗
Treatment of tibial shaft fractures by interlocking nailing.
Between 1982 and 1986, 60 tibial shaft fractures were treated by interlocking nailing. Of these, 10 were complicated by a pseudarthrosis. The results were assessed after a minimum follow-up of 2 years and were found to be good both in patients with fresh fractures and with pseudarthroses; in only 3 out of 60 cases was the outcome poor. The advantages of the techniques include: its suitability for virtually all types of shaft fractures ease of surgery early mobilization and weightbearing, with a low risk of infection rapid consolidation. Relative drawbacks are: radiation exposure longer preoperative preparation involvement of the entire shaft if infection develops irritation of the patellar tendon.
Adolescent↗
Internal fixation of pathologic fractures. A retrospective study.
The records of 44 patients who underwent internal fixation for metastatic fractures between 1970 and 1989 were studied. Excluded were pathologic fractures involving the spine, pelvis, ribs and clavicles. None of the patients was still alive at the time of the study.
Adolescent↗
Vascularized bone transfer for tibial pseudarthrosis. Part I: Vascularized fibula transplantation. A report of 4 cases in the treatment of traumatic bone defects of the tibia.
The limited experience of reconstruction of four cases of large tibial defects with free vascularized fibular grafts is presented. Healing occurred in three of the four patients, and one developed a distal pseudarthrosis. One graft fractured twice but healed with a hypertrophic callus.
Adolescent↗
Kashin-Beck's disease.
A case of Kashin-Beck's disease is presented. It is an acquired, disabling, polyarthritic, degenerative condition of early onset, sometimes leading to a variable degree of dwarfism. It occurs endemically in certain Asian areas. Treatment is, if possible, preventive. In the established disease the therapy is that of any other form of secondary osteoarthritis. Reconstructive surgery and removal of loose bodies may be needed in severe cases (11). Early detection, facilitated by careful family history taking, is a prime requisite, especially in non-endemic areas (7).
Ankle↗
[Bone-patellar tendon-bone ligamentoplasty for the substitution of the posterior cruciate ligament].
The authors describe a technique in which a free patellar tendon graft is used for intraarticular reconstruction of the posterior cruciate ligament through an anterior and posterior approach. Only patients under 50 years of age with functional instability not responding to exercise therapy were elected for this type of surgery. Between November 1982 and May 1988, 12 patients were operated upon. In 9 patients the follow-up averaged 34 months. The subjective results were evaluated following the Lysholm rating system; the objective results were assessed by means of a clinical examination which was always performed by the same physician. The results were very encouraging and warrant a continued use of the technique with proper indications.
Adult↗
Prosthetic versus tendon allograft replacement of ACL-deficient knees.
ACL reconstruction is still controversial. Between November 1985 and October 1987, 57 ACL reconstructions were performed using a Dacron graft. Evaluation was done using the Lysholm rating system and Tegner scale. The Lysholm score averaged 84.2. Regarding the level of performance, the patients had lost an average of 2.1 points on the Tegner scale. 18 of the 57 patients developed a synovitis. In 11 patients (19 per cent) the implant had to be removed. CT scan of the operated knee proved the Dacron graft to be nonfunctioning in as many as 40 per cent of the patients. Because of this high complication rate, the authors started to use deep-frozen (-70 degrees C) tendon allograft material. Both Achilles and Tibialis Posterior tendons were implanted using the over-the-top technique with or without an additional extra-articular procedure. Complications as seen with the rigid synthetic ligaments were absent. The preliminary results seem satisfactory in that the functional demands placed on the knee are not restricted.
Adolescent↗
CT scan of the knee: correlation with clinical and arthroscopic findings.
CT was performed in a series of 150 consecutive clinically diagnosed meniscal lesions of the knee. Six to 12 contiguous slices, each 1 mm thick, were obtained starting from the tibial plateau and proceeding cranially to the intercondylar fossa. The medical imaging team was not informed of the medical history of the patients nor of the relevant clinical diagnosis. Arthroscopic findings were subsequently correlated with the CT findings. With the arthroscopic diagnosis defined as correct, a CT sensitivity rate of 80% was obtained. The specificity of the test was 93%. This study of 75 consecutive meniscal tears was designed to evaluate arthroscopic meniscal suturing using an inside-out technique.
Adolescent↗
Occipito-cervical fusion in rheumatoid arthritis.
