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Biomedical subjects

J F Fetto

Publications and source records attributed to J F Fetto.

7 recordsLinked to original sources

The anterior cruciate ligament-deficient knee: a diagnostic and therapeutic algorithm.

The anterior cruciate ligament (ACL) of the knee is a common site of sports-related injury. The natural history of chronic instability, reinjury, and further intra-articular damage is well documented. Appropriate management of ACL insufficiency must be based upon a knowledge of the available diagnostic and therapeutic options, their indications, and their effectiveness. At the same time, the treatment plan must be tailored to the demands and expectations of the individual patient.

Algorithms

Functional outcome of hip fusion in the young patient. Follow-up study of 10 patients.

In the young patient, an osteoarthritic or osteonecrotic hip presents a challenging therapeutic problem. Until the long-term results of noncemented total hip arthroplasty are known, hip fusion provides an option to cemented total hip arthroplasty in the young patient with hip disease. The authors describe the outcome of hip fusion in 10 patients with an average follow-up period of 8.5 years. Seventy percent of the patients had a good or very good result with pain relief, and 90% or more had a good or excellent functional result with support aids, ambulation, and climbing stairs. All 10 patients were subjectively satisfied with their hip fusion. A lower incidence of pain in the contralateral hip, ipsilateral knee, and lower back was noted at 8.5 years than that reported at long-term follow-up evaluation and was associated with a satisfactory anatomic position of hip arthrodesis.

Adult

Injury to the anterior cruciate ligament producing the pivot-shift sign.

The clinical entity termed the pivot shift was studied in cadaver specimens and its significance was evaluated. It was found to be highly correlated with a tear of the anterior cruciate ligament, and it corresponded to a sudden anterior-internal rotation subluxation-dislocation of the tibia and posterior horn of the lateral meniscus beneath the lateral femoral condyle.

Adolescent

Medial collateral ligament injuries of the knee: a rationale for treatment.

Isolated MCL I and MCL II lesions evidence good recovery of integrity and function under non-operative modes of treatment. Isolated MCL III lesions may also be treated by non-operative management, but with the expectation of a slightly less successful result. However, there is an 80% incidence of concomitant ligament injury with this grade of lesion. The prognosis following injury to the MCL is significantly influenced by the presence of concurrent compromise of other ligaments, particularly that of the anterior cruciate ligament. Resolution of knee instability and dysfunction following a mixed MCL injury of any grade severity is best accomplished through operative intervention. Therefore, it is the authors' opinion that isolated MCL III and all mixed MCL lesions are best managed with operative treatment. Because of the apparent influence compromise of other ligament structures have on the recovery of MCL function, an attempt must be made to repair all acutely injured structures at the time of surgery. The keystones of a satisfactory result are early and accurate diagnosis, prompt treatment, and when indicated, complete surgical repair.

Adolescent

Knee ligament injuries: a standardized evaluation method.

An analysis of the data with total scores in non-acute terms obtained from 280 patients suggests that knee injuries can be evaluated as: Good-Excellent=generally normal or near normal function, with few or no signs and minimal symptomatology, 41-50 points; Fair (+)=slight functional disability, with few signs and mild symptomatology, 36-40 points; Fair (-)=moderate functional disability, with significant clinical signs and moderate symptomatology, 31-35 points; Poor=severely disabled, with marked signs and symptoms of a compromised knee, less than 30 points. These gross categorizations correlate well with the patient's own evaluations of his condition and the physicians' clinical assessment of the status of a given knee. Although the majority of patients have been followed for four years or less with this method, it is felt that the method presented has provided: A consistency and organization of the workup, diagnosis, treatment, and study of knee ligament injuries, not previously available at our institution; an objective measure of individual patient response to treatment and eventual recovery; in general, more objective means of assessing modalities of therapy and modes of primary repair and reconstruction of ligaments; a tool facilitating communication both among physicians and between physicians and patient; a means by which the long term follow-up of an individual patient by more than one physician can become a more efficient undertaking; an increasing data bank of standardized observations from which many ideas are yet to evolve; and most importantly, an improvement and the means possible for further improvement in the care rendered patients with knee ligament injuries; also, the present computerized format has given rise to additional benefits not directly related to the immediate problem of knee ligament injury. One such benefit is the ability to request and receive rapidly, a concise, yet complete legal summary of a patient's hospital course.

Athletic Injuries