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Biomedical subjects

L C Almekinders

Publications and source records attributed to L C Almekinders.

At least 19 recordsLinked to original sources
PubMed2001

Impingement syndrome.

Pain from rotator cuff pathology is a common problem in upper extremity athletes. Impingement of the rotator cuff tendons on the subacromial arch is an important cause. Primary age-related degeneration and instability, however, should not be forgotten as causes for cuff pathology. Conservative treatment is successful in many athletes. Surgical subacromial decompression is reserved for resistant cases. Although often helpful, surgical treatment generally requires a long recovery for throwing athletes and can be associated with residual symptoms.

Acromion↗
PubMed2001

Operative versus nonoperative treatment of knee dislocations: a meta-analysis.

Although several studies have investigated the optimal treatment of knee dislocations, all have been composed of a small number of patients and therefore have made it difficult to draw definitive conclusions. The literature on knee dislocation was reviewed to allow a meta-analysis and determine whether operative or nonoperative treatment had better outcomes. Range of motion, flexion contracture, Lysholm score, instability, ability to return to preinjury employment, and ability to return to preinjury athletic activities were compared using statistical methods. A total of 132 knee dislocations treated surgically and 74 treated nonoperatively were included. Average range of motion was 123 degrees in the surgical group and 108 degrees in the nonoperative group (P<.001). Flexion contracture averaged 0.5 degrees for the surgical group and 3.5 degrees for the nonoperative group (P<.05). A significant difference (P<.001) also was found in the Lysholm scores, with a surgical group mean of 85.2 and a nonoperative group mean of 66.5. There was no significant difference in the ability to return to preinjury employment or athletic activity or in the amount of instability between the two groups. Surgical treatment appears to be associated with improved outcomes, although significant disability is still possible after successful surgical treatment.

Activities of Daily Living↗
PubMed2000

Outcomes of the operatively treated knee dislocation.

Despite being a serious injury with early complications associated with a high degree of morbidity, the outcomes of knee dislocations have improved dramatically since the days of Sir Astley Cooper. Currently, most authors favor early surgical reconstruction of the injured ligamentous structures. With modern surgical techniques and rehabilitation protocols, most patients are able to achieve functional range of motion and stability necessary for everyday life. Despite improvements in treatment, stiffness and pain, rather than instability, can be a problem. Patients continue to have difficulty returning to pre-injury levels of athletic competition and manual labor, although a significant number of patients have achieved these goals. As physicians, we must be knowledgeable in the current surgical techniques and rehabilitation protocols used in the treatment of knee dislocations, and the typical prognosis of the injury. By informing our patients of hurdles that they will be forced to overcome, in their path to recovery, before initiating treatment, patients will better understand the seriousness of the injury, which, it is hoped, will lead to compliance with their rehabilitation and thus better outcomes.

Activities of Daily Living↗
PubMed1999

Anti-inflammatory treatment of muscular injuries in sport. An update of recent studies.

Stretch-induced muscle injuries or strains, muscle contusions and delayed-onset muscle soreness (DOMS) are common muscle problems in athletes. Anti-inflammatory treatment is often used for the pain and disability associated with these injuries. The most recent studies on nonsteroidal anti-inflammatory drugs (NSAIDs) in strains and contusions suggest that the use of NSAIDs can result in a modest inhibition of the initial inflammatory response and its symptoms. However, this may be associated with some small negative effects later in the healing phase. Corticosteroids have generally been shown to adversely affect the healing of these acute injuries. Animal studies have suggested that anabolic steroids may actually aid in the healing process, but clinical studies are not yet available and the exact role of these drugs has yet to be determined. Studies on anti-inflammatory treatment of DOMS have yielded conflicting results. However, the effect of NSAIDs on DOMS appears small at best. Future research may have to focus on different aspects of these injuries as the emphasis on anti-inflammatory treatment has yielded somewhat disappointing results.

Animals↗
PubMed1998

Radiographic evaluation of anterior cruciate ligament graft failure with special reference to tibial tunnel placement.

Graft failure in anterior cruciate ligament (ACL) reconstruction can result from anterior placement of the tibial tunnel. Conventional radiographic evaluation of this problem does not take into account potential changes in tibio-femoral relationship caused by ACL instability. A retrospective radiographic evaluation of failed as well as successful ACL reconstructions was carried out. Both published radiographs as well as those obtained of patients treated by the authors were evaluated for tibial tunnel placement, roof impingement, and tibial position relative to the femur. In the second part of the study, the radiographs were obtained under standard conditions in both failed ACL reconstructions and normal knees. The results of both parts of the study indicate that lateral radiographs of the extended knee with ACL instability are likely to show subtle anterior tibial subluxation. The subluxation can give the impression of roof impingement on the graft. However, the majority of the failed knees had similar tibial tunnel placement compared with successful reconstructions and would appear unimpinged once corrected for subluxation. The diagnosis of graft impingement by the femoral intercondylar roof has to take into account potential tibial subluxation. Impingement as a cause graft failure may be less common than previously thought.

