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Biomedical subjects

L Engebretsen

Publications and source records attributed to L Engebretsen.

At least 55 records · Page 3Linked to original sources
PubMed1995

Patellar tendinitis--a case report of elongation and ossification of the inferior pole of the patella.

Patellar tendinitis is a condition that occurs in patients who are involved in repetitive use of the extension mechanism. The most common symptoms are pain at the inferior pole of the patella, and radiographic changes may also occur. This case report demonstrates an extreme example of elongation of the inferior pole of the patellar tendon. The ossification caused the patient pain, which was resolved with surgical removal of the bone.

Adult↗
PubMed1995

Comparison between two techniques for surgical repair of the acutely torn anterior cruciate ligament. A prospective, randomized follow-up study of 48 patients.

This prospective, randomized study was designed to evaluate the early outcome of ACL repair with biologic or synthetic augmentation. Forty-eight consecutive patients with an acute proximal rupture of the ACL were included. The repairs in 22 patients were augmented with the Kennedy Ligament Augmentation Device (LAD), while 26 patients received a repair augmented with an autologous bone-patellar tendon-bone graft. All patients followed a standard rehabilitation protocol. Follow-up evaluations at 1 and 2 years postoperatively were based on the Tegner activity level, Lysholm functional score, clinical instability tests and KT-1000 arthrometer measurements. There were no significant differences in activity level or functional score between the LAD and patellar tendon groups at the 2-year follow-up. Ten patients in the LAD group (46%) sustained reruptures of the ACL and LAD at the 2-year follow-up, while two patients in the patellar tendon group had a KT1000 side difference of 4 mm or more. However, none of the patients in the patellar tendon group had a positive pivot shift. During the first postoperative year, 8 patients (31%) in the patellar tendon and 2 in the LAD group (9%) underwent arthroscopic debridement for correction of an extension deficit. These range of motion complications were probably related to the anterior placement of the tibial tunnel and the conservative rehabilitation protocol. Because of the unacceptable high incidence of reruptures in the LAD group, we concluded that the augmentation technique with the LAD is unacceptable.

Adolescent↗
PubMed1995

Extraarticular transposition of the patellar tendon for anterolateral instability of the knee. Poor results in 52 patients after 5-14-year follow-up.

Several extraarticular surgical procedures have been proposed to eliminate the anterolateral rotatory instability of an anterior cruciate-deficient knee. We examined the outcome in 52 patients with an extraarticular transposition of the lateral third of the patellar tendon to the lateral femoral condyle. The mean follow-up time was 9 years. The evaluation was based on the patients' subjective assessment, the Tegner activity level score, range of motion, Lysholm functional score, assessment of knee instability using manual testing as well as arthrometer measurements, and weight-bearing radiographs. At follow-up, 37 patients stated that they had good-to-excellent knee function. The mean Tegner score dropped from a preinjury level of 7 to 5.43 patients had a good-to-excellent Lysholm score. 20 patients had a positive Lachman sign of grade 2 or 3, and 23 patients had a side-to-side difference of more than 3 mm as measured by an arthrometer. 17 had a positive pivot shift sign. 12 patients had meniscal resections performed after the primary operation, and 27 had radiographic evidence of arthrosis. Although the outcome of this technique is equivalent to or better than results reported for other extraarticular procedures, the recurrence rate of symptomatic instability and the deterioration of subjective knee function are too high.

Adolescent↗
PubMed1995

The clinical presentation of shoulder instability including on field management.

In the athlete, shoulder instability may result from external high-energy trauma or repetitive overuse. Our understanding of how shoulder instability may contribute to and result from shoulder injury has improved considerably during the past decade. In addition, the delicate balance between mobility and stability and the interrelationship between instability and rotator cuff disease make the clinical management of the unstable shoulder and its field treatment a challenge for physicians, therapists, trainers, and others responsible for the care of injured athletes.

Arm Injuries↗
PubMed1994

[Evaluation of the rotator cuff with magnetic tomography].

Rotator cuff tears are difficult to diagnose clinically, both in the acute and the chronic phase. Both conservative and surgical treatment give the best results if the injury is detected early. Magnetic resonance imaging (MRI) has recently been introduced for diagnoses of cuff tears. The purpose of this study was to establish the accuracy of MRI in relation to surgical findings in the same patient group. MRI was used in the diagnosis of 25 patients who later underwent surgery for injury to the rotator cuff. During the surgery, 19 total tears were identified, of which 15 had been described by MRI. MRI showed a sensitivity of 79% and a specificity of 83%. The predictive value of a positive test was 83%. In experienced hands, MRI is extremely accurate for detecting rotator cuff injuries, but ultrasonography should still be the first method of diagnosis in Norway, because of its accuracy when used by experienced practitioners, and its availability and low cost.

Adult↗
PubMed1994

Method for establishing and measuring in vivo forces in an anterior cruciate ligament composite graft: response to differing levels of load sharing in a goat model.

