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Biomedical subjects

P Hamberg

Publications and source records attributed to P Hamberg.

At least 19 recordsLinked to original sources
PubMed2001

Semitendinosus muscle in anterior cruciate ligament surgery: Morphology and function.

PURPOSE: To evaluate the fate of the hamstring muscles in general and the semitendinosus muscle in particular, after anterior cruciate ligament (ACL) reconstruction with an autologous semitendinosus tendon graft from the ipsilateral side. TYPE OF STUDY: Prospective consecutive case series investigation. METHODS: Included were 16 consecutive patients, 14 male and 2 female, with a mean age of 26 years. The inclusion criterion was chronic unilateral ACL insufficiency with no concomitant knee ligament injuries. ACL reconstruction was performed with a quadruple semitendinosus tendon graft using the EndoButton technique (Acufex, Mansfield, MA). Intraoperatively, muscle specimens were taken from the semitendinosus muscle on the harvested side. Follow-up at a minimum of 6 months included clinical examination, isokinetic strength performance, magnetic resonance imaging (MRI) of the thigh and knee, and ultrasound-guided muscle biopsy procurement from the semitendinosus muscle for histochemical and enzymatic analyses. RESULTS: Of the patients, 75% showed regeneration of their semitendinosus tendons. The neotendons all inserted below the knee joint where they had fused with the gracilis tendon to a conjoined tendon inserting in the pes anserinus. The semitendinosus muscle had a smaller cross-sectional area on the operated side but none showed total atrophy. Less atrophy was present in the patients with a regenerated semitendinosus neotendon compared with those without regeneration (P =.029). In the latter group the semimembranosus muscle seemed to compensate for this with hypertrophy (P =.019). Cross-sectional muscle fiber areas, the relative number of each fiber type and oxidative potential as estimated by citrate synthase activity, showed no significant differences between the operated and nonoperated legs. The isokinetic strength of the hamstrings and quadriceps was significantly lower in the operated leg than in the nonoperated leg. CONCLUSIONS: With this surgical technique, the semitendinosus muscle can recover and the tendon has, according to the MRI images, a great potential to regenerate after its removal.

Adolescent↗
PubMed2001

The semitendinosus tendon regenerates after resection: a morphologic and MRI analysis in 6 patients after resection for anterior cruciate ligament reconstruction.

Recently, the surprising observation has been made, supported by clinical and MRI findings, that the semitendinosus tendon can regenerate after being harvested in its whole length and thickness for anterior cruciate ligament reconstruction. We studied 6 patients with previous anterior cruciate ligament reconstruction, using a quadruple semitendinosus tendon autograft. In 5 of these, physical examination and MRI showed that the tendond had regenerated. In all 6 patients, the findings were documented macroscopically by open surgical exploration and in the 5 regenerated tendons, also morphologically by biopsies. Macroscopically, histologically and immunohistochemically the regenerated tendons closely resembled normal ones with focal scar-like areas. Our present findings and earlier studies show that full length and thickness harvesting of the semitendinosus tendon in most cases result in full-length tendon regeneration with tissue closely resembling the normal tendon.

Adolescent↗
PubMed2001

A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament.

In a two-centre study, 164 patients with unilateral instability of the anterior cruciate ligament were prospectively randomised to arthroscopic reconstruction with either a patellar tendon graft using interference screw fixation or a quadruple semitendinosus graft using an endobutton fixation technique. The same postoperative rehabilitation protocol was used for all patients and follow-up at a median of 31 months (24 to 59) was carried out by independent observers. Four patients (2%) were lost to follow-up. No significant differences were found between the groups regarding the Stryker laxity test, one-leg hop test, Tegner activity level, Lysholm score, patellofemoral pain score, International Knee Documentation Committee (IKDC) score or visual analogue scale, reflecting patient satisfaction and knee function. Slightly decreased extension, compared with the non-operated side, was found in the patellar tendon group (p < 0.05). Patients with associated meniscal injuries had lower IKDC, visual analogue (p < 0.01) and Lysholm scores (p < 0.05) than those without such injuries. Patients in whom reconstruction had been carried out less than five months after the injury had better final IKDC scores than the more chronic cases (p < 0.05). We conclude that patellar tendon and quadruple semitendinous tendon grafts have similar outcomes in the medium term. Associated meniscal pathology significantly affects the final outcome and early reconstruction seems to be beneficial.

