PubMed Health⌕ Search

Biomedical subjects

P Hamberg

Publications and source records attributed to P Hamberg.

9 recordsLinked to original sources
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↗
PubMedDate not supplied

Muscle rehabilitation after arthroscopic meniscectomy with or without tourniquet control. A preliminary randomized study.

Nineteen patients with isolated meniscus lesions were randomly assigned to operation with or without tourniquet. All patients underwent arthroscopic meniscectomy. Measurements of CK (creatinin-kinase), CK-B (isoenzymes MB of creatinin-kinase), LD (lactate dehydrogenase), ASAT (aspartate aminotransferase), and ALAT (alanine aminotransferase) were performed preoperatively and postoperatively over 6 days. The muscle torque was measured on a Cybex II isokinetic dynamometer preoperatively, 1 week and 4 weeks postoperatively. The mean CK level rose significantly in both groups, but did not pass the upper normal serum level. There was no effect on the other muscle enzymes. Quadriceps torque was significantly lowered in both groups 1 week after operation. Four weeks postoperatively, it was still lowered in the nontourniquet group, which also had a slower increase in torque between weeks 1 and 4 than the tourniquet groups. There was no effect from the operation on isometric or hamstrings torque. The slight rise in CK was similar to that seen after hard physical exercise. The decrease in muscle torque was, therefore, mostly due to pain inhibition. The slightly slower rehabilitation in the nontourniquet group may be caused by the technique of raising saline flow and pressure during the arthroscopy to control bleeding. This causes extravasation of fluid which may increase postoperative pain and stiffness.

Adult↗
PubMedDate not supplied

Healed meniscal tears in unstable knees. A long-term followup of seven years.

Peripheral vertical ruptures of the medial (N = 24) and the lateral (N = 4) meniscus were repaired in 28 patients (mean age, 27 years). They all had an ACL lesion, combined in 26 cases with a MCL tear. These injuries were reconstructed or sutured during the same session as the meniscus repairs. Approximately 1 year later, meniscal healing was proven arthroscopically in 20 and the other 8 had no clinical signs of meniscal rerupture. All patients were reexamined between 6 to 8 years after the initial repair. Instrumented stability testing, the Lysholm knee function score and an activity score (Tegner) were used. The patients' subjective evaluations were also recorded. In spite of the previous reconstruction, all knees were quite unstable (mean +5 mm increased laxity compared with the uninjured side). At followup, 3 of the 28 repaired menisci (11%) had reruptured in connection with a minor trauma during sports or daily activity. The knee function score averaged 88 points, the activity level dropped 2 steps compared with activities before injury (from 7 to 5). Twenty patients were satisfied with the results, 5 partly satisfied, and 3 not satisfied. A healed meniscal tear has a good chance of survival in an unstable knee. The most critical period of meniscal repair probably lies in the healing period just after surgery.

Adolescent↗