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Biomedical subjects

R Biedert

Publications and source records attributed to R Biedert.

At least 19 recordsLinked to original sources
PubMed2000

Free nerve endings in the medial and posteromedial capsuloligamentous complexes: occurrence and distribution.

Free nerve endings (FNEs) of type IVa play a distinctive role in the articular nociceptive and sensorimotor system of the knee. This study qualitatively and quantitatively analyzed FNEs in the medial and posteromedial capsuloligamentous complexes. Biopsy specimens from ten precisely defined anatomical locations were taken from seven fresh cadaver knee joints. The specimens were fixed with 4% formaldehyde solution and stained with hematoxylin-eosin. The results were examined using immunohistochemistry. The occurrence of FNEs is described in combination with their specific pattern of distribution. A high number of FNEs were found in all investigated elements with a maximum relative density in the insertion of the semimembranosus muscle in the direct attachment on the tibial margin. The number was lowest in the superficial medial collateral ligament. The results were correlated with anatomical and biomechanical functions of the stabilizing effect of the medial capsuloligamentous complex. Our findings indicate that lesions and surgical procedures can alter normal sensory feedback and coordination by modifying the use of muscle fiber during specific movements.

Humans↗
PubMed1998

[Overuse syndrome of the soft tissues of the lower extremity].

Sports activities with high demands and stresses to the musculoskeletal system increase the risk of overuse injures. The etiologic mechanisms are multifactorial, with both intrinsic and