PubMed Health⌕ Search

Biomedical subjects

J P Fulkerson

Publications and source records attributed to J P Fulkerson.

At least 19 recordsLinked to original sources
PubMed2000

Anterior knee pain in females.

There are clear differences between men and women regarding anterior knee pain. Anatomic factors including increased pelvic width and resulting excessive lateral thrust on the patella are primary factors that predispose females to anterior knee pain. Effects of estrogen on connective tissue synthesis have been reported, but there is no clear mechanism by which this would affect anterior knee pain. Postural and sociologic factors such as wearing high heels and sitting with legs adducted can influence the incidence and severity of anterior knee pain in women.

Female↗
PubMed1999

The female knee--anterior knee pain.

There are clear differences between men and women with regard to anterior knee pain. Anatomic factors including increased pelvic width and the resulting excessive lateral thrust on the patella are significant in female predisposition to anterior knee pain. Effects of estrogen on connective tissue synthesis have been noted, but there is no clear mechanism by which this would affect anterior knee pain. Postural and sociologic factors such as wearing high heels and sitting with legs adducted can influence the incidence and severity of anterior knee pain in women.

Arthralgia↗
PubMed1998

The effects of bone plug length and screw diameter on the holding strength of bone-tendon-bone grafts.

The effect of bone plug length and Kurosaka screw (DePuy, Warsaw, IN) diameter on graft holding strength of the bone-tendon-bone construct was determined. Random length porcine bone plugs were assigned to fixation with 7 or 9 mm Kurosaka screws. Peak load to failure was determined. There was a significant decrease in peak load to failure of the 5-mm long bone plugs compared with longer bone plugs. No difference was found between longer lengths of bone plug in either the 7- or 9-mm screw diameter groups. The 9-mm diameter screws significantly increased peak load to failure for both 1- and 2-cm bone plug lengths.

Animals↗
PubMed1997

Arthroscopy of the patellofemoral joint.

There are multiple causes of patellofemoral pain that can be difficult to differentiate. A careful history and physical examination along with appropriate radiographic evaluation lead to the correct diagnosis in most cases. Most patients respond to a comprehensive nonoperative program that emphasizes stretching and strengthening of the quadriceps mechanism. Arthroscopy should be used judiciously when approaching patellofemoral problems. Regarding alignment, arthroscopy offers little benefit but may provide visualization for lateral release to relieve tilt. Arthroscopy of the patellofemoral joint does provide valuable information about articular cartilage breakdown location, extent, and pattern, which may help with future treatment decisions. Arthroscopy is helpful in the diagnosis and treatment of plicae and in ruling out other intraarticular causes of knee pain.

Arthroscopy↗
PubMed1995

An alternative cruciate reconstruction graft: the central quadriceps tendon.

The central quadriceps tendon, above the patella, is thicker and wider than the patella tendon. Using precise technique, one can obtain a tendon graft for cruciate reconstruction with 50% greater mass than a patellar tendon bone-tendon-bone graft of similar width. The central quadriceps tendon graft may be harvested by a second surgeon while the first surgeon is simultaneously accomplishing notch-plasty and tunnel placement for cruciate ligament reconstruction. Consequently, this cruciate ligament reconstruction graft offers time savings as well as greater tendon volume. The central quadriceps tendon graft is difficult to harvest, with significant risk of entering the suprapatellar pouch and losing knee distension during ACL reconstruction. By careful adherence to the technique described in this article, the surgeon can obtain this reconstruction graft safely. It is important to recognize the anatomic subtleties of the proximal patella, which include a curved proximal surface, dense cortical bone, and closely adherent suprapatellar pouch. Proper technique is of utmost importance in obtaining this tendon graft safely and efficiently.

Anterior Cruciate Ligament↗
PubMed1993

Anterior knee pain--a symptom not a diagnosis.

A careful history and physical examination are the cornerstones of consistently successful diagnosis and treatment of anterior knee pain symptoms. Nonoperative treatment must be based on physical examination findings and should include both flexibility and strengthening. If an extended conscientious trial of nonoperative therapy fails to produce improvement, properly selected surgical procedures produce improvement in over 80% of cases. Realignment procedures, including lateral release, should only be proposed when malalignment can be documented. Although anterior knee pain has been called the "low back pain of the knee" by frustrated clinicians, effective treatment is likely when these principles are employed.

Diagnosis, Differential↗
PubMed1992

Comparison of initial pull-out strength of arthroscopic suture and staple Bankart repair techniques.

This study was performed to investigate the initial failure strength of arthroscopic suture and staple techniques use to treat recurrent anterior shoulder instability. Eight canine shoulder complexes were fashioned so that four 1-cm wide strips of capsule remained attached to the glenoid in each specimen (total of 32 test specimens) these specimens were tested to tensile failure on an Instron model 1331 testing machine either intact (n = 5), or after the capsule was sharply dissected off the bone and repaired with an arthroscopic staple (n = 11) or arthroscopic suture technique (n = 12). The control group failed at 17.75 +/- 7.14 kg, the suture repair at 11.0 +/- 2.56 kg, and the staple repair at 4.77 +/- 2.32 kg. These failure strengths were all statistically different from each other (p less than 0.0001). All failures occurred at the capsular bone interface. The authors do not advance one technique over the other but do advise surgeons to be mindful of the results when instituting early shoulder motion after arthroscopic Bankart procedures.

