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Biomedical subjects

J Lysholm

Publications and source records attributed to J Lysholm.

At least 19 recordsLinked to original sources

Local anti-type II collagen antibody production in rheumatoid arthritis synovial fluid. Evidence for an HLA-DR4-restricted IgG response.

OBJECTIVE: To investigate the production of type II collagen (CII) antibodies in the synovial fluid (SF) of rheumatoid arthritis (RA) patients, and to examine the HLA dependence of this local production. METHODS: The ELISPOT method was used for enumerating anti-CII-reactive cells. Serologic tissue typing was performed. RESULTS: Anti-CII-reactive cells were found in the SF of 16 of 31 patients, but not in any of the peripheral blood samples obtained in parallel. SF anti-CII antibody production showed no correlation with clinical parameters, but its frequency increased significantly with age. The IgG anti-CII response occurred exclusively in patients who were positive for HLA-DR4 and was significantly associated with DR4. CONCLUSION: Anti-CII production may be important in local immune complex formation. The indirect demonstration of a DR4-restricted T cell response to CII is an indication of a pathogenetic role of collagen autoimmunity in RA.

Adult

Results of arthroscopic acromioplasty related to rotator cuff lesions.

Seventy-nine patients with a history of the subacromial impingement syndrome were treated by arthroscopic acromioplasty. The results were evaluated with a new scoring system designed to assess subjective symptoms before and after operation. The outcome was related to the pathological lesions of the rotator cuff seen at arthroscopy and graded by our modification of the Neer classification. The overall results were satisfactory in 67%, with men having better results than women. Those with a history of injury did better than those without, and the results in those with partial or total cuff tears were better than those with intact cuffs. Since the state of the cuff affects the result, arthroscopy should precede acromioplasty.

Acromion

T-cell receptor V-gene usage in synovial fluid and synovial tissue from RA patients.

The question of whether there is a preferential use of certain V genes in T cells entering an inflamed joint has hitherto been studied mainly using unfractionated cells from synovial fluid and tissue respectively, and no clear answer to the question has yet been provided. Concomitantly, evidence has been provided that the use of V genes may differ considerably between CD4+ and CD8+ T cells, and consequently that detection of biased V-gene expression within an inflammatory lesion may require separate analysis of the two T-cell subsets. In this paper we have therefore studied T-cell receptor V-gene expression in rheumatoid arthritis by means of double stainings of synovial fluid and blood for available anti-TCR monoclonal antibodies and antibodies to CD4 and CD8, respectively. Double stainings were also performed with anti-TCR antibodies and antibodies to activation markers HLA-DR and IL-2R. A certain bias towards the preferential use of certain V genes was seen particularly in the synovial fluid samples within both the CD4+ and CD8+ T-cell populations, but no uniform pattern was evident among the 35 patients investigated.

Arthritis, Rheumatoid

The late course of acute partial anterior cruciate ligament tears. A nine to 15-year follow-up evaluation.

Twenty-two patients had an acute anterior cruciate ligament (ACL) tear. Nineteen patients were treated conservatively, except for associated injuries. In three patients, a reinsertion of the torn portion of the ACL was done surgically. All patients were reexamined after nine to 15 years with special emphasis on stability testing; this was done manually and with instruments. Knee function score and activity level were also measured. Standing roentgenograms with the knee in slight flexion were taken as well. At follow-up examination, none of the patients had needed ACL reconstruction. Knee function was good, with a mean Lysholm score of 93 points. Patients had changed activities from recreational team sports to light individual sports. Manual laxity values were similar to the values obtained at the time of initial injury. A 1-mm sagittal laxity increase was found on the injured knee with the Stryker laxity tester. Slight signs for osteoarthrosis were found in more than half of the knees, mainly in cases with chondral fractures or meniscectomy. In general, conservative treatment had a good long-term prognosis.

Activities of Daily Living

Arthroscopy for the diagnosis of shoulder pain.

Arthroscopy under anaesthesia was used to investigate 123 patients with painful shoulders. The clinical diagnosis was compared with the arthroscopic findings. Four types of rotator cuff lesions were found in which there were significant differences between sex and age. Instability detected under anaesthesia was an important cause of pain. These examinations proved valuable in the diagnosis of shoulder pain, particularly when the clinical diagnosis was uncertain.

Adult

Arthroscopy and stability testing for anterior shoulder instability.

The extreme manifestation of anterior shoulder instability is anterior dislocation. Minor anterior instability often gives rise to vague symptoms from which a diagnosis is difficult. The use of arthroscopy may increase diagnostic accuracy in cases of anterior shoulder instability. Examinations were performed on 145 patients with shoulder complaints using stability testing under anesthesia and arthroscopy; of these, 62 patients were found to have anterior shoulder instability. The clinical signs were compared with the findings on stability testing and arthroscopy, and the morphological changes noted on arthroscopy were recorded. The combination of arthroscopy and stability testing proved valuable in the diagnosis of minor anterior instability and for the morphological changes and associated injuries in established anterior dislocations.

Adult

Proresid in the long-term treatment of rheumatoid arthritis.

Drug withdrawal rate and reasons for treatment termination were studied in a retrospective life-table analysis of patients with rheumatoid arthritis prescribed Proresid, a semisynthetic podophyllotoxin derivative. Two years after starting with Proresid medication, half of the patients were still on treatment. After 5 years the termination rate had risen to 71%. Gastrointestinal side effects were the most common reason for abandoning medication. The results are compared with those found in other studies of similar desing. It is concluded that Proresid is a valuable and well-tolerated disease-modifying drug for long-term treatment of rheumatoid Arthritis.

Actuarial Analysis

The effect of derotation braces on knee motion.

