Nocardia osteomyelitis. Case report and review of the literature.
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Adult↗
Biomedical subjects
L C Almekinders
Publications and source records attributed to L C Almekinders.
Tibial subluxation in anterior cruciate ligament-deficient knees: Implications for tibial tunnel placement.
PURPOSE: This study was performed to determine whether subtle anterior subluxation occurs in anterior cruciate ligament (ACL)-deficient knees with the knee in full extension. TYPE OF STUDY: Radiographic evaluation of tibial position in ACL-intact and ACL-deficient knees. METHODS: Twenty-four subjects with arthroscopically documented ACL-deficient knees were compared with 20 subjects with arthroscopically documented ACL-intact knees. A previously reported method was used to evaluate the tibial position relative to the femur. RESULTS: Measurements on standing lateral radiographs revealed asymptomatic but significant anterior subluxation of the tibia compared with the ACL-intact subjects. CONCLUSIONS: The possibility of anterior tibial subluxation with the knee in full extension should be taken into account when deciding on tibial tunnel placement or when evaluating for postoperative graft impingement by the intercondylar notch.
Adult↗
Fixed tibial subluxation after successful anterior cruciate ligament reconstruction.
Anterior cruciate ligament reconstruction results in improved function and stability in many patients. However, it is not known whether the improved stability is associated with an improved tibiofemoral relationship. We used stress radiographs to determine not only stability but also the tibiofemoral relationship in 15 patients who had a clinically successful anterior cruciate ligament reconstruction. Their results were compared with those of 14 volunteers with normal knees. The average Lysholm score for the patients was 94. None of the patients had more than 3 mm of side-to-side difference on KT-1000 arthrometer testing. Maximal anteroposterior tibial translation as measured by stress radiography was slightly increased in the reconstructed knees but was not statistically significantly different (6.6 +/- 3.2 mm versus 5.0 +/- 3.3 mm). However, with a posteriorly directed stress the tibia in the reconstructed knees did not translate posteriorly to the same extent as did the control knees, resulting in a significant difference in tibial position (-1.2 +/- 3.0 mm versus -4.0 +/- 3.3 mm). Surgical anterior cruciate ligament reconstruction may result in reduced anteroposterior tibial translation, accomplished, in part, through restraining posterior translation, leaving the tibia with persistent subluxation. Fibrosis and contracture of the posterior structures may explain this phenomenon.
Anterior Cruciate Ligament↗
Healing of experimental muscle strains and the effects of nonsteroidal antiinflammatory medication.
The healing process of muscle strains and the effect of nonsteroidal antiinflammatory medication were studied using an experimental animal model. A standardized strain of the tibialis anterior muscle in adult male rats was produced by a controlled stretch of the muscle. Groups I and II underwent a unilateral strain of the tibialis anterior muscle and were immobilized in the postinjury period. The rats in Group II were fed piroxicam in the postinjury period. Group III underwent a sham procedure and were also immobilized. At 0, 2, 4, and 11 days postinjury both injured and contralateral control muscles were evaluated by determining tensile strength characteristics and histologic appearance. Group I showed a significant drop in maximum failure load to 25.7% of the control leg at Day 2 with a gradual return to the level of Group III at Days 4 and 11 (40.9% and 50.1%). Group II showed a similar drop but was still stronger than Group I at 2 days with 40.8% of the control leg and continued to drop until 4 days postinjury (33.7%). Histology showed a delay in inflammatory reaction and muscle regeneration in Group II. At 11 days both Groups I and II showed regenerated muscle fibers bridging the entire defect and an increase in endomyseal fibrosis. It is concluded that muscle strains continue to weaken in the early postinjury period. Non-steroidal antiinflammatory medication, such as piroxicam, might delay muscle regeneration.
Animals↗
An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy. A prospective, randomized, double-blinded study.
The potential benefits of a nonsteroidal antiinflammatory drug to 67 patients undergoing knee arthroscopy were evaluated in a prospective, randomized, placebo-controlled, double-blinded study. Group A received the drug (diclofenac, 75 mg twice daily) for 3 to 5 days before and for 7 days after surgery. Group B received a placebo preoperatively and the drug postoperatively. Group C received a placebo at both times. Codeine was available postoperatively for all patients if needed. Outcomes reported by the subjects included pain, crutch use, and return to activities. Outcomes assessed by physicians included knee effusion, range of motion, and gait. Knee flexion and extension strengths were measured isokinetically pre- and postoperatively. Pain scores on the 1st postoperative day were higher in Group C than in Group A. Pain scores at all other time points were not significantly different in the three treatment groups. Groups A and B required less codeine during the first 72 hours after surgery than Group C (mean, 2.9 +/- 1.0 versus 6.8 +/- 1.0 pills). Recovery of function, recovery of strength, and physical examination parameters were not significantly different in the three treatment groups. Diclofenac was an effective analgesic in the immediate postoperative period. Recovery from arthroscopy, however, was not enhanced by taking the drug.