Between 1977 and 1988 twenty-five patients with rheumatoid arthritis involving the cervical spine were treated by an occipito-cervical fusion. Twenty-two patients are included in this study. The main indications for surgery were intractable pain and progressive neural impairment. The operative procedure consisted of an H-bone graft fixed with steel wire in 19 cases, fusion of occiput-C2 six times and of occiput-C3 thirteen times. A Hartshill-Ransford (5, 12) loop was used in three cases: occiput-C3 twice and occiput-C7 once. The mean duration of follow-up was 3 years 8 months in 17 patients. Improvement of symptoms and signs was achieved in 88%. There were 2 post-operative deaths. The high rate of pseudarthrosis in our series was confirmed by several authors. The loop technique provides a more stable fixation and will be our technique of choice in the future.
Adult↗
Giant-cell tumor involving a lumbar vertebra. Long-term follow-up after radiotherapy.
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Adult↗
Treatment of the irreducible hip.
"Irreducible" congenital dislocation of the hip should not be regarded as a special pathological entity. Thirty-eight cases with a previous and failed treatment attempt were reviewed. Recognition of the renal cause of "irreducibility" (iatrogenic or anatomopathological) and institution of an appropriate treatment protocol result in adequate reduction in the vast majority of cases. However, osteochondritis is not an uncommon finding when the results of secondary treatment are evaluated. The percentage of more severe cases is higher after open procedures.
Hip Dislocation, Congenital↗
Open reduction and innominate osteotomy in the treatment of C.D.H. between 15 and 18 months of age.
In our department, sixteen patients with CDH (17 hips) have been treated with open reduction and innominate osteotomy. The children were between 15 and 18 months old at the moment of surgery and the follow-up period ranged from two to eight years. Fourteen hips had an excellent or good radiological evaluation. About 50% showed signs of minor growth disturbances or partial avascular necrosis. Clinical evaluation showed 7 excellent, 3 good and one fair result. There is a short period of treatment with this procedure and technical difficulties or major complications did not occur. One additional surgical intervention had to be carried out (a varus derotation osteotomy) after a mean follow-up of five years.
Female↗
Flucloxacillin compared with cefazolin in short-term prophylaxis for clean orthopedic surgery.
Two-hundred and fifty-two patients were included in a prospective, randomized, double-blind trial comparing the efficacy of flucloxacillin with that of cefazolin for clean orthopedic surgery. The preventive antibiotic regimen consisted of three 1-g injections perioperatively. There were 126 patients in each group, and the follow-up period was at least 6 months. Two deep (1.6%) and five superficial (4.0%) infections occurred in the flucloxacillin group. Three deep (2.4%) and five superficial (4.0%) infections developed in the cefazolin group.
Adolescent↗
Research in rehabilitation. Belgium.
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Belgium↗
Posterior subtalar joint arthrography. A useful tool in the diagnosis of hindfoot disorders.
Obscure hindfoot disorders are often classified under the heading of sinus tarsi syndrome (STS). The diagnosis of STS is based upon subjective symptoms: tenderness over the lateral aperture of the sinus tarsi and hindfoot instability. Arthrography of the posterior subtalar joint is an objective parameter, identifying peri- or intraarticular pathology as the cause of symptoms. In 27 patients with STS, the pathologic arthrographic findings include less-marked microrecesses in the sinus tarsi region, ganglions at the anterior aspect of the subtalar joint, retraction of the joint recesses, a smooth and rounded appearance of the capsule, and a frozen subtalar joint. Through analysis of these films, the appropriate therapeutic approach can be outlined; infiltrations into the sinus tarsi itself, intraarticular corticosteroid injections, or subtalar arthrodesis for resistant cases are the procedures of choice. In the authors' experience, surgical curettage of the sinus tarsi has no place in the treatment of STS.
Adolescent↗
Acetabular bone stock reconstruction with frozen femoral head allografts and the use of a cementless screw cup in total hip revision surgery. A 5 years' clinical, radiologic and scintigraphic follow-up.
This prospective study reviews the behaviour of a cementless conical screw cup in total hip revision surgery with or without the use of bone grafts to reconstruct acetabular bone stock. Clinical and radiologic results are given. For proper radiographic interpretation a new classification system is suggested, based on histologic features, the principles of which are explained. The results of auto- or allografts for the treatment of the same pathological condition are compared. The difference between both grafts successively in bone incorporation, biochemical behaviour, morbidity and mortality rate is discussed. The difference between a cancellous and a cortical bone transplant in the mechanism of repair is discussed. This study also analyzes acetabular bone graft activity using serial technetium-99m bone scans. Some guidelines for rehabilitation programs can be deduced from these observations. Finally, a correlation between graft incorporation and the acetabular deficiency to be reconstructed can be postulated.
Acetabulum↗