Four different types of derotation braces and an elastic knee support were tested on ice-hockey players. The elastic support did not noticeably affect rotation and abduction-adduction of the knee. All four braces reduced rotation and abduction-adduction in test actions simulating sports situations. Flexion-extension was slightly affected by two of the individually made braces in one action. Running a figure eight was slower with two of the individually made braces. The best braces, one individually made and one ready-made, limited rotation and abduction-adduction effectively, but did not affect performance. Minor differences in design may account for differences in effect and may alter the protection afforded by a brace.

Braces

Evaluation of cruciate ligament injuries. A review.

A good system for evaluating the degree of impairment, disability, and handicap of the patient with a cruciate ligament injury includes functional score, activity grading, stability testing, and measurements of performance and strength, all of which are relevant to different aspects of knee function. The symptom-related knee score gives a more differentiated picture of the disability than does a binomial rating of symptoms. A way of grading the disability in an objective way is to use a performance test. This test could also be used for monitoring rehabilitation before full activity has been resumed. The activity grading scale is very useful for grading the handicap.

Gait

The correlation between osteoarthrosis as seen on radiographs and on arthroscopy.

The correlation between arthroscopic and radiographic osteoarthrosis was studied in 63 patients (51 +/- 12 years) with degenerative changes in the medial compartment of the knee involving the medial meniscus with or without chondral damage. Chondral damage on arthroscopy was classified in grades 1-3 modified after Outerbridge. The radiographic evaluation was done according to Ahlbäck classification. Twenty-eight patients (44%) did not show any significant chondral damage on arthroscopy (grades 0-1). The radiographic findings in this group were usually normal. Three patients, however, showed a slight narrowing of the medial joint space (Ahlbäck I). All three had severely degenerated menisci, and two of them showed superficial fibrillation of both the tibia and the femur. Twenty-four patients (38%) showed a partial thickness chondral damage with fragmentation of the surface (grade 2). Radiographic findings were usually normal; however, patients with involvement of both the tibia and the femur often showed a joint space narrowing on radiographs. Eleven patients (18%) showed destruction of the cartilage down to subchondral bone (grade 3). The typical radiographic finding was a joint space obliteration (Ahlbäck II). Involvement also of the lateral compartment as assessed on arthroscopy was significantly more common in patients with 2nd and 3rd degree chondral disease and Ahlbäck II and III on radiographs than in those with 2nd and 3rd degree chondral damage and normal radiographs. In all but one of the patients with involvement of both compartments, the lateral compartment was considered normal on radiographic examination.

Adult

The relation between pain and torque in an isokinetic strength test of knee extension.

Twenty-five patients (20 +/- 3 years) with patella tendinitis were followed over an 8-week period in order to study the relation between quadriceps muscle torque, in a Cybex test, and knee pain on exertion. Each patient was examined on three occasions; at 0, 4, and 8 weeks. During the first 5 weeks the patient was put through a treatment program with initial rest, activity modification, and local injection of betamethasone or Arteparon. Half of the patients improved, with less pain and higher torque, and the rest experienced no change. There was a significant negative correlation between pain and torque, stronger to measurements at 30 degrees than at 180 degrees/s (r = -0.59 and -0.40). The linear regression analysis, however, revealed that the same relative difference in pain was equivalent to a bigger difference in torque at 180 degrees than at 30 degrees/s.

Adult

Simple tests for surveying muscle strength and muscle stiffness in sportsmen.

Thirty-nine elite runners were examined by Cybex II for thigh muscle strength. In addition, the maximal abduction, flexion and extension in the hip, dorsal flexion in the ankle, standing five steps, long and vertical jump, and side and front split were measured. For the latter five tests, an ordinary measuring tape was used. To establish reference values, 111 district level runners and 24 keep-fit joggers were examined by the three jump tests and the side and front split. Twenty randomly selected runners were examined twice to determine the reproducibility. The mean CV% was 1.9 +/- 1.4. There was a statistically significant correlation between the results in the vertical jump, the standing five steps, and long jump and muscle strength (P less than 0.001), in particular as to the values in the higher angle velocity. Furthermore, there was a correlation (P less than 0.001) between the results in side and front split and the hip. There was a covariation between the three ranges of motion, suggesting that stiffness in the hip was a general condition involving all directions of movements. The sensitivity for the jump tests and the side/front splits was 75%-91%. The specificity for the same test varied between 70% and 100%.

Adult

The correlation between arthroscopic findings and the patellofemoral pain syndrome.

For this study, 1,784 arthroscopies were analysed. Abnormalities of the patellofemoral joint consisting of patellar malalignment and/or patellar chondral damage were present in 175 (10%). Two types of lesion were identified, distinguished by the alignment of the patellofemoral joint, namely, subluxation with or without chondral damage (group I) and chondral damage without subluxation (group II). Group I (mean age, 25 years) included a greater proportion of women than group II; in 72%, the predominant clinical feature was patellofemoral pain syndrome (PFPS). Group II (mean age, 43 years) included fewer women; PFPS was found in only 32%, but in 82% there were signs of degenerative joint disease, which could explain the symptoms. Patellar subluxation was correlated to the PFPS, whereas chondral damage alone was not.

Adult

Strengthening exercises for old cruciate ligament tears.

Fifty-three consecutive patients with troublesome old cruciate ligament lesions underwent a 3-month thigh and calf muscle training program. Before training, the diagnosis was established by arthroscopy and clinical examination under anesthesia. Significant improvement in strength, performance, knee score, and activity level took place; the majority were improved and declined surgery. A period of strength training is recommended before the decision to undertake surgery for cruciate ligament injury.

Adult