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Biomedical subjects

Lin-Hsiu Weng

Publications and source records attributed to Lin-Hsiu Weng.

14 recordsLinked to original sources
PubMed2006

Long-term results of extracorporeal shockwave treatment for plantar fasciitis.

BACKGROUND: Extracorporeal shockwave treatment has shown mixed short-term results for plantar fasciitis. However, the long-term results are not available. HYPOTHESIS: Long-term results of shockwave treatment are comparable with short-term results. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: This prospective study consisted of 149 patients (168 heels) with an established diagnosis of chronic plantar fasciitis, including 79 patients (85 heels) in the shockwave treatment group and 70 patients (83 heels) in the control group. In the shockwave group, patients received 1500 impulses of shockwaves at 16 kV to the affected heel in a single session. Patients in the control group received conservative treatment consisting of nonsteroidal anti-inflammatory drugs, orthotics, physical therapy, an exercise program, and/or a local cortisone injection. Patients were evaluated at 60 to 72 months (shockwave group) or 34 to 64 months (control group) with a 100-point scoring system including 70 points for pain and 30 points for function. The clinical outcomes were rated as excellent, good, fair, or poor. RESULTS: Before treatment, the groups showed no significant differences in the scores for pain and function. After treatment, the shockwave group showed significantly better pain and function scores as compared with the control group. The overall results were 69.1% excellent, 13.6% good, 6.2% fair, and 11.1% poor for the shockwave group; and 0% excellent, 55% good, 36% fair, and 9% poor for the control group (P < .001). The recurrence rate was 11% (9/81 heels) for the shockwave group versus 55% (43/78 heels) for the control group (P < .001). There were no systemic or local complications or device-related problems. CONCLUSION: Extracorporeal shockwave treatment is effective and safe for patients with plantar fasciitis, with good long-term results.

Adult↗
PubMed2006

Three-year changes in bone mineral density around the knee after a six-month course of oral alendronate following total knee arthroplasty. A prospective, randomized study.

BACKGROUND: Bone mineral density decreases after total knee arthroplasty and is believed to affect prosthetic fixation. Treatment with alendronate has been shown to improve short-term bone mineral density after total knee arthroplasty; however, the long-term effects of this therapy are unknown. The purpose of this study was to evaluate the long-term effects of a six-month course of alendronate on bone mineral density after total knee arthroplasty. METHODS: Sixty patients were randomly assigned to receive either oral alendronate at a dosage of 10 mg/day for six months or no alendronate. The bone mineral density in the distal aspect of the femur and the proximal aspect of the tibia was measured preoperatively and at six, twelve, and thirty-six months after total knee arthroplasty. RESULTS: Fifty-four patients (twenty-nine in the alendronate group and twenty-five in the control group) completed the study. The alendronate group showed significant increases in bone mineral density in the distal aspect of the femur compared with the controls at six months (+4.8% and -14.2%, respectively; p < 0.01) and twelve months (+1.6% and -11.5%, respectively; p < 0.01). No significant difference in bone mineral density was detected between the groups at thirty-six months (-3.9% and -12.2%, respectively; p = 0.08). Similar trends in bone mineral density changes were also observed in the proximal aspect of the tibia. CONCLUSIONS: A six-month course of alendronate initially increased bone mineral density at six and twelve months after total knee arthroplasty, but no difference was noted after thirty-six months. The effect of alendronate on bone mineral density after total knee arthroplasty may be limited after discontinuation of therapy.

Administration, Oral↗
PubMed2005

Posterior cruciate ligament reconstruction using hamstring tendon graft with remnant augmentation.

