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Biomedical subjects

M Nakhostine

Publications and source records attributed to M Nakhostine.

11 recordsLinked to original sources
PubMed1995

Isolated avulsion of the popliteus tendon.

We report four patients with a mean age of 17 years (14 to 22) with external rotation injuries of the knee in slight flexion. Radiographs showed a small fragment in the area of the lateral femoral condyle. At operation, the fragment, consisting of the femoral insertion of the popliteus, was anatomically reduced and fixed. At a mean follow-up of 35 months all the knees had an excellent function score. An isolated lesion of the popliteus often presents as a tendon avulsion whereas major damage to the posterolateral corner of the knee involves combined ligamentous injuries. In patients with an acute haemarthrosis and lateral pain in a stable knee, the diagnosis of isolated avulsion of the popliteus tendon should be suspected. Arthroscopy with special attention to the lateral gutter is indicated. We advise anatomical reduction and fixation of the fragment to prevent possible long-term effects on other posterolateral structures.

Adolescent↗
PubMed1994

Effect of ankle position and a plaster cast on intramuscular pressure in the human leg.

Intramuscular pressure was measured with transducer-tipped catheters that had been inserted into the anterior and deep posterior compartments of the leg in seven healthy adults. Intramuscular pressure increased three to sevenfold (depending on the position of the ankle) in both compartments after the application of a plaster cast from the proximal part of the thigh to the malleoli. While the cast was in place, the baseline intramuscular pressure was elevated by the inflation of a tourniquet, which was located on the proximal part of the thigh, to a pressure of sixty millimeters of mercury (8.00 kilopascals). The intramuscular pressure in both the anterior and the deep posterior compartments was found to be lowest when the ankle joint was between the neutral and the resting positions (between 0 and 37 degrees of flexion). After the cast was bivalved and the opening on each side was spread approximately one-half centimeter, there was a significant decrease in intramuscular pressure of 47 per cent in the anterior compartment and of 33 per cent in the deep posterior compartment (p < 0.05 for both).

Adult↗
PubMed1993

The effects of non-weight-bearing and limited motion on the tensile properties of the meniscus.

Recent clinical studies have suggested that many of the complications of prolonged immobilization after knee surgery can be prevented by permitting early motion while minimizing loading of healing tissues. The purpose of this study was to determine the effects of such a regimen on the tensile properties of the meniscus. The right knee of 10 skeletally mature sheep received a sham operation after which the hindlimb was placed in a harness that prevented weight bearing while permitting limited knee motion. The left knee served as the nonoperated control. Twelve weeks after surgery, paired specimens from the medial meniscus of each limb were tested in tension with the load parallel to the circumferentially oriented collagen fibers. No significant differences in the modulus, tensile strength, and ultimate strain between treated and control medial menisci were identified. Our data thus suggest that preventing weight bearing while permitting even limited motion of the knee will prevent any detrimental effect on the tensile properties of the meniscus in the circumferential direction.

Animals↗
PubMed1993

Intramuscular pressure varies with depth. The tibialis anterior muscle studied in 12 volunteers.

Pressures in the tibialis anterior muscle were recorded at rest and during exercise with transducer-tipped catheters in 12 volunteers while they were supine or standing. The recordings were repeated with venous stasis created by an inflated tourniquet cuff on the thigh. Catheters were placed at 3 different sites in the muscle: catheter I adjacent to the deep surface of the fascia over the anterior compartment; catheter II between the fascia and the central tendon; and catheter III deep in the muscle close to the interosseous membrane. In both the supine and standing positions the intramuscular pressure at rest and the muscle relaxation pressure during exercise, obtained by catheter II, were greater than the corresponding pressures measured by the superficially located catheter I in the normal as well as in the volume loaded limb. The same conditions for pressure measurement consistently revealed lower pressures recorded by catheter III compared to II, but the difference was not significant. Our results indicate that intramuscular pressure increases centripetally, as the centrally lying tendon is approached. We conclude that pressure measurements for diagnosis of acute and chronic compartment syndromes and in ergonomic studies should be based on recordings from a standard location of the catheter within the muscle and a standard posture of the subject.

Adult↗
PubMed1993

A special high tibial osteotomy technique for treatment of unicompartmental osteoarthritis of the knee.

Tibial osteotomy is a well-established procedure for treatment of the varus osteoarthritic knee. A special new technique of oblique tibial osteotomy at the level of the tibial tubercle, preserving the medical cortex and iliotibial band, is presented which allows partial weight bearing the first postoperative day. Postoperatively the femorotibial alignment should be 5 degrees to 7 degrees of valgus in elderly patients. Because in younger individuals the intact iliotibial band is a strong restraint against varus deformity, we seek to correct to 3 degrees to 5 degrees of valgus in these patients. Of 172 cases treated with this technique between 1982 and 1986, 50 patients were retrospectively reviewed. After a follow-up period of 6 months to 3 years, pain was relieved in 46 patients. Complications consisted of 5 secondary wound healings, including 2 superficial infections, 1 tibial plateau fracture, and 3 varus recurrences.