Anterior Cruciate Ligament↗
PubMed1998

Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature.

Tendonitis is a common diagnosis in sports medicine. The traditional view of tendonitis is a tendon injury resulting from repetitive mechanical load with a subsequent inflammatory response. The English literature from 1966 to the present on the etiology, diagnosis, and treatment of tendonitis was evaluated. There is some scientific support in the literature for the diagnosis of tenosynovitis and tendinosis as a pathologic entity. Actual inflammation of tendon tissue consistent with tendonitis has not been seen clearly in patho-anatomic studies. Conclusive evidence confirming that repetitive mechanical load is a major etiologic factor could not be found. Similarly, strength deficits, inflexibility, and improper equipment have not been studied in a controlled prospective manner. Other factors such as age and tendon vascularity have been consistently correlated with these injuries although their overall importance remains difficult to assess. There are no controlled studies on treatment through physical therapy aimed at flexibility and/or strengthening. Treatment with anti-inflammatory drugs has been studied extensively. However, only nine of 32 studies are prospective and placebo controlled. Some pain relief was found in five of the nine controlled studies, but healing of the tendon problem was not studied in these short follow-up studies. Twenty-three studies on steroid injections were found. Eight were prospective and placebo controlled studies, with three showing beneficial effects of the injection at follow-up. It was concluded that much of the pathology and etiology of tendonitis remains unclear. The possibility must be considered that current treatment methods may not significantly affect the natural history.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Post-operative problems following anterior cruciate ligament reconstruction.

Seventy adult patients were studied during the postoperative rehabilitation period following anterior cruciate ligament reconstruction in order to investigate the role of pre-, intra-, and postoperative factors in range of motion and graft problems. A standard bone-patellar tendon-bone autograft was used for the reconstruction. Pre- and intraoperative factors such as concomitant injuries, time from injury to surgery, age, sex, and tunnel placement were recorded. Tunnel placement was recorded on intraoperative radiographs of the final guide pin placement and compared to pin placement on cadaver knees. The results indicated a significant relation between early reconstruction (< 1 month) following the injury and range of motion problems during the early rehabilitation period (P < 0.001). This relation disappeared by the end of the first postoperative year. Prolonged surgery was also associated with early motion problems (P < 0.05). Graft laxity or failure was correlated with an earlier return of range of motion (P < 0.05). We hypothesized that graft failure can have a biologic cause rather than a mechanical one since intraoperative X-rays indicated a near-anatomic tunnel placement in this patient group when compared to ideal placement in the cadaver knees.

Adolescent↗
PubMed1994

Outcome in the treatment of chronic overuse sports injuries: a retrospective study.

Overuse injuries due to repetitive motion are common in recreational and elite athletes. Some overuse injuries resolve quickly after activity modification, but others can persist, which often prompts the patient to seek medical attention. This study retrospectively reviewed outcome and compliance in the treatment of chronic overuse sports injuries. One hundred and two patients were contacted by telephone an average of 27 months following their initial visit for chronic overuse injury. A questionnaire regarding the treatment and outcome was completed. Of this group, 38 (37%) claimed to be completely better, 28 (28%) were improved, but 36 (35%) were not better or worse. Anterior knee pain had a significantly worse outcome than any other injury (p < 0.05). Excluding anterior knee pain, 71% were improved or completely better. Neither activity modification nor combination treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy through stretching and strengthening exercises was associated with a better result. Noncompliance rates were 9% for NSAID therapy and 13% for exercise treatment. These results indicate that chronic overuse injuries are not always self-limiting but can result in prolonged symptoms.

Adolescent↗
PubMed1993

Osteomyelitis. Common causes and treatment recommendations.

Infections involving bone continue to be a common problem. In children this is usually an acute haematogenous osteomyelitis. Early diagnosis with culture of an aspiration specimen is of paramount importance. Treatment with antibacterial agents is often successful unless pus is obtained in aspiration. In cases with an established abscess, surgical drainage is often needed in addition to antibiotic treatment. Staphylococcus aureus is the most common causative organism, although other microbes are often found in special circumstances such as in neonates, patients with sickle cell disease and those with nail puncture wounds. In adults, a pyogenic osteomyelitis is often due to direct trauma and generally is chronic in nature. Surgical debridement is the mainstay of treatment in these cases. Antibiotic treatment is often helpful but not curative by itself. Fungal and mycobacterial osteomyelitis is especially common in immunocompromised hosts. Amphotericin B remains the preferred treatment for fungal infections. Long term antituberculous multiple drug therapy is often sufficient to treat mycobacterial osteomyelitis.

