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Biomedical subjects

L E Paulos

Publications and source records attributed to L E Paulos.

At least 19 recordsLinked to original sources
PubMed1992

Biceps tendon and superior labral injuries.

Twenty-two patients sustained injury to the biceps tendon, rotator cuff interval, or superior labrum. Seven patients with "interval lesions" underwent biceps tenodesis, one biceps repair, and three subscapularis repairs. All were satisfied, although one tenodesis failed with distal biceps retraction. Key arthroscopic findings included biceps or subscapularis fraying. Thirteen patients with "S.L.A.P. (superior labrum anterior to posterior) lesions" underwent labral debridement. All but one obtained pain relief. Eight cadaveric shoulders exhibited extreme anatomic variability of the bicipital origin/superior labral attachment. Biomechanical study showed anterior-superior and posterior-superior labral strain with simulated biceps contraction to be greatest in shoulder abduction (p < 0.01). Biceps tendon strain was greatest in shoulder adduction (p < 0.05). A continuum of injuries to the biceps tendon exist, from the rotator cuff interval to the labral attachment. Key arthroscopic findings may assist in the difficult diagnosis of interval lesions. Individual anatomy and mechanism of injury may determine the site of the lesion.

Adult↗
PubMed1992

Complications of patellofemoral joint surgery.

The goal of patellofemoral surgery, as is true in any surgical procedure, is the maximum benefit with the least morbidity. It is imperative that the surgeon be aware of the potential complications of operating on the patellofemoral joint. It was with this goal in mind that this review was undertaken. Complications specific to surgical therapy for LPCS, malalignment, degenerative arthritis, and trauma were covered. Procedure-specific complications were discussed, as well as IPCS and reflex sympathetic dystrophy. Recommendations on how to avoid these complications were made. Specific treatment recommendations, where appropriate, were also put forth.

Femur↗
PubMed1991

Rehabilitation following knee surgery. Recommendations.

Satisfactory results following knee surgery can be obtained only through the combined efforts of the surgeon, patient and therapist. A rehabilitative plan is based upon consideration of the effects of disuse and immobility on musculoskeletal tissues, and knowledge of the healing requirements following injury and specific surgical procedures. A balance must be made between simultaneous demands for protection against undue stress to facilitate healing and the need for stress to retard atrophy of musculoskeletal tissue. A thorough review of these concepts forms the basis for a rational approach to rehabilitation after specific surgical procedures. The phasic approach to knee rehabilitation is based upon progression in a logical fashion through the chronology of immobility, range of motion, progressive weight bearing and strengthening exercises. The latter category can be subdivided into its own progression from isometrics, isotonics, functional exercises through isokinetics. The ultimate goal and final phase is a safe return to full activity. By integrating a thorough knowledge of the healing parameters of musculoskeletal tissues and the simultaneous coexisting needs for protection and controlled stress, specific rehabilitative programmes can then be designed for the most common surgical procedures including: anterior and posterior cruciate ligament reconstruction, meniscal repair and meniscectomy, lateral release and hyaline cartilage procedures.

Braces↗
PubMed1991

Anterior cruciate ligament reconstruction with autografts.

Arthroscopically assisted ACL reconstruction has undergone rapid development in recent years. Although achievement of stability has been well-documented in open ACL reconstructive procedures, improved results may be obtained by reducing operative morbidity. Arthroscopically assisted ACL reconstruction appears to offer significantly diminished morbidity and thus offers more predictable rehabilitation, at least initially, after surgery. Improvements in instrumentation continue to refine the precision of this technique. Proper graft selection is an important issue that is paramount to the evolution of ligament reconstruction surgery. Although the central third patellar tendon is presently the operation by which all new techniques must be compared, the use of nonautogenous grafts may complement arthroscopic reconstruction by allowing further reduction in surgical morbidity. In this article we have expanded on some of the advantages of arthroscopic ACL reconstruction, given an overview of arthroscopic techniques, and described the techniques we prefer.