Adolescent↗
PubMed1991

[Possibilities for treating chronic radius head dislocations].

Thirteen patients with neglected luxation of the proximal radius who were treated with different surgical procedures at the Orthopaedic Department of the Kantonsspital in St. Gallen (Switzerland) returned for evaluation at an average of 7 years postoperatively. The luxation was traumatic in 11 cases (7 Monteggia-fractures) and in 2 cases due to a dysplasia of the forearm. In 7 patients the deformity recurred and in 1 a synostosis between radius and ulna was noticed. In 4 cases the wrist showed a relative overlength of the ulna. Proximal osteotomy of the ulna in combination with open reduction of the proximal radius gave better results than the other procedures. Congenital luxation of the proximal radius does not cause much symptoms but surgical treatment often results in recurrence of the deformity. Therefore, we only occasionally advocate operative therapy in these cases.

Adolescent↗
PubMed1991

Effects of an in-substance conduit with injection of a blood clot on tears in the avascular region of the meniscus.

The purpose of this study was to test the hypothesis that healing of a stable tear in the avascular region of the meniscus occurs when a horizontal conduit, extending from the periphery to the defect, is filled with an exogenous fibrin clot. In 6 sheep a full-thickness laceration was made in the lateral meniscus, and autologous blood clot was then injected into the conduit. Three animals in the control group received identical meniscal tears but no additional treatment. Casting and a harness prevented weight-bearing and maintained the knee in a flexed position. Twelve weeks after the operation histologic examination revealed only partial healing in one animal. In both the experimental and control groups increased numbers of dividing chondrocytes on either side of the tear were seen. We conclude that an in-substance conduit in combination with the injection of a blood clot is not sufficient to facilitate complete healing of a tear within the avascular region of the lateral meniscus of the sheep when the knee is immobilized only with a harness.

Animals↗
PubMed1990

Effects of abrasion therapy on tears in the avascular region of sheep menisci.

This study was designed to test the hypothesis that abrasion of the parameniscal synovium aids healing of a stable tear in the avascular region of the meniscus in a sheep model. In six sheep, a 5-7-mm longitudinal full-thickness tear was made in the avascular inner half of the anterior part of the lateral meniscus. The parameniscal synovium was abraded superiorly and inferiorly from the meniscus periphery to the lesion. Three animals in a control group received identical meniscal tears but no abrasion treatment. A harness prevented weight bearing and maintained the knee fully flexed after surgery. Twelve weeks after the operation, no healing was seen in any tears. Histologic examination revealed in both groups increased numbers of dividing chondrocytes on either side of the tear. In the test group, several layers of fibroblasts, which appeared in two menisci to derive from the upper meniscal surface, were seen covering both cut surfaces of the tear. It is concluded that the distance from the periphery to the defect is too far for abrasion therapy to stimulate sufficient cellular ingrowth to facilitate repair of tears in the avascular region of the meniscus.

Animals↗
PubMedDate not supplied

Reconstruction of mid-substance anterior cruciate rupture in adolescents with open physes.

Five cases of anterior cruciate ligament reconstruction, performed for symptomatic episodes of giving way or during surgery for associated injury, were carried out in preepiphyseal closure adolescents (ages 12-15 years), utilising a strip of iliotibial band placed over the top of the lateral femoral condyle in a MacIntosh type repair, and avoiding drilling through epiphyseal plates. At a mean follow-up of 4.4 years, all five were symptomatically satisfactory and all five patients had returned to their preinjury level of sports activity. Although objective assessment revealed that increased laxity, when compared to the normal leg anterior laxity measured by the KT-1000, was within normal limits in four of five patients. Only one patient, who had had a fracture of the contralateral femur, had any leg length discrepancy.

Adolescent↗
PubMedDate not supplied

Functional knee braces increase intramuscular pressures in the anterior compartment of the leg.

The effect of three different functional knee braces on intramuscular pressures in the anterior compartment of the leg was investigated in 8 healthy subjects. Pressures were recorded with the microcapillary infusion technique while the subjects were either supine, sitting, or standing. Pressures at rest in the anterior tibial muscle increased significantly following application of each of the three knee braces regardless of posture. Similarly, muscle relaxation pressure during exercise also increased significantly on brace application. A pressure of 40 mm Hg was exceeded in 9 of 18 intramuscular pressure measurements with the subject standing. The tested functional knee braces increased muscle pressures at rest and muscle relaxation pressure during exercise to levels that, according to other studies, might decrease muscle blood flow significantly. External compression from a knee brace on leg muscles might, therefore, induce premature muscle fatigue because of local insufficient perfusion of the working muscle.

Adult↗