Biomedical subjects

Peter Jokl

Publications and source records attributed to Peter Jokl.

10 recordsLinked to original sources

PubMed2006

Hip arthroscopy without a perineal post: a safer technique for hip distraction.

Pudendal nerve palsy is a reported complication of hip arthroscopy. We report a technique using a deflated taped beanbag rather than a perineal post. The patient is placed in the supine or lateral position on a fracture table. The beanbag is contoured around the patient's flank and thorax. The distal aspect of the beanbag is placed no further than the iliac crest, and care is taken to avoid compression of the posterior aspect of the axillary region or the posterior humerus. The molded beanbag is deflated, a blanket is positioned over the abdomen and lower thorax, and with the use of 3-in-wide cloth tape, the patient and beanbag are secured to the operative table circumferentially. The superior margin of the deflated beanbag remains firm, preventing compression of the thorax and avoiding compromised ventilation. The arm on the operative side is placed across the chest and secured to avoid obstruction of the operative field. This patient positioning provides sufficient stability for adequate traction and good visualization while minimizing the risk of a pudendal nerve palsy.

Arthroscopy↗

PubMed2006

Psychosocial factors and surgical outcomes: an evidence-based literature review.

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.

Affect↗

PubMed2005

Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes.

PURPOSE: The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function. TYPE OF STUDY: Longitudinal, prospective study. METHODS: Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively. Patients and their physicians completed ratings on knee pain and function at each time point. In addition, at their preoperative visit, patients and physicians completed ratings predicting their postoperative pain and functional status. RESULTS: Physicians rated patients as having less pain and greater knee function preoperatively and at 24 weeks postoperatively. Patients had more significant differences between predicted and actual ratings. CONCLUSIONS: Physicians tended to underestimate knee pain and overestimate knee function compared with patients. However, physicians better predicted postoperative knee pain and function ratings than did patients. These findings suggest that physician-patient discussions about preoperative expectations and postoperative reality might be an important part of clinical care. LEVEL OF EVIDENCE: Level II, Prospective Longitudinal Study.

Anterior Cruciate Ligament↗

PubMed2005

Implications of the pivot shift in the ACL-deficient knee.

UNLABELLED: The Losee repair controls rotational subluxation of the lateral femoral condyle, or pivot shift, but does not reliably eliminate Lachman laxity. Despite this surgical limitation, many patients who were operated on continued to do high-demand activities at the last followup. We hypothesized that Lachman findings alone did not predict poor surgical outcome or progression to osteoarthritis. We report on 87 patients evaluated at an average of 9 years (range, 5-21 years) postoperatively. Prospectively collected examinations and radiographic, subjective, and objective outcome measures were recorded and statistically evaluated. The presence of a postoperative pivot shift or residual varus laxity correlated with poor patient subjective evaluations and poor scoring outcomes. Lachman laxity with an absent pivot shift had no correlation with the outcome measures or onset of radiographic progression to osteoarthritis. Meniscectomy, additional knee surgery, increased valgus or varus laxity, and time from injury until the final radiograph positively correlated with the onset of osteoarthritis. Elimination of the pivot shift was necessary to achieve successful relief of symptoms and functional outcome. In the absence of a pivot shift, Lachman laxity was not solely predictive of poor outcomes. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Anterior Cruciate Ligament Injuries↗

PubMed2003

Vascular leiomyoma presenting as medial joint line pain of the knee.

We present the case of a 27-year-old woman with a subcutaneous vascular leiomyoma occurring around the knee. The patient presented with a several-year history of medial-sided knee pain with an unknown etiology. The clinical presentation, magnetic resonance imaging, and histopathologic features are reported, and the literature pertaining to the clinicopathologic characteristics is reviewed. By including vascular leiomyomas in the differential of painful lower extremity subcutaneous masses, an early accurate diagnosis is possible.

Adult↗

PubMed2003

MR arthrography of anterior cruciate ligament reconstruction grafts.

OBJECTIVE: Our objective was to determine the accuracy of MR arthrography for identification of tears of anterior cruciate ligament reconstruction grafts and for detection of localized anterior arthrofibrosis and impingement. MATERIALS AND METHODS: We retrospectively identified 27 patients (mean age, 31 years; range, 18-45 years) with anterior cruciate ligament reconstruction who had undergone MR arthrography followed by arthroscopy within 1 year. Three radiologists independently reviewed the MR arthrograms for the presence or absence of graft tear, localized anterior arthrofibrosis, and impingement. RESULTS: Graft tears were identified with 100% sensitivity by all three reviewers with specificities of 100%, 89%, and 94%. Localized anterior arthrofibrosis was identified with 100% sensitivity by all reviewers, with specificities of 79%, 71%, and 38%. Impingement was detected with sensitivities and specificities of 83% and 100%, 83% and 52%, and 33% and 90% by the three reviewers, respectively. Interobserver agreement was almost perfect for detection of graft tear (kappa = 0.83, 0.92, and 0.83), was fair to moderate for detection of localized anterior arthrofibrosis (kappa = 0.50, 0.32, and 0.22), and was slight to fair for detection of impingement (kappa = 0.40, 0.08, and 0.35). CONCLUSION: MR arthrography can accurately depict the presence of anterior cruciate ligament graft tears. Localized anterior arthrofibrosis and graft impingement were less accurately detected and showed greater observer variability.