Anterior Cruciate Ligament↗
PubMed1991

Prophylactic lateral knee braces.

Since the first reported use of knee braces for prophylactic purposes in 1979, these braces have gone through a period of widespread popularity and use, followed by increasing skepticism as to their effectiveness. Early use was unsupported by significant clinical or laboratory data. Multiple studies regarding prophylactic knee braces have since been presented in the orthopedic and sports medicine literature, often with conflicting findings and conclusions. A review is presented with the purpose of educating the reader to the historical use and investigation of these braces, along with recommendations for their future.

Athletic Injuries↗
PubMed1991

Radiographic assessment of instability of the knee due to rupture of the anterior cruciate ligament. A quadriceps-contraction technique.

We compared the results of a radiographic technique for the measurement of instability of the knee with those obtained with a KT-1000 arthrometer. The study was conducted on both knees of sixty patients who had a ruptured anterior-cruciate ligament in one knee, as well as in ten control subjects. The radiographic technique included the examination of a true lateral radiograph, made while the knee was in full extension and the quadriceps was maximally contracted, with a 66.7-newton downward force produced by a 6.8-kilogram weight suspended from the ankle. As demonstrated by both techniques, the maximum difference between the displacements of the right and left knees in the control subjects was 2.5 millimeters and the mean difference between the displacements in the two knees in the patients was 7.5 millimeters. In fourteen of the sixty knees in which the ligament was ruptured, the injury was acute. The forward translation of the medial side in these fourteen knees was compared with that in the forty-six knees in which the injury was chronic. The mean difference in the displacement of the medial side in the right and left knees was 3.5 millimeters in the fourteen patients who had an acute injury and 5.0 millimeters in the forty-six patients who had a chronic injury. Thirteen of the sixty patients had disruption of the posteromedial corner of the injured knee, and the translation of the medial side in these knees was significantly increased compared with that in the intact knees of the same patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The ballet technique shoe: a preliminary study of eleven differently modified ballet technique shoes using force and pressure plates.

Ballet dancers are vulnerable to various stress-related injuries; foot and ankle injuries are the most common. This study determined if the pressure across the foot could be more evenly distributed by wearing various modified technique shoes padded with PPT, Spenco, or Sorbathane, alone or in combinations. A professional ballet dancer performed a jump by taking a single step on his left foot, jumping and landing with his right foot on the force and pressure plates with each modified shoe plus one unmodified shoe. The results of this study revealed: (1) total force cannot be reduced, (2) center of gravity and the majority of the pressure is maintained over the first and second metatarsal heads, and (3) the modified technique shoe can more evenly distribute pressure to the medial arch and away from the toes, metatarsal heads, and heel.

Athletic Injuries↗
PubMed1990

[Arthroscopic surgery: meniscus refixation and meniscus healing].

The stabilizing function of the meniscus and the negative effect of a complete or partial meniscectomy have been demonstrated in many studies. On the other hand, it has also been shown that meniscus tears in certain locations can heal very well. The prerequisite is that the torn meniscus can be revascularized from the capsule. Revascularization can be achieved by stimulating the formation of new vessels, but also by the build-up of collagen after induction of fibrochondrocytes and fibroblasts. The requirements for meniscus reconstruction are: careful preparation of the tear, exact repositioning, and precise placement of the sutures. The additional activation of regenerating processes is promoted by using a fibrin clot. In this study, 54 patients underwent meniscus repair, but the results in this group that also received a fibrin clot are not included. In the case of longitudinal-vertical tears of the meniscus inside the 3-mm zone margin, it was decided that the procedure was indicated when tears longer than 1.5 cm were concerned. The inside-out technique was used. Subjective and objective examination of 52 patients showed that the clinical results were good to very good in 92%.

Adolescent↗
PubMed1990

Choosing functional knee braces.