Adult↗
PubMed1993

Effects of repetitive motion on human fibroblasts.

Repetitive motion injuries such as tendonitis are common sports injuries. However, few scientific studies are available on the effects of repetitive motion on mesenchymal cells and the presumed inflammatory response. This study used a new in vitro model to study the effects of repetitive motion. Human tendon fibroblasts were subcultured and plated on culture wells with flexible bottoms. The cells were repetitively stretched using a micro-processor-controlled pressure unit that causes a cyclic deformation of the flexible bottom. The wells were divided in the following groups: group I controls without repetitive motion, group IIA repetitive motion with 0.25 strain at 0.17 Hz (10 cycles.min-1), group IIB repetitive motion with 0.25 strain and 0.17 Hz in presence of 25 microM indomethacin, and group III repetitive motion with 0.25 strain at 1 Hz (60 cycles.min-1). After 3 h of stimulation the supernatant fluids were harvested and evaluated for prostaglandin E2 (PGE2), leukotriene B4 (LTB4), and lactate dehydrogenase (LDH). The results showed significantly (P < 0.001) increased levels of PGE2 in groups IIA (46.9 +/- 4.7 pg.0.1 ml-1) and III (65.7 +/- 8.0 pg.0.1 ml-1). This represents a 1.3- and 1.8-fold increase, respectively, compared with the control group I (36.4 +/- 5.9 pg.0.1 ml-1). LTB4 was significantly (P < 0.001) elevated in the indomethacin-treated group IIB (45.0 +/- 11.0 pg.0.1 ml-1) compared with very low levels in all other groups. LDH was not significantly different in any of the experimental groups compared with the control group I. The results indicate that repetitive motion induces production of PGE2.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1992

Results following treatment of traumatic dislocations of the knee joint.

In a retrospective study, 31 patients were identified over a period of 25 years as having sustained traumatic knee dislocations without associated fractures. Three patients had early amputation secondary to vascular complications. Ten popliteal artery disruptions and five peroneal nerve palsies were diagnosed. At the time of follow-up evaluation (average, 40 months), 16 patients were examined. Operatively treated patients (n = 6) tended to have better motion (129 degrees) than nonoperatively treated patients (108 degrees). Varus instability was seen in only two patients treated nonoperatively. All patients except one experienced persistent functional limitations. Roentgenographic follow-up examination showed similar degenerative changes in both groups.

Activities of Daily Living↗
PubMed1991

Results of surgical repair versus splinting of experimentally transected muscle.

Complete muscle tears or transections can be treated by splinting or surgical repair. Although repair is often advocated in the young and athletic population, no well-controlled studies compare the results of splinting and surgical repair. I studied the effects of surgical repair versus splinting only of transected muscles in an experimental model. In group I (n = 14), a unilateral transection of the extensor digitorum longus (EDL) muscle of the Sprague-Dawley rat was treated with splinting only. In group II (n = 14), the muscle was surgically repaired as well. Active and passive strength measurements at day 7 and 14 showed an earlier return of passive strength in group II at day 7. No statistically significant differences at day 14 were noted. In this model, earlier return of active and passive strength occurred in surgically repaired muscle disruption as compared with nonrepaired muscles.

Animals↗
PubMed1991

Tips of the trade #32. Gradual closure of fasciotomy wounds.

A technique of gradual closure of fasciotomy wounds is presented. At the time of fasciotomy, staples are placed at the edge of the fasciotomy wound. A large nylon suture is threaded through the staples in a pattern similar to the lacing of a shoe. Postoperatively, this suture is tightened daily; this results in gradual closure of the wounds without further surgery.

Fasciotomy↗
PubMed1991

Vertebral Candida infections. A case report and review of the literature.

Vertebral Candida infection in a 57-year-old woman became symptomatic three months following Candida septicemia associated with a central venous catheter. The infection was successfully treated with amphotericin B and ketoconazole. Review of the literature revealed 29 cases of Candida infection with vertebral involvement. Intravenous drug abuse and central venous catheters were identified as predisposing factors in 13 cases. An average delay from Candida septicemia until the time the patient sought treatment was 3.3 months. Antifungal agents generally resulted in resolution of the infection.

Candidiasis↗