In order to determine the appropriate load history for optimal remodeling of an anterior cruciate ligament graft, methods for establishing and measuring the graft force due to an external load could be set to a preselected value in in vivo are required. Our objectives with this study were to (a) develop a method in which the graft force due to an external load could be set to a preselected value in a living animal, (b) show that this force could be maintained after fixation, and (c) determine what happens to the forces after the animal has functioned for as long as 2 weeks postoperatively, when differing levels of load sharing between the segments had been set at surgery. The anterior cruciate ligament was reconstructed in 12 goats with use of a bone-patellar tendon-bone graft and a synthetic augmentation device. The forces in the graft segments were established, at the time of surgical fixation, with use of a force-setting technique. In five animals, the tendon segment was set to carry 90% of the total graft force; in the remaining seven animals, the augmentation segment was set to share 90% of the total graft force. Graft forces were measured, with the use of buckle transducers mounted extra-articularly over the anterior tibia, under a 67 N anterior tibial load at 60 degrees of knee flexion before and after fixation and at 2 weeks postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Activation of the complement system and adverse effects of biodegradable pins of polylactic acid (Biofix) in osteochondritis dissecans.

Biodegradable pins of polyglycolic acid (PGA) or polylactic acid (PLA) have been used in the treatment of fractures and osteotomies during the past 5 years. Adverse effects reported have included swelling at the implantation site and sinus formation, considered to represent nonspecific foreign-body reactions. Recent reports, however, have shown severe reactions after intraarticular fracture fixation. Reactions in 2 patients, treated with polylactic pins for osteochondritis dissecans (OCD) in our hospital, prompted the present clinical investigation and further evaluation of the complement-activating potential of polylactic pins. 10 knees underwent arthroscopic fixation of an OCD-lesion with Biofix (PLA) pins. Clinical follow-ups were carried out at 2, 6, and 12 weeks and at 6 and 12 months. Blood samples were collected from 5 patients 9-24 months postoperatively for biocompatibility tests. Quantification of human C5a des Arg was performed with a recently developed sandwich ELISA technique, using neoepitope-specific monoclonal antibodies. 6 knees developed diffuse swelling and a prolonged postoperative course. 2 patients had a particularly prolonged course which could not be attributed to infection. Levels of C5a des Arg in plasma incubated in the presence of polylactic acid were higher than in plasma incubated in the absence of PLA. The high frequency of long-term postoperative inflammatory signs in these knees treated for OCD and the demonstration of a complement activation potential of PLA pins warrant further studies on the biocompatibility of this material. Until more information is available, we do not recommend intraarticular use of PLA pins.

Adolescent↗
PubMed1994

Intercondylar notch width and the risk for anterior cruciate ligament rupture. A case-control study in 46 female handball players.

We measured the intercondylar notch of the femur in female handball players from radiographs of 20 players with previous unilateral anterior cruciate ligament injury, and 26 controls without injury. The groups were comparable regarding age, height, weight and level of performance. Intercondylar fossa radiographs were obtained in a posteroanterior axial position. The anterior opening of the intercondylar notch was narrower in the healthy knee of the injured group compared to the controls. There was an increased risk of anterior cruciate ligament injury associated with decreasing notch opening: female handball players with 17 mm or less anterior notch width were 6 times more susceptible to anterior cruciate ligament injury compared to players with wider notch width.

Adolescent↗
PubMed1993

[Current principles in the treatment of knee ligament injuries].

Knee ligament injuries are the leading cause of disability from injuries occurring during sports. The incidence of these injuries is increasing in Norway, owing to greater participation in recreational and competitive sports. In Norway, the main contributor to anterior cruciate ligament injuries is European team handball where women who compete at a high level sustain a large number of injuries. This paper describes modern principles of diagnosis and treatment of these injuries, based on personal research and a review of the literature.

Athletic Injuries↗
PubMed1993

Maintenance of set force in anterior cruciate ligament grafts.

This study was undertaken to determine how accurately total graft force and load-sharing between graft segments could be set and maintained during augmented anterior cruciate ligament (ACL) reconstruction in the goat knee. Special procedures were developed to reduce the effect of tissue creep and to overcome difficulties in the setting of graft force. Five knees from goat cadavers were reconstructed using a bone-tendon-bone graft (PT) and a synthetic augmentation device (LAD). Prescribed levels of total graft force and load-sharing between the autograft and LAD were set under a standardized external joint load. Immediately after fixation, the set force declined an average of 9 and 3% in the LAD and PT, respectively. After three subsequent exercise sequences, the set forces fell from their initial level by an average of 25% for the LAD and 28% for the PT. An analysis of variance did not show the loss of force with exercise to be statistically significant. We conclude from this in vitro study that our method can be used to set forces in an ACL reconstruction with reasonable maintenance of load-sharing but that losses of approximately 30% of total graft force after exercise of the reconstructed joint are to be expected.