Despite good early functional results, the posterior laxity of the knee is not completely eliminated after posterior cruciate ligament (PCL) reconstruction. The PCL can retain the normal tension only when the injured ligament is maintained anatomically. This article describes a technique of PCL reconstruction using hamstring tendon graft with PCL remnant augmentation. The harvested hamstring tendons were quadrupled, sized, and pretensioned before use. The PCL remnants and the synovium were preserved. Minimal debridement was performed to gain access to the insertion sites. The tibia and femoral tunnels were created with graft size-matched reamers. The graft was transfixed at 70 degrees of knee flexion with a 15-lb anterior drawer force on the proximal tibia. This surgical technique has several advantages. The hamstring graft acts as an independent PCL reconstruction and maintains the PCL remnant tension. The PCL remnants and synovium may be beneficial to ligament healing and postoperative rehabilitation. The procedure is technically feasible and cosmetically acceptable. The selection of autograft precludes the risks of allograft and artificial ligament. The short-term results are encouraging, but long-term results are needed to confirm the value of this technique for PCL reconstruction.

Arthroscopy↗
PubMed2005

The effect of shock wave treatment at the tendon-bone interface-an histomorphological and biomechanical study in rabbits.

PURPOSE: This study was performed to investigate the effect of shock wave treatment on the healing at tendon-bone interface in rabbits. MATERIALS AND METHODS: Thirty-six New Zealand White rabbits were used in this study. The anterior cruciate ligament was excised and replaced with the long digital extensor. The right knees (study group) were treated with 500 impulses of shock waves at 14 kV, while the left knees (control group) received no shock waves. Histomorphological studies were performed in 24 rabbits at 1, 2, 4, 8, 12 and 24 weeks. Biomechanical studies were performed in 12 rabbits at 12 and 24 weeks. RESULTS: There was significantly more trabecular bone around the tendons noted in the study group compared with the control group at different time intervals after 4 weeks (P<0.05). The contacting between bone and tendon was significantly better in the study group than the control group after 8 weeks (P<0.05). The tensile strength of the tendon-bone interface was significantly higher in the study group than the control group at 24 weeks (P=0.018), whereas similar modes of graft failure were noted between the two groups. CONCLUSION: Shock wave treatment significantly improves the healing rate of the tendon-bone interface in a bone tunnel in rabbits. The effect of shock waves appears to be time-dependent.

Animals↗
PubMed2005

Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone-grafting.

BACKGROUND: There is continuing controversy regarding the optimal treatment for patients with symptomatic early-stage osteonecrosis of the femoral head. We compared the results of noninvasive treatment with extracorporeal shock waves with those of core decompression and bone-grafting in similar groups of patients. METHODS: Patients with stage-I, II, or III osteonecrosis were randomly assigned to be treated either with shock waves or with core decompression and nonvascularized fibular grafting. The shock-wave group consisted of twenty-three patients (twenty-nine hips), and the surgical group consisted of twenty-five patients (twenty-eight hips). The patients in the two groups had similar demographic characteristics, duration and stage of disease, and duration of follow-up. The patients in the shock-wave group received a single treatment with 6000 impulses of shock waves at 28 kV to the affected hip. The evaluation parameters included clinical assessment of pain with a visual analog pain scale, Harris hip scores, and an assessment of activities of daily living and work capacity. Radiographic assessment was performed with serial plain radiographs and magnetic resonance imaging. RESULTS: Before treatment, the two groups had similar pain and Harris hip scores. At an average of twenty-five months after treatment, the pain and Harris hip scores in the shock-wave group were significantly improved compared with the pretreatment scores (p < 0.001). In this group, 79% of the hips were improved, 10% were unchanged, and 10% were worse. Of the hips treated with a nonvascularized fibular graft, 29% were improved, 36% were unchanged, and 36% were worse. In the shock-wave group, imaging studies showed regression of five of the thirteen lesions that had been designated as stage I or II before treatment and no regression of a stage-III lesion. Two stage-II and two stage-III lesions progressed. In the surgical group, four lesions regressed and fifteen (of the nineteen graded as stage I or II) progressed. The remaining nine lesions were unchanged. CONCLUSIONS: Extracorporeal shock-wave treatment appeared to be more effective than core decompression and nonvascularized fibular grafting in patients with early-stage osteonecrosis of the femoral head. Long-term results are needed to determine whether the effect of this novel method of treatment for osteonecrosis of the femoral head endures.