Adolescent↗

PubMed2002

Muscle contusion injury and myositis ossificans traumatica.

In athletic competition, muscle contusion injury is a frequent and debilitating condition. Found in traditional contact and noncontact sports, contusions also can occur to the nonathlete by simple falls and accidents. The injury consists of a well-defined sequence of events involving microscopic rupture and damage to muscle cells, macroscopic defects in muscle bellies, infiltrative bleeding, and inflammation. The repair of the tissue can be thought of as a race between remodeling and scar formation. In the current study, the authors describe the relevant body of research directed at delineating the incidence, factors that affect injury severity, and treatment of muscle contusion injury. Emphasis is given to animal models that allow reproducible, quantitative injury, and study of the effects of various treatment modalities. Myositis ossificans traumatica, one of the most debilitating consequences of contusion injuries, also is discussed. The incidence, causative factors, and prevention strategies are reviewed.

Animals↗

PubMed2002

Grade 2C signal in the meniscus [correction of mensicus] on MR imaging of the knee.

OBJECTIVE: The objective of our study was to evaluate the clinical significance of grade 2C meniscal [corrected] signal (an extensive triangular or wedge-shaped signal that does not reach the surface on more than one image) on MR imaging of the knee. MATERIALS AND METHODS: Review of 1106 MR imaging reports over 2 years revealed 88 patients with menisci described as containing triangular, wedge-shaped, extensive, or grade 2C signal. Image review by consensus of two radiologists found 34 menisci in 29 patients that fit criteria for grade 2C signal. Seven menisci containing grade 2C signal were evaluated with arthroscopy. An additional three patients with grade 2C meniscal signal with arthroscopic correlation were identified from 4 previous years. RESULTS: Prevalence of grade 2C signal was 1.5% (34/2212 menisci). Seven (21%) of these 34 menisci had subsequent arthroscopy and three of these had meniscal tears. Including the three additional menisci with grade 2C signal from 4 previous years, five (50%) of 10 menisci with grade 2C signal were torn at arthroscopy. No difference was noted between torn and intact menisci in the number of images with grade 2C signal. In patients with tears, the range was three to 10 images (mean, 6.6 images) compared with a range of two to 10 images (mean, 6.6 images) in patients without tears. The maximal percentage of area of abnormal signal in patients with tears ranged from 70% to 90% (mean, 80%) compared with a range of 60-90% (mean, 82%) in patients without tears. The patient age range was 23-64 years (mean, 47 years) in patients with tears and 16-67 years (mean, 47 years) in patients without tears. CONCLUSION: Grade 2C meniscal signal has a low incidence. Although half of patients with symptoms meriting arthroscopy have tears, most patients with grade 2C signal are not treated with arthroscopy.

Adolescent↗

PubMed2002

Effect of aging on male and female master athletes' performance in strength versus endurance activities.

Aging has traditionally been associated with several functional declines within the musculoskeletal system. In this study, we characterized and compared age-related changes in performance in power and endurance activities (ie, power-lifting, stationary rowing). From age 25 to age 85, men's and women's rowing performance decreases 29%; from age 25 to age 55, men's rowing performance decreases 0.12% per year, and women's performance decreases 0.23% per year. The pattern of decline in power-lifting performance is characterized by earlier onset and more rapid progression. During the fourth decade, men's and women's power-lifting performance decreases 3% per year; thereafter, their performance decreases 1% per year. The difference between the age-related change rates for rowing and power-lifting is statistically significant (P = .05). The older athletes' performance in both activities suggests that the capacity for significant function in activities requiring power and endurance persists throughout life in individuals who train and who remain in good health. That strength decreases more rapidly than endurance capacity points to the importance of resistance exercises for minimizing muscle weakness in an aging population.

Adult↗

PubMedDate not supplied

Technical tips in orthopaedics: meniscal repair with use of an in situ fibrin clot.

The importance of meniscal preservation has become increasingly clear, and many authors advocate repair of the meniscus whenever possible, forgoing patient age and tear location. In accordance with the common goal of preserving meniscal tissue, we describe a simple technique to augment meniscal repairs with the use of an in situ fibrin clot. The site is prepared accordingly: the synovium directly above the tear site is abraded with a shaver, rasp, or small intra-articular banana blade. Next, the water inflow cannula is closed, and the outflow cannula is opened to vacuum suctioning, allowing collapse of the distended joint. Under these circumstances, negative intra-articular pressure is produced in the knee joint. This condition is maintained for a period of 1 to 2 minutes and induces bleeding from the abraded synovial site. The knee in a dependent position causes the blood to run down the synovial wall and into the meniscal cleft, pooling there and forming a clot adherent to the edges of the separated meniscal tear. This procedure has been found to be a simple and minimally invasive mechanism for clot placement. The exposed collagen of the meniscal tear provides an ideal surface for a relatively tenacious clot attachment. It provides the healing factors reported to induce successful meniscal healing.

Arthroscopy↗