PubMed Health⌕ Search

Biomedical subjects

K E Jacobson

Publications and source records attributed to K E Jacobson.

10 recordsLinked to original sources
PubMed1999

Technical pitfalls of collateral ligament surgery.

The technical pitfalls of collateral ligament surgery include: Failure to properly diagnose and appropriately recommend surgery; posterolateral instability is the most commonly missed acute associated instability pattern Failure to correct all components of the injury (see Table 1): lateral meniscus, arcuate ligament, and popliteus, lateral gastrocnemius, and biceps muscles Failure to properly reattach and repair the damaged structures Peroneal nerve damage during the surgical approach and repair Wound problems: breakdown, hematoma Loss of motion This article presented a concise introduction to the anatomy of the collateral and capsular ligaments of the knee. This information should prove valuable in avoiding pitfalls in the diagnostic and surgical approach to the knee. To fully appreciate the anatomy, one must study it in the anatomy laboratory by performing repeated dissections. Only then can one appreciate how beautifully all of the structures function in unison. Application of this knowledge will help surgeons continue to improve and refine their approach to knee injuries.

Athletic Injuries↗
PubMed1995

Septic arthritis in a collegiate football player.

A 23-year-old collegiate football player reported to the training room the day after a game, complaining of severe pain in his right shoulder. He recalled no significant injury during the game. Physical examination revealed pain, tenderness, and apprehension with all attempts to palpate or move the joint. There was no obvious effusion, redness, or warmth about the shoulder joint. The neurovascular examination was negative, and x-rays revealed no fracture. The patient's temperature was 102 degrees F. The team orthopedist aspirated 10cc of purulent fluid from the joint. Subsequent analysis revealed a white cell count greater than 50,000 mm(3), but no organisms were seen. The diagnosis of septic arthritis was made on the basis of the elevated cell count of the joint aspirate, in conjunction with fever (102 degrees F) and the clinical findings of an excessively painful joint. The patient was admitted for arthroscopic irrigation and debridement of the joint. Cultures subsequently showed a light growth of a Gram-negative organism. The patient was treated initially with intravenous broad-spectrum antibiotics and was ultimately discharged and put on oral antibiotics at the time of discharge. Rehabilitation followed the usual protocol for diagnostic arthroscopy, and the patient made an excellent recovery. He has had no residual sequelae or recurrence of infection.

Journal Article↗
PubMed1995

A new operation for chronic lateral ankle instability.

We have treated 45 patients (47 ankles) for chronic lateral instability by a new reconstructive procedure. The operation includes lateral shift of the entire lateral capsule-ligament complex and proximal advancement of the talocalcaneal ligament and the inferior extensor retinaculum. We reviewed 39 patients (39 ankles) at a mean of 4.6 years (2 to 7) after operation. There were 29 men and 10 women with an average age of 27 years (19 to 43); 11 of them were competitive college-level athletes and 28 were recreational athletes. The functional rating was excellent in 26 patients, good in 8, fair in 3 and poor in 2. Thirty-six patients (92%) were satisfied with the result and 34 (9 of 11 college-level athletes and 25 of 28 recreational athletes) have been able to return to their preinjury level of sport. At the last review, there had been only three episodes of recurrent ankle instability, all in recreational athletes; none had required further surgery. The unsatisfactory results were associated with pre-existing degenerative changes in the ankle.

Adult↗
PubMed1994

Surgical treatment of diffuse pigmented villonodular synovitis of the knee.

Twenty-five cases of diffuse pigmented villonodular synovitis of the knee in 23 patients were reviewed to determine the results of surgical treatment. All the cases met strict histologic criteria for diagnosis. Long-term clinical follow-up data (average, 58 months) were available for all patients. One case for a patient who was treated by marginal excision recurred within one year. All other cases (initial and recurrent) were treated by total synovectomy, preserving the functional integrity of the knee. Proximal extensor realignments were performed in patients in which chronic distention had caused a redundancy of retinacular tissues. Adhesions, an early complication in eight patients, responded well to closed manipulation and did not adversely affect long-term functional outcome. The outcome was excellent in seven and good in 16 the patients. Two of the patients have had recurrences but have not had another operation. Using this technique, the recurrence rate (8%) and morbidity are significantly lower than those reported previously.

Adolescent↗
PubMed1992

Anterolateral impingement of the ankle.