Adult↗
PubMed2004

Arthroscopic single- versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft.

This prospective study compared the clinical results of single- and double-bundle posterior cruciate ligament (PCL) reconstruction with a minimum follow-up of 2 years. There were 35 patients including 19 single- and 16 double-bundle posterior cruciate ligament reconstructions using hamstring autograft. The average age was 29.4 +/- 13.6 years versus 28.2 +/- 10.4 years; and the average follow-up was 41.0 +/- 13.1 months versus 28.1 +/- 4.2 months for single- and double-bundle reconstruction, respectively. The indication for surgery was functional disability of the knee due to pain and instability as the result of high-energy PCL injury. The evaluation parameters included functional assessment, ligament laxity, functional score and radiographs of the knee. The results showed no significant difference in functional assessment, ligament laxity, functional score and radiographic changes of the knee between the two techniques. The rate of overall satisfaction with the operation was comparable from patient and surgeon perspectives. Contrary to many recent reports, the results of this study showed that single- and double-bundle PCL reconstruction using hamstring autograft produced comparable clinical results in medium-term follow-up. The difference between single- and double-bundle PCL reconstruction, if any, can be concluded only with long-term results and larger number of patients.

Adolescent↗
PubMed2004

Comparison of autogenous and allogenous posterior cruciate ligament reconstructions of the knee.

This prospective clinical study was performed to compare the functional results and clinical outcomes of 32 autogenous and 23 allogenous posterior cruciate ligament (PCL) reconstructions with an average follow-up of 34 months. Both groups showed similar age, gender and follow-up time. The indications for surgery included knees with functional disability due to pain and instability from high-energy PCL injury with failure of conservative treatments. Arthroscopic single-bundle PCL reconstruction was performed with a similar technique in both groups with the exception of graft selection. All patients received the same postoperative rehabilitation. The evaluation parameters included functional assessment, ligament laxity, functional score, kinematics evaluation and radiographic examination. Autogenous and allogenous PCL reconstructions showed comparable functional results and clinical outcomes. No statistically significant difference was noted in ligament laxity and radiographic changes between the two groups. Complications were more prevalent with autogenous grafts. In conclusion, autogenous and allogenous tendon grafts are equally effective in PCL reconstruction.

Adolescent↗
PubMed2004

Prevention of deep-vein thrombosis after total knee arthroplasty in Asian patients. Comparison of low-molecular-weight heparin and indomethacin.

BACKGROUND: A prospective clinical study was performed to compare the efficacy of low-molecular-weight heparin and indomethacin for the prevention of deep-vein thrombosis after total knee arthroplasty in Asian patients. METHODS: One hundred and fifty patients undergoing total knee arthroplasty were randomly divided into three groups. One group consisted of fifty-one patients who received no prophylaxis with an anticoagulant (the control group), one consisted of fifty patients who received the low-molecular-weight heparin Fraxiparine (the Fraxiparine group), and the third consisted of forty-nine patients who received indomethacin (the indomethacin group). Bilateral ascending venography was performed preoperatively and at five, six, or seven days postoperatively. A third venogram was made at three months for patients who had had a deep-vein thrombosis. RESULTS: The prevalence of deep-vein thrombosis was 71% in the control group, 50% in the Fraxiparine group (p = 0.042), and 45% in the indomethacin group (p = 0.011). Only 28% of the deep-vein thromboses were symptomatic, and there were no pulmonary emboli. CONCLUSIONS: Compared with no prophylaxis, Fraxiparine and indomethacin significantly lowered the prevalence of deep-vein thrombosis after total knee arthroplasty. Prophylaxis against deep-vein thrombosis in the Asian population appears to be warranted. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed2004

Nonunion of the femur treated with conventional osteosynthesis combined with autogenous and strut allogeneic bone grafts.

