Biomedical subjects

Jay C Albright

Publications and source records attributed to Jay C Albright.

4 recordsLinked to original sources

PubMed2006

An analysis of the causes of failure in 57 consecutive posterolateral operative procedures.

PURPOSE: To investigate 57 failed posterolateral procedures in 30 consecutive knees to determine factors that may have contributed to the failure. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty patient records were reviewed by an independent surgeon. The index posterolateral operations were done for 13 acute and 17 chronic knee injuries. The anterior cruciate ligament was ruptured in 17 knees, the posterior cruciate ligament was torn in 5 knees, and both cruciates were ruptured in 8 knees. In 25 knees, 46 revision posterolateral procedures had been performed, of which 27 had also failed (in 21 knees). Five knees did not undergo revision of the posterolateral structures. RESULTS: In 22 knees, multiple factors were identified that most likely contributed to the failure of the posterolateral procedures. The most common factors were nonanatomical graft reconstruction (23 knees), untreated varus malalignment (10 knees), and failure to successfully reconstruct all ruptured knee ligaments, including cruciates (27 knees). Thirty-nine anterior cruciate ligament procedures were done in 24 knees, including 24 primary and 15 revision operations. Seventeen posterior cruciate ligament procedures were done in 13 knees, including 13 primary and 4 revision operations. At the time of writing, 16 of 24 knees had a functional anterior cruciate ligament graft and 5 of 13 had a functional posterior cruciate ligament graft. CONCLUSION: The results suggest greater emphasis during the index operation for anatomical graft reconstruction of one or more of the posterolateral structures as necessary, restoration of all ruptured cruciate ligaments, and correction of varus malalignment.

Adolescent↗

PubMed2006

Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function.

BACKGROUND: High tibial osteotomy has been associated with significant complications, including delayed union or nonunion, loss of correction, arthrofibrosis, and patella infera. HYPOTHESES: A technique for opening wedge osteotomy that incorporates an autogenous iliac crest bone graft will prevent delayed union or nonunion, allow early rehabilitation and weightbearing, and prevent knee arthrofibrosis and patella infera. Secondly, the authors' methods for calculating the desired correction of valgus alignment prevent undesired alterations in tibial slope. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 55 consecutive patients who underwent high tibial osteotomy were observed at a mean of 20 months postoperatively. Preoperative and postoperative measurements of radiographs were conducted by independent examiners for bony union, tibial slope, and patellar height. The osteotomy opening size ranged from 5 to 17.5 mm; 35 knees (64%) had openings < or =10 mm, and 20 knees (36%) had openings >11 mm. RESULTS: The osteotomy united in all patients. Three patients had a delay in union, which resolved by 6 to 8 months postoperatively. A loss of fixation occurred in 1 patient, who admitted to full weightbearing immediately after surgery; the osteotomy required revision. The iliac crest graft site healed without complications, and there were no infections, loss of knee motion, nerve or arterial injuries, alterations in tibial slope, or cases of patellar infera postoperatively. Full weightbearing was achieved at a mean of 8 weeks (range, 4-11 weeks) postoperatively. CONCLUSIONS: The operative technique including use of an autologous iliac crest bone graft in addition to a progressive rehabilitation program successfully prevented nonunion, change in tibial slope, and knee arthrofibrosis in this study.

Adult↗

PubMed2006

Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon.

In knees with insufficient or previously disrupted medial retinacular and patellofemoral ligaments caused by subluxation or dislocation, anatomic reconstruction of the medial patellofemoral ligament may be performed. This procedure involves harvesting of an 8 x 70-mm medial quadriceps tendon graft, which leaves the quadriceps tendon retinacular attachment intact and avoids patellar and femoral drill holes. This graft is passed beneath the retinaculum adjacent to the femoral epicondyle and is sutured to the medial intermuscular septum-a procedure that reproduces the medial patellofemoral ligament and is supported by imbrication of the remaining medial retinaculum. The tension of the graft and of the medial retinaculum is set at closure with the knee in 30 degrees to 45 degrees of flexion; this allows the patella to be moved a distance equal to 25% of its width. Avoidance of drill holes allows the procedure to be used regardless of skeletal maturity and reduces fracture complications, inadequate graft placement, and failure of fixation. Postoperative rehabilitation includes immediate knee motion from 0 degrees to 90 degrees and partial weight bearing.

Arthroscopy↗

PubMed2006

Medium-term follow-up of Achilles tendon lengthening in the treatment of ankle equinus in cerebral palsy.

INTRODUCTION: The optimal treatment for equinus of the ankle in ambulatory patients with cerebral palsy is not known. This study assessed the medium term follow-up results of treatment of spastic ankle equinus deformity in cerebral palsy using Hoke or coronal Z-lengthening of the Achilles tendon. It was hypothesized that the use of Achilles tendon lengthening (TAL) as a treatment for spastic ankle equinus during gait results in a high rate of over-weakening of the triceps surae resulting in crouch gait. We also investigated patient characteristics that could identify which patients are at risk for crouch gait due to triceps surae weakening from Achilles tendon lengthening. MATERIALS AND METHODS: Seventy-nine patients (114 procedures) who had undergone Achilles lengthening were retrospectively reviewed to determine how many patients developed crouch gait with dorsiflexion of the ankle throughout stance phase requiring anterior-floor-reaction bracing. The following patient characteristics were evaluated: age at surgery, geographic type of cerebral palsy, length of follow-up, need for anterior-floor-reaction bracing, length of time after surgery when brace was prescribed, age at time of need for bracing, side of surgery, technique used, additional procedures performed at time of TAL, previous or later procedures performed, and walking ability. RESULTS: The average age at the time of TAL was 7 years and 3 months, and the average follow-up was seven years. The geographic type of cerebral palsy greatly affected the outcome. None of the twenty-three hemiplegic patients required bracing. Fourteen of 34 (41%) patients with spastic diplegia and seven of fourteen (50%) patients with spastic quadriplegia required bracing. There was no significant difference in outcome between the Hoke and the Z-lengthening procedures. Patients who underwent more procedures and bilateral procedures were more likely to require anterior-floor-reaction bracing. CONCLUSIONS: Achilles tendon lengthening as practiced by the senior author results in a high rate of over weakening of the triceps surae as defined by the need for a floor reaction brace. Results are best in patients with hemiplegia and non-hemiplegic patients who require only single leg surgery, and who do not require concomitant or subsequent surgery. Alternative treatment, such as gastrocnemius fascial lengthening, or non-surgical treatment may be the optimal treatment of ambulatory patients with spastic diplegia and quadriplegia who have spastic ankle equinus during gait.

Achilles Tendon↗