Choosing a functional brace for knee injury is a complex issue complicated by a lack of quantitative research on the subject and an increasing number of braces currently on the market. The correct brace decision will be facilitated by a better understanding of knee injury biomechanics and by a thorough understanding of the choices available. The ultimate selection of a brace should be based on sound mechanical criteria and individualized for each patient. The brace must be mechanically effectual and one the patient likes, has confidence in, and will tolerate. In combination with aggressive rehabilitation, the functional brace can make a significant contribution to returning individuals to functional activity.

Anterior Cruciate Ligament↗
PubMed1990

Bracing for patellar instability.

Knee pain secondary to problems with patellar tracking is common. The initial treatment for these problems is conservative. Patellar orthotics have been used extensively to treat a variety of extensor mechanism problems. Millions of health care dollars are spent annually on the use of these braces. There are many different patellar orthotics on the market today. The use and design of most of these devices are unclear and often lack a solid biomechanical foundation. The practical mechanical function of these braces is to reduce the lateral displacement of abnormal patellofemoral tracking. Orthotics that are designed and tested using practical biomechanical principles for applying a medially directed force to the patella seem to have a role in treating patients with knee pain secondary to patellar malalignment and instability. Well-defined and controlled clinical studies of the use of patellar braces are lacking.

Biomechanical Phenomena↗
PubMed1990

In vitro assessment of prophylactic knee brace function.

In an attempt to evaluate the effectiveness of prophylactic knee bracing and to determine the influence of brace design and material characteristics on the protection of knee ligaments, a series of biomechanical studies were completed. The first series of tests were preliminary parametric tests of brace function utilizing cadaver limbs to understand the failure biomechanics of the medial restraints during low- and high-rate valgus-producing knee trauma. Static and dynamic mechanical properties of the braces were also studied. Finally, a limited series of brace/cadaver knee low-rate loading response tests were performed. With the information obtained from preliminary testing, an instrumented surrogate knee was developed and validated for lateral impact responses. The surrogate allowed for the measurement of ligament force time response during a controlled impact. Special impact facilities were constructed to allow the measurement and control of impact momentum. The effectiveness of six different prophylactic braces in preventing MCL and ACL injury was evaluated using the surrogate and impact facility. Impact parameters of mass, velocity, knee flexion angle, and limb restraint were varied to simulate different direct lateral impact conditions of game play. Testing results were normalized and expressed as an impact safety factor to allow for comparison of braces. An ISF of 1.5 (representing a ligament force reduction of 30%) was arbitrarily chosen as the minimum standard for brace performance. The majority of prophylactic knee braces tested proved to be biomechanically inadequate for protecting the MCl from a direct lateral impact. A few, however, appear to protect the ACL preferentially. In the case of a controlled, direct lateral blow, all but a few braces tested provided some beneficial protection to the MCL and ACL, but performed well below the standard 1.5 ISF level. Therefore, based on the biomechanical research, it is our opinion that the concept of prophylactic lateral knee bracing can be effective. We recommend that prophylactic braces not be abandoned, but rather improved, biomechanically validated, and further evaluated through well-controlled prospective clinical studies.

Anterior Cruciate Ligament↗
PubMed1988

The well-leg support.

The authors present a method of support for the well leg that allows total circumferential access to the knee, especially the medial and posteromedial sides. The method is inexpensive, easy to use, and safe. It appears to relieve stress on the lower back, which can occur with standard support. In addition, hyperextension of the hip and possible femoral nerve traction injury are avoided.

Arthroscopes↗
PubMed1988

Postsurgical care for arthroscopic surgery of the knee and shoulder.

The use of a consistent, organized, and individualized plan of postoperative care and rehabilitation has aided us in helping our patients achieve an early return to function while minimizing cost and time off work or sport. An integral part of this plan is a home program of therapy outlined by a physical therapist after surgery, but carried out largely by the patient with simple affordable home equipment or easily accessible gymnasium equipment. Well-motivated patients will make optimal use of time and effort in achieving their own goals of return to function with appropriate guidance.