BACKGROUND: In this study, we reviewed the results of conventional osteosynthesis combined with strut onlay allografts and autogenous bone grafts as the treatment for nonunion of the femur. METHODS: We conducted a retrospective study of 18 patients with nonunion of the femur treated with internal fixation (eight 95 degree fixed-angled blade plates, 7 intramedullary nails, 2 dynamic hip compression plates and screws, and 1 condylar buttress plate) and autogenous bone grafts and cortical strut allografts. There were 1.8 operations on average before surgery. The average time from the initial treatment of the fracture or osteotomy to surgery was 32.5 months. The average follow-up was 32.2 months. RESULTS: All 18 nonunions had healed by the time of follow-up. Positive intraoperative cultures (Staphylococcus epidermidis) in 2 patients were resolved by parenteral antibiotics with no additional treatment. Removal of implants was required in 5 patients because of screw irritation or bony union. One concomitant quadricepsplasty as well as 2 excisions of a protruding graft were required because of restricted knee motion or impingement. CONCLUSIONS: For difficult nonunions of the femur in the current study, strict adherence to the principles of the treatment of nonunion and the addition of strut allografts to enhance stability and repair potential proved to be a good alternative.

Adult↗
PubMed2003

Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.

Despite the success in clinical application, the exact mechanism of shock wave therapy remains unknown. We hypothesized that shock wave therapy induces the ingrowth of neovascularization and improves blood supply to the tissues. The purpose of this study was to investigate the effect of shock wave therapy on neovascularization at the tendon-bone junction. Fifty New Zealand white rabbits with body weight ranging from 2.5 to 3.5 kg were used in this study. The right limb (the study side) received shock wave therapy to the Achilles tendon near the insertion to bone. The left limb (the control side) received no shock wave therapy. Biopsies of the tendon-bone junction were performed in 0, 1, 4, 8 and 12 weeks. The number of neo-vessels was examined microscopically with hematoxylin-eosin stain. Neovascularization was confirmed by the angiogenic markers including vessel endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) expressions and endothelial cell proliferation determined by proliferating cell nuclear antigen (PCNA) expression examined microscopically with immunohistochemical stains. The results showed that shock wave therapy produced a significantly higher number of neo-vessels and angiogenesis-related markers including eNOS, VEGF and PCNA than the control without shock wave treatment. The eNOS and VEGF began to rise in as early as one week and remained high for 8 weeks, then declined at 12 weeks; whereas the increases of PCNA and neo-vessels began at 4 weeks and persisted for 12 weeks. In conclusion, shock wave therapy induces the ingrowth of neovascularization associated with early release of angiogenesis-related markers at the Achilles tendon-bone junction in rabbits. The neovascularization may play a role to improve blood supply and tissue regeneration at the tendon-bone junction.

Achilles Tendon↗
PubMed2003

Reducing the "killer turn" in posterior cruciate ligament reconstruction.

PURPOSE: Graft abrasion caused by sharp graft angulation at the graft-tunnel margin of the proximal tibia (the "killer turn") may cause graft failure after posterior cruciate ligament (PCL) reconstruction using the traditional anteromedial route tibial tunnel. One method to reduce the graft angulation is to use the anterolateral route tibial tunnel. However, less acute graft angulation may increase joint translation because of a decrease in graft compressive force. The purpose of this study was to compare the graft angulation and joint translation between anteromedial and anterolateral route tibial tunnels. TYPE OF STUDY: Biomechanical study. METHODS: Twelve above-the-knee amputation specimens were used in this study. Anteromedial and anterolateral tibial tunnels were made at the desired locations, and the same femoral tunnel was used. Graft angulation was measured by inserting a malleable pin into the tibial and femoral tunnels. Measurements of graft angulation were performed with the knee in extension and in 90 degrees of flexion. The joint translation was measured by the posterior translation of the tibia on the femur at 90 degrees of flexion with a 15-lb posterior force applied to the anterior proximal tibia after PCL reconstruction through the respective tunnels. RESULTS: The difference in graft angulation between anterolateral and anteromedial route tibial tunnels was statistically significant (P <.001); however, the difference in joint translation showed no statistical significance between the 2 tunnel routes. CONCLUSIONS: The anterolateral route tibial tunnel significantly reduced the sharp graft angulation ("killer turn") at the graft tunnel margin of the proximal tibia, but it did not increase the joint translation as compared with the traditional anteromedial route tibial tunnel. The anterolateral route tibial tunnel is thought to be a better choice when arthroscopic PCL reconstruction is performed with the tunnel technique.