Adult↗
PubMed2001

There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft. A prospective randomized study of 107 patients.

The main objective of this study was to study solely early postoperative morbidity following anterior cruciate ligament (ACL) reconstruction by comparing the gold standard procedure, the bone-patellar tendon-bone graft (BTB), and one of the most common alternatives, the semitendinosus tendon graft (ST). The prospective study included 107 randomized patients (50 BTB and 57 ST). The follow-up period was set to 20-35 weeks postoperatively (mean 26.8 +/- 3.5 weeks). One patient suffered early graft rupture and 89 (84%) of the remaining 106 patients were able to attend the follow-up within the given time limit. There were no differences in sick leave between the groups. The Lysholm score, Tegner activity level score and Visual Analog Scales (VAS) with the questions "How does your knee function?" and "How does your knee affect your activity level?" revealed no differences between the groups. Subjective patellofemoral pain, patellofemoral compartment findings and donor site morbidity were more common in the BTB group, P < 0.05. Lachman test grade 1+ was more common in the ST group, P < 0.05, but there was no significant difference in instrumented Lachman side-to-side comparison. The ST group scored better in the one-leg hop test than the BTB group, P < 0.05. No correlations between these clinical and functional findings and subjective knee function scores were found. In conclusion, ACL reconstruction with ST tendon graft presented fewer short-term postoperative problems as compared to reconstruction with BTB.

Adolescent↗
PubMed2000

Arthroscopic meniscectomy: treatment costs and postoperative function in a historical perspective.

We report short-term data from 82 consecutive patients with arthroscopic meniscectomy 1995-1998 in stable knees and without severe cartilage changes. All patients were treated as outpatients, the operating time was, on average, 23 SD12 minutes and 3 of 4 patients were back at work within 1 week. Almost half of the patients still had some knee problems 3 months after surgery, but thereafter a substantial improvement was seen. We also report original data from a consecutive series of patients having arthroscopic meniscectomy 1980-81. In that series, the frequency of total meniscectomies was higher, the operating time longer, but the time to recovery was shorter than in 1995-98. In contrast to 1995-98, most of the patients in 1980-81 were followed by the doctor and had supervised rehabilitation. However, sick leave was similar in the two series. The total costs for an arthroscopic meniscectomy in 1998 was less than half the costs in 1980-81. We conclude that the improved technique for arthroscopic meniscectomy during the last 15-20 years and less supervised rehabilitation have reduced the costs, but not the recovery time.

Adolescent↗
PubMed1999

Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study.

Utilisation of the semitendinosus and gracilis tendons in reconstruction of the anterior cruciate ligament (ACL) has become more common during the last few years. In recent studies a regeneration potential in the harvested tendons has been observed. In this study, 11 consecutive patients who underwent ACL reconstruction with a quadruple semitendinosus graft were examined 6-12 months postoperatively by MRI. Another two patients were examined within 2 weeks after surgery. The median age of the patients was 24 years and there were 8 males and 3 females. The right knee was involved in six patients and the left knee in five. A low-field 0.2 Tesla Siemens open MRI was used for examinations and T1 and T2 weighted transaxial sequences over the thigh and the knee joint were performed. In some instances, additional sagittal sequences were used. ROI analysis of the pixel value of the signal and area determinations on transaxial sequences was performed for both the involved and the healthy side. In 8 of the 11 patients examined 6-12 months postoperatively, a regeneration of the semitendinosus tendon with normal anatomical topographies to the level of the tibial plateau was found. Three of these eight patients were analysed more distally and fusion of the semitendinosus and gracilis tendons was found approximately 30 mm below the joint line before they inserted as a "conjoined tendon" into the pes anserinus. At the mid-thigh level, the semitendinosus muscle had a smaller area and a higher signal than that on the normal side. However, this difference was smaller in the patients showing normal distal tendon regeneration. This study indicates that the semitendinosus tendon has a strong potential for regeneration and that the muscle atrophy seems to be less in the patients with a more normalised distal insertion of the tendon in the pes anserinus.