Animals↗
PubMed1993

Osteochondral lesions and cruciate ligament injuries. MRI in 18 knees.

Magnetic resonance images were obtained prior to arthroscopy and surgery in 18 knees with acute anterior cruciate ligament injury. The incidence of osseous lesions was assessed and the findings were compared with those at arthroscopy. A total of 28 osseous lesions were detected by MRI in 15 knees, but none of these were detected by radiographs or arthroscopy.

Adolescent↗
PubMed1993

Radiologic features of shoulder instability.

Roentgenographic studies in a patient with shoulder instability generally identify the presence of a Hill-Sachs lesion, the presence of bony abnormalities of either the anterior or posterior rim, the presence or absence of fractures, and thick pathologic changes in the joint structure, which not only may provide insight into the diagnosis, but also may give the clinician insight into whether these pathologic changes are likely to be improved with operative and nonoperative treatment modalities. Clearly, the anteroposterior view, particularly with internal rotation, seems important in the diagnosis of the unstable shoulder. The West Point axillary view seems to be a useful one to identify the presence of glenoid rim problems. An additional view, such as the Stryker notch view, may identify the extent and presence of Hill-Sachs lesion when this may not be present on the other two views. Computed tomography arthrography, magnetic resonance imaging scan, and stress testing probably has limited applicability in the routine roentgenographic diagnosis of the unstable shoulder.

Acute Disease↗
PubMed1991

[Patellofemoral pain. Diagnosis and treatment].

Patellofemoral pain is a frequent complaint among recreational and competitive athletes. Studies from Sweden and Norway among junior and senior high school students showed that every third to fourth student currently suffers, or has previously suffered, from patellofemoral pain. This paper presents current trends in diagnosis and treatment of patellofemoral pain. It describes the clinical examination, and discusses the additional information obtained from tests like radiography, CT and MT. Arthroscopy can establish the degree of cartilage damage and joint articulation, but should not be used as a general diagnostic tool. Treatment of patellofemoral pain should consist of patient education and a carefully designed rehabilitation programme emphasizing eccentric quadriceps exercises, primarily in close chain modes. A knee sleeve with a lateral cushion seems to alleviate symptoms in some patients. If the problems are not reduced by a well executed exercise programme over six months, surgical intervention should be discussed on the basis of a specific diagnosis. The article includes a review of recent studies on patellar shaving, spongialization, lateral release, proximal/distal realignment, tibial tubercle elevation and medialization, and patellectomy.

Athletic Injuries↗
PubMed1990

[Anterior cruciate ligament injuries in handball playing. Mechanisms and incidence of injuries].

A retrospective study was performed on 144 anterior cruciate ligament injuries sustained while playing team handball. The incidence of this severe injury was 1.8% per year or 0.82 injuries per 1,000 playing hours in female athletes playing at a high division level, mainly on synthetic surfaces. The risk in other groups, and when playing on parquet, was considerably lower. The injury mechanisms indicate that a major risk factor was too good friction between shoes and playing surface. 2/3 of the injuries were non-contact injuries, and only 1/10 were caused by foul play. Cutting and jumping were the most common causes of injury. Further research on friction between shoe and playing surface is recommended.

Adolescent↗
PubMed1990

[Primary suture of the anterior cruciate ligament at a county hospital].

25 patients with fresh anterior cruciate ligament ruptures were followed up 36 months after primary suture. Every fourth knee was unstable and in 20/25 of the patients the level of activity was reduced. The study indicates that a county hospital can obtain results comparable with those of university clinics when performing primary suture. The results may be improved by means of augmentation techniques in ACL injuries in the young, active population. It is concluded that also county hospitals equipped with orthopedic specialists should be able to carry out augmentation procedures in ACL tears.

Adolescent↗
PubMed1990

Factors affecting graft force in surgical reconstruction of the anterior cruciate ligament.

The effect of the maximum unloaded graft length (Lo) and femoral fixation hole location on graft force with the knee under anteriorly directed tibial loads was measured in five fresh cadaver knees with a reconstruction of the anterior cruciate ligament (ACL). The reconstruction was performed using a composite graft consisting of the semitendinosus and gracilis tendons augmented with the Kennedy ligament augmentation device (LAD). Buckle transducers were used to measure ligament and graft forces. The total graft force was adjusted to match the intact ACL at 30 degrees flexion using a force-setting method so that a standardized reference configuration could be repeatedly obtained. The graft force was highly sensitive to Lo, typically changing by 50% with a change in Lo of 3 mm. Variation in femoral hole location of 5 mm anterior, posterior, proximal, and distal to the anatomic position produced changes in graft force, particularly at 60 degrees and 90 degrees flexion; however, these changes were not statistically significant. The effect of femoral hole location varied considerably between knees. This variability makes predicting proper hole placement difficult, and suggests the need to adjust each knee at surgery to account for this variable femoral hole position sensitivity.

Adult↗