Animals↗
PubMed1992

Preoperative computed tomography scanning and arthroscopy in predicting outcome after lateral retinacular release.

We initiated a study to look at preoperative, flexed-knee, midpatellar computed tomography (CT) scans and intraoperative arthroscopic findings of lateral patellar articular degeneration in predicting the results after lateral retinacular release for failed nonoperative treatment of anterior knee pain. Twenty patients with 30 painful knees underwent preoperative flexed-knee, midpatellar CT scans that were retrospectively classified by the method of Fulkerson into normal alignment, lateral subluxation, lateral patellar tilt, and combined tilt and subluxation. Arthroscopy was performed before open lateral release. The lateral facet of the patella was graded as either minimal changes (Outerbridge I or II) or advanced (Outerbridge III or IV) changes. Patients were followed for a minimum of 2 years and graded on a standard patellofemoral rating scale. Only 22 of 30 knees that were thought to be clinically malaligned, actually were malaligned by CT scan; eight CT scans were interpreted as normal. The results were further stratified into group A (CT-documented tilt, minimal facet changes), group B (CT-documented tilt, advanced facet changes), and group C (normal CT). Ninety-two percent of group A were rated good or excellent. Twenty-two percent of Group B rated good/excellent, 33% fair, 44% poor. Only 13% of group C rated good (one patient). Based on the results of the study, we recommend lateral release for anterior knee patients with CT-proven patellar tilt who have not responded to conservative treatment and have minimal facet changes with minimal or no subluxation. Lateral retinacular release should not be offered as a treatment to the patient with a normally aligned patella because poor results will most likely result.

Adolescent↗
PubMed1992

Distal realignment of the patellofemoral joint. Indications, effects, results, and recommendations.

Effective treatment of patellofemoral malalignment is possible with precise diagnosis. This precision must begin with a thorough history and physical examination. Both nonoperative and operative treatment are guided by the specific patterns identified. Distal realignment procedures including anteromedial tibial tubercle transfer necessitate meticulous surgical technique to achieve maximal benefit with a low rate of complications.

Femur↗
PubMed1991

Operative management of patellofemoral pain.

In short, the surgical treatment of patients with patellofemoral pain will depend on understanding each specific disorder and the pattern of articular degeneration. Tilt alone generally responds well to lateral release. Subluxation, particularly when more severe, may require medial imbrication and/or a distal (Trillat) procedure in addition to lateral release to achieve extensor mechanism balance. When there is significant patellar arthrosis, an oblique osteotomy deep to the tibial tubercle will permit unloading of the patellar articular surface in addition to realignment. A small amount of metaphyseal bone placed in this oblique osteotomy will permit straight anterior displacement of the tibial tubercle of 15-20 mm with minimal bone graft when necessary. These basic surgical procedures will permit adequate treatment of most patients with resistant patellofemoral pain (with or without arthrosis) when non-operative measures have failed and the appropriate procedure is selected for a specific mechanical disorder.

Athletic Injuries↗
PubMed1990

Attachment of epiphyseal cartilage cells and 17/28 rat osteosarcoma osteoblasts using mussel adhesive protein.

These experiments show that mussel adhesive protein (MAP) enhances the attachment of osteoblasts and epiphyseal cartilage cells to plastic culture dishes and Vitallium. When MAP was applied to culture plate surfaces, there were two- to fivefold increases in the numbers of cells attaching compared to control surfaces (no MAP). Results were confirmed using two different cell attachment assay techniques. Osteoblast replication and culture on MAP is possible, suggesting that MAP is not toxic to cells. MAP also holds applied cells to surfaces as initially attached.

Animals↗
PubMed1989

Skeletal muscle hemangioma: a cause of unexplained pain about the knee.

Two cases of perplexing pain about the knee secondary to hemangioma of the vastus medialis are presented. The diagnostic criteria, pathological histology, and treatment are reviewed. Magnetic resonance imaging has distinct advantages over both computed tomography scans and angiography as a diagnostic tool.

Adult↗
PubMed1989

Evaluation of the peripatellar soft tissues and retinaculum in patients with patellofemoral pain.

Peripatellar muscle, retinaculum, and tendon must be examined carefully in every patient with patellofemoral pain. A hemangioma in the distal quadriceps can cause anterior knee pain. Patellar articular cartilage disruption is not consistently associated with patellofemoral pain, although chronic malalignment of the patella may eventually lead to cartilage damage. In many patients, before articular degeneration occurs, retinacular pain may evolve that is related to chronic stress in retinacular structures around the patella. Consequently, soft-tissue restraints around the patella should be evaluated completely and carefully in all patients with patellofemoral pain.

Biomechanical Phenomena↗
PubMed1988

Entrapment of the medial meniscus in a fracture of the tibial eminence.

Fracture of the intercondylar eminence of the tibia is unusual in adults. Long-term morbidity is uncommon. This is a case in which the anterior horn of the medial meniscus became entrapped in the fracture site after non-operative treatment of a completely displaced fracture, causing persistent medial knee pain. Arthroscopic release of the entrapped meniscus provided excellent relief of symptoms.

Adult↗