Activities of Daily Living↗
PubMed1988

The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee.

Posteroanterior weight-bearing radiographs, made with the knee in 45 degrees of flexion, were compared with conventional radiographs for fifty-five patients who had surgical treatment for a lesion causing pain in one knee. Narrowing of the cartilage space of two millimeters or more was defined as indicative of major degeneration (grade III or IV). Comparison of the intraoperatively observed degeneration with the narrowing that was seen on the radiographs revealed that the posteroanterior weight-bearing radiographs that were made with the knee in 45 degrees of flexion were more accurate (p less than 0.01), more specific (no false-positives) (p less than 0.01), and more sensitive (fewer false-negatives) than the conventional extension weight-bearing anteroposterior radiographs.

Adult↗
PubMed1987

Discoid lateral meniscus: case report of arthroscopic attachment of a symptomatic Wrisberg-ligament type.

The symptomatic discoid lateral meniscus is a well-known congenital anomaly that is of three different types: complete, incomplete, and Wrisberg-ligament type. The Wrisberg-ligament type has no meniscotibial attachment posteriorly, and in the past has been treated by total (open or arthroscopic) meniscectomy. In this article, we review the literature and report a previously unreported case of arthroscopic peripheral attachment after central partial meniscectomy of a Wrisberg-ligament type discoid lateral meniscus, with documentation of healing at arthroscopic second look 1 year following surgery.

Adult↗
PubMed1986

Arthroscopic meniscal repair evaluated with repeat arthroscopy.

Arthroscopic meniscal repair is a technically feasible approach to the treatment of meniscal tears in young active individuals. To evaluate this premise, we repaired 29 minisci in 27 patients and then arthroscoped their knees 3 months later. Repairs were limited to displaceable longitudinal tears. In 16 patients ligaments were intact. Eleven patients were anterior cruciate ligament deficient, six of whom underwent concomitant ACL reconstructions. In two patients, bicompartmental tears were encountered. Under arthroscopic control, using curved cannulae, horizontal mattress sutures of absorbable monofilament were placed across the tear, out through the capsule, and tied over the fascia, deep to the skin. No arthrotomies were performed, and all portions of the menisci could be reached with this method. Twenty-four of 29 repairs healed completely; 5 healed partially (30 to 50% healing). Four of the five failed repairs occurred in unstable anterior cruciate ligament deficient knees.

Adolescent↗
PubMedDate not supplied

Current trends in repair and rehabilitation of complete (acute) anterior cruciate ligament injuries. Analysis of 1984 questionnaire completed by ACL Study Group.

Results of a 21 question survey, taken at the ACL Study Group meeting in 1984, present a composite picture of current practices in ACL reconstruction and rehabilitation. Forty-four of the 50 questionnaires were returned. Responses represented views from knee surgeons in the United States, Canada, Australia, Sweden, and Switzerland. These results were compared with a report of a 1980 international survey in which views of 40 knee experts from the United States, Canada, England, France, and Sweden were summarized. Questions on the two surveys were similar, particularly about rehabilitation. Although the time span between the two surveys was only 4 years, we can see both consistencies and changes. Responses about length of time between ACL repair and full range of motion (by 6 months) were essentially the same (88% in 1980, and 86.4% in 1984). However, changes were evident in length of immobilization (longer in 1980) and prescribing isometric contractions of quadriceps 1st week postoperatively (more frequently in 1980). Surgeons allowed patients to return to full activity sooner in 1980 than in 1984. Electrical stimulation was being used more frequently in 1984, and apparently the practice of simultaneous hamstring and quadriceps contraction has come into prominence since 1980 as it was not mentioned in the first survey. In 1984, 50% of the respondents indicated they prescribed it. Since standardized reporting systems are not established, we cannot do reliable statistical analyses on large samples. At the present time, making surveys with responses from similar groups every few years is the best available way to capture trends in treatment of ACL injuries.

Braces↗