Adolescent↗
An in vitro investigation into the effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts.
Soft tissue injuries due to repetitive motion are common sports injuries and are often treated with antiinflammatory therapies. We investigated the in vitro effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts. In addition, we studied the effects related to the presence of inflammatory cells. Repetitive motion was associated with an increased release of prostaglandin E2 and increased deoxyribonucleic acid (DNA) and protein synthesis. The presence of nonsteroidal antiinflammatory medication decreased prostaglandin E2 release and DNA synthesis but increased protein synthesis. Contact with macrophages caused a marked additional increase in prostaglandin E2 and a concomitant increase in DNA synthesis. Release of interleukin-6 by the macrophages also suggested that this cytokine plays a role in the response to repetitive motion. Our results can aid in the search for a more scientific approach to the treatment of soft tissue injuries associated with repetitive motion. They suggest that nonsteroidal antiinflammatory medication may have potentially negative effects during the proliferative phase of a healing since it was associated with decreased DNA synthesis. However, it may be beneficial in the maturation and remodeling phase since it stimulated protein synthesis.
Anti-Inflammatory Agents, Non-Steroidal↗
Patellar tendinitis: the significance of magnetic resonance imaging findings.
We evaluated the significance of magnetic resonance imaging findings in patients with patellar tendinitis. Midline sagittal magnetic resonance images were taken of 12 knees from 10 patients and of 17 knees from 15 age- and activity-matched subjects who underwent imaging for reasons other than patellar tendinitis. Of the 12 magnetic resonance imaging scans of knees with clinical patellar tendinitis, 3 (25%) exhibited no defect and only 7 (58%) had unequivocal intratendinous lesions. Among the 17 scans of subjects without clinical patellar tendinitis, 5 (34%) showed no defect and 4 (24%) had unequivocal intratendinous lesions. Proximal tendon width was significantly larger for the tendinitis patient group (5.0 +/- 1.7 mm versus 3.9 +/- 1.0 mm), although considerable overlap was present. All subjects with unequivocal intratendinous signal changes had a significantly longer nonarticular inferior patellar pole and were significantly older (38.1 years versus 26.8 years). Only Blazina stage III lesions were associated with abnormal findings on magnetic resonance imaging. As a whole, the sensitivity and specificity of magnetic resonance imaging was 75% and 29%, respectively. In younger patients with relatively mild symptoms, magnetic resonance imaging did not show significant changes; in older, active patients changes may be present in asymptomatic knees.
Adult↗
The effects of aging, antiinflammatory drugs, and ultrasound on the in vitro response of tendon tissue.
We investigated the effects of aging and various treatments on rat patellar tendon using an in vitro model. In the first part of the study, the 3H-thymidine and 3H-proline incorporation rates at 12 and 24 hours were determined in transected patellar tendon explants from young (21 days), intermediate age (8 to 10 weeks), and older (4 to 6 months) rats. In the second part, the same incorporation rates were measured in the older tendon explants in response to treatment with control medium, medium with a high and low concentration of indomethacin, and medium with a high and low concentration of dexamethasone. Finally, the effects of ultrasound treatment were measured and compared with a sham ultrasound treatment. The results indicated an age-dependent response of the tendon. The youngest specimens consistently showed the highest incorporation rates. The addition of a high concentration of dexamethasone resulted in a small negative effect on the 3H-thymidine incorporation. Ultrasound and indomethacin had no significant effects. This study indicates that aging is associated with a lower metabolic activity of tendon. In this model, currently used treatment methods failed to result in direct positive effects on tendon tissue, and a high concentration of dexamethasone appeared to have a small negative effect.
Aging↗
Tendinitis and other chronic tendinopathies.
Chronic tendon problems are common in orthopaedic patients. Relatively little is known about the etiology of these common problems and the efficacy of available treatments. It is believed that the cause of many injuries is repetitive mechanical trauma followed by an inflammatory response. Other factors, such as age-related degeneration and relative avascularity in the tendon, may play an important etiologic role as well. Histopathologic studies have generally revealed degenerative lesions consistent with tendinosis and/or inflammation of the peritendinous tissues consistent with peritendinitis. Initial treatment should focus on patient counseling and correction of associated mechanical factors, if present. Nonsteroidal anti-inflammatory drugs can give pain relief, but there is no convincing evidence that they alter the natural history. Corticosteroid injections can be used selectively in resistant cases, but recurrences are frequent. Surgery can be very successful when the affected tendon is treated directly.
Anti-Inflammatory Agents↗
Will we be able to repair osteoarthritic joints? New drugs and surgical techniques for cartilage problems.
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Anti-Inflammatory Agents, Non-Steroidal↗