Aged↗
PubMed2003

Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting.

BACKGROUND: The purpose of this retrospective study was to analyze the results of treatment of nonunions of the distal part of the femur with internal fixation combined with cortical allograft struts and autogenous bone-grafting. METHODS: Thirteen patients with a distal femoral nonunion were treated with open reduction and internal fixation combined with deep-frozen cortical allograft struts and autogenous iliac bone grafts. The level of nonunion was infra-isthmal in three patients and supracondylar in ten. Ten nonunions were fixed with a blade-plate or condylar buttress plate; two, with an antegrade locked nail; and one, with an antegrade locked nail and a compression plate. Seven unicortical, five bicortical, and one tricortical allograft struts, with an average length of 10 cm, were used. Autogenous iliac bone grafts were inserted into the nonunion site and between the allograft and host femur. The average time from the surgery to the latest follow-up examination was thirty-four months (range, twelve to seventy months). RESULTS: All nonunions united, at an average of five months. The average arc of knee motion improved from 45 degrees preoperatively to 73 degrees postoperatively. According to The Hospital for Special Surgery knee rating system, the average knee score improved from 20 points preoperatively to 71 points at the latest follow-up examination. Three patients had hardware removed after healing of the nonunion, and one patient underwent quadricepsplasty for knee contracture. There were no postoperative infections. Two patients had shortening of the limb of >2 cm. CONCLUSION: Open reduction and internal fixation supplemented with allograft struts and autogenous bone graft is an effective treatment for nonunion of the distal part of the femur. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed2003

The effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty.

BACKGROUND: Bone mineral density around the knee is related to the mechanical properties of bone. Alendronate has been shown to be effective for the treatment of osteoporosis and for reducing the rate of osteoporotic fractures. The purpose of the present study was to investigate the effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty in women. METHODS: Ninety-six women with an average age of seventy years who were undergoing total knee arthroplasty were randomly divided into two groups. Patients in the study group received oral alendronate at a dose of 10 mg/day for six months, whereas patients in the control group did not. The bone mineral density in the distal part of the femur and proximal part of the tibia was determined preoperatively and at six and twelve months postoperatively. RESULTS: In the control group, the bone mineral density showed significant decreases of 13.8% (p < 0.001) and 7.8% (p = 0.003) in the distal part of the femur and of 6.5% (p = 0.002) and 3.6% (p = 0.141) in the proximal part of the tibia at six and twelve months, respectively. In the study group, however, the bone mineral density showed significant increases of 10.0% (p = 0.010) and 1.9% (p = 0.049) in the distal part of the femur and of 9.4% (p < 0.001) and 5.4% (p = 0.032) in the proximal part of the tibia at six and twelve months, respectively. The overall differences in bone mineral density between the study and control groups were significant (p = 0.011 for the proximal part of the tibia, and p = 0.033 for the distal part of the femur). CONCLUSIONS: We found significant postoperative decreases in bone mineral density in the distal part of the femur and proximal part of the tibia in women who had undergone total knee arthroplasty. Oral administration of alendronate for six months postoperatively significantly improved the bone mineral density. While the clinical benefits of alendronate after total knee arthroplasty remain unproven and the duration of follow-up in the present study was quite short, the improvement in bone mineral density may have a clinically important effect on prosthetic fixation and the rate of periprosthetic fractures after total knee arthroplasty.

Absorptiometry, Photon↗