Anterolateral impingement syndrome of the ankle is caused by entrapment of the hypertrophic soft tissue in the lateral gutter. The impingement process begins when an inversion sprain tears the anterior talofibular, and/or the calcaneofibular ligament. The ligamentous injury is not severe enough to cause chronic instability; however, inadequate immobilization and rehabilitation may lead to chronic inflammation in the ligament, resulting in formation of scar tissue. This tissue then becomes trapped between the talus and the lateral malleolus, causing irritation, pain, and further synovitis. The end result is chronic lateral ankle pain. Initial treatment involves physical therapy modalities and nonsteroidal anti-inflammatory medications. Those patients refractory to conservative treatment require arthroscopic debridement. A recent study has shown that arthroscopic debridement is successful in relieving pain and disability in high percentages of patients. Most patients were able to return to their previous levels of work and sports. Successful treatment of anterolateral impingement requires an accurate diagnosis with a clinical evaluation that excludes other causes of chronic ankle pain.

Ankle Injuries↗
PubMed1989

Diagnosis of anterior knee pain.

A methodical approach to the evaluation of patients with anterior knee pain is extremely helpful. By exploring salient points from the patient's symptoms and history and adding important data from a comprehensive physical examination, the pieces of the puzzle can be fitted together and an accurate diagnosis can be made. This will allow the formulation of a specific plan of rehabilitation that is designed with a knowledge of patellofemoral biomechanics and that will expedite the recovery process and facilitate a return to full function.

Humans↗
PubMed1989

Clinical presentation of complete tears of the rotator cuff.

To determine whether the presence and extent of a tear of the rotator cuff could be predicted on the basis of a patient's history, physical examination, and radiographic findings, detailed data from the histories and physical examinations of 103 patients who were known to have a tear of the rotator cuff were correlated with the radiographic and operative findings on these patients. An age-matched control group of fifty-one patients who had similar symptoms, but whose arthrograms showed normal results, was used to establish a baseline incidence of ten specific radiographic findings in the shoulder. Two discrete groups of patients who had a tear of the rotator cuff were identified. Twenty-eight patients (27 per cent) had a tear of a single tendon; the histories and the physical and radiographic findings in this group were consistent with a symptomatic local mechanical-impingement process in the shoulder. Sixty (80 per cent) of the seventy-five patients in the other group had a history of acute trauma to a shoulder. The patients in this second group were older and were non-athletic, and had not previously had symptoms that were severe enough to need treatment. These patients were subsequently found to have a complete tear of more than one of the tendons of the rotator cuff. Multiple radiographic findings in the shoulder and other coexisting orthopaedic conditions also were more common in these patients. In this group, we believe that acute trauma in a shoulder that had chronic degenerative changes, rather than localized mechanical impingement, caused the tendons to rupture.

Adolescent↗
PubMed1985

Chronic posterolateral rotatory instability of the knee.

Posterolateral rotatory instability of the knee, usually accompanied by other instabilities, is easily missed, misdiagnosed, and mistreated. The correct diagnosis requires a complete examination of the knee, including both the external rotation-recurvatum and posterolateral drawer tests. The most effective operative approach when the lesion is interstitial or at the site of the femoral attachment consists of advancing the arcuate ligament complex and its osseous attachment anteriorly and distally on the femur to support the arcuate ligament repair. When the lesion is distal and the arcuate ligament attachment to the tibia and fibula is loose, this area must be stabilized. In a consecutive series of 140 patients, 141 knees were reconstructed with this procedure. Ninety-five patients (ninety-six knees), with a follow-up of two to thirteen years, form the basis for this report. Seventy-one of the patients had undergone a combined total of 112 prior operations on the knee without functional recovery. After surgery directed at the arcuate ligament complex, eighty-two knees (85 per cent) were objectively rated as good; thirteen (14 per cent), as fair; and one, as poor. Subjectively, seventy-five (78 per cent) of the patients considered the result to be good; twenty-one (22 per cent), fair; and none, poor. Functionally, seventy-seven (80 per cent) of the knees were rated by the patient as good; sixteen (16 per cent), as fair; and three (4 per cent), as poor. This is the first report on the long-term results of reconstruction of the arcuate ligament complex for the correction of chronic posterolateral rotatory instability. The results demonstrate the effectiveness of the procedure.

Adolescent↗
PubMed1984

Evaluation of normal values for stationary and moving two-point discrimination in the hand.

Stationary and moving two-point discrimination were tested in a normal population stratified by age and sex. The 467 subjects tested consisted of 202 females and 265 males whose ages ranged from 4 years to 92 years. Statistical analysis of the data revealed the following: (1) Moving two-point values were of lesser magnitude than stationary two-point values in all areas tested; (2) test values for median innervated areas were lower by both methods than values for ulnar innervated areas; (3) there was a gradual increase in the magnitude of the test values for both methods with advancing age; (4) female subjects consistently tended to discriminate at shorter distances when compared with male subjects at corresponding sites; and (5) the absolute values obtained were dependent upon the individual examiner, but the statistical significance applied to the data of all of the examiners.

Adolescent↗