Adult↗
PubMed1999

Extramedullary fixation of 107 subtrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus 3 other screw-plate systems.

We compared the efficacy of a load-sharing device, the Medoff sliding plate (MSP), with that of 3 other load-bearing screw-plate devices for the fixation of subtrochanteric fractures in a randomized multicenter trial of 107 elderly patients. 55 fractures were operated on with the MSP, and 52 with the dynamic hip screw (DHS) with or without a trochanteric stabilizing plate (TSP) or with the dynamic condylar screw (DCS). The patient material in the groups was similar regarding age, domestic situation, preinjury walking ability and fracture types. We followed the patients clinically and radiographically for a minimum of 1 year. There was no significant difference in walking ability or return rate to the home at follow-up. Fixation failure occurred in 1/55 fractures operated on with the MSP, in 3/32 with the DHS, in 3/12 with the DCS and in 2/8 with the DHS/TSR The difference in the rate of fixation failure was statistically significant, when the MSP group was compared to the 3 load-bearing devices in the other group (1 vs 8). On the basis of this experience, we think that the load-sharing principle of the MSP, which seems to facilitate fracture impaction and stability, appears to be a good alternative in extramedullary fixation of subtrochanteric fractures.

Aged↗
PubMed1997

Local NSAID gel (eltenac) in the treatment of osteoarthritis of the knee. A double blind study comparing eltenac with oral diclofenac and placebo gel.

In a randomized, double blind, multicentre study with 4 weeks follow-up of 290 patients with osteoarthritis of the knee joint, a topical NSAID (eltenac) was compared with oral diclofenac and placebo. The main outcome, Lequesne's Index and pain by VAS showed no statistically significant differences between neither of the active treatments and placebo for the total study population. However, in patients with more severe symptoms, both active groups showed statistically significant differences to placebo. No severe adverse drug reactions were seen but the number of GI reactions were three times higher in the diclofenac group compared to the topical treatment. Local skin reactions were twice as frequent in the eltenac than in the placebo group. Taking into account the nature of the treatment for a chronic disease like OA, our results indicate that eltenac gel could be a safe alternative to oral NSAIDs.

Administration, Oral↗
PubMed1992

Knee arthroscopy using local anesthesia.

This study confirms the feasibility of performing arthroscopy and arthroscopic surgery with patients under local anesthesia. Seventy patients underwent arthroscopy under local anesthesia using mepivacaine with adrenaline. In 49 patients, arthroscopic surgery was performed. It is important to wait at least 20 min after the injection of the anesthetic before surgery to anesthetize the medial part of the joint. There were few complications. Diagnostic and surgical arthroscopy can be successfully performed in the majority of patients with local anesthesia.

Adult↗
PubMed1989

Non-operative treatment of meniscal tears.

In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial meniscal lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which tend to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study.

Adolescent↗
PubMed1987

The correlation between osteoarthrosis as seen on radiographs and on arthroscopy.

The correlation between arthroscopic and radiographic osteoarthrosis was studied in 63 patients (51 +/- 12 years) with degenerative changes in the medial compartment of the knee involving the medial meniscus with or without chondral damage. Chondral damage on arthroscopy was classified in grades 1-3 modified after Outerbridge. The radiographic evaluation was done according to Ahlbäck classification. Twenty-eight patients (44%) did not show any significant chondral damage on arthroscopy (grades 0-1). The radiographic findings in this group were usually normal. Three patients, however, showed a slight narrowing of the medial joint space (Ahlbäck I). All three had severely degenerated menisci, and two of them showed superficial fibrillation of both the tibia and the femur. Twenty-four patients (38%) showed a partial thickness chondral damage with fragmentation of the surface (grade 2). Radiographic findings were usually normal; however, patients with involvement of both the tibia and the femur often showed a joint space narrowing on radiographs. Eleven patients (18%) showed destruction of the cartilage down to subchondral bone (grade 3). The typical radiographic finding was a joint space obliteration (Ahlbäck II). Involvement also of the lateral compartment as assessed on arthroscopy was significantly more common in patients with 2nd and 3rd degree chondral disease and Ahlbäck II and III on radiographs than in those with 2nd and 3rd degree chondral damage and normal radiographs. In all but one of the patients with involvement of both compartments, the lateral compartment was considered normal on radiographic examination.

Adult↗
PubMed1985

Surgical or conservative treatment of the acutely torn anterior cruciate ligament. A randomized study with short-term follow-up observations.

In a prospective study, 90 consecutive patients with total midstructural tears of the anterior cruciate ligament (ACL) were assigned at random to surgical (Group I) or conservative (Group II) treatment. Within 18.2 months of operation, 95% of the patients in Group I and 11% of those in Group II had a stable knee. The mean knee function score in Group I was 89 points, and 75% achieved more than 84 points (good or excellent). In Group II the mean score was 85; only 53% achieved more than 84 points (p less than .05). Group II patients showed greater mean quadriceps strength than those in Group I. The ability to perform a one-leg jump and to run a figure eight was similar in both groups. Early primary suture of the acutely torn ACL usually resulted in a stable knee, whereas conservatively treated patients showed knee instability. At the 18-month interval, however, the patients' functional performance seemed to be comparable in the two groups.

Adolescent↗
PubMed1984

A comparison between arthroscopic meniscectomy and modified open meniscectomy. A prospective randomised study with emphasis on postoperative rehabilitation.

Arthroscopy is now well established as a method of diagnosing meniscal lesions, and its advantages have been pointed out in several reports. Arthroscopic surgery, however, is difficult to master, so that for meniscectomy open methods remain commoner. By taking advantage of the new instruments and equipment developed for arthroscopic operations, a modified technique of open meniscectomy, designed to improve the postoperative course, has been developed. In a prospective randomised study, the results after this modified open meniscectomy were comparable with those obtained after arthroscopic operation and were significantly better than those after conventional meniscectomy. The best results of all, however, were those after partial arthroscopic meniscectomy.

Adult↗
PubMed1984

Knee function after arthroscopic meniscectomy. A prospective study.

In a prospective study, operation under arthroscopy was done in 100 consecutive patients (11 women and 89 men) with a lesion of one meniscus. Meniscectomy was done in 86 patients with medial meniscus tears and in 14 with lateral tears. After 2 weeks, 85 patients were back at work.

Adolescent↗
PubMed1984

Arthroscopy of the knee in children.

A review was carried out of arthroscopy of the knee in children. During a 34-month period, 2,378 arthroscopies were performed, 80 of these on children less than 16 years of age. Seventy-one cases were reviewed, which is approximately 2% of all children seen at the clinic. Thirty procedures were carried out in patients with hemarthrosis. Eleven patients required operative repair or reconstruction. There were 13 ruptures of the anterior cruciate ligament (43%), 4 ruptures of the posterior cruciate ligament, 14 ruptures of the medial collateral or posterior oblique ligament, and 5 ruptures of the lateral meniscus. Forty-one arthroscopies were done in patients without hemarthrosis or history of acute trauma. A clinical diagnosis of meniscus tear was correct in only 20%. Only one meniscectomy was performed and another meniscus tear was repaired. The most common diagnostic finding was abnormality of the patellofemoral articulation, which was diagnosed in 31 patients. Arthroscopic shaving of the patella was rarely indicated. As in adults, hemarthrosis indicates significant injury to the knee. Meniscus lesions are rare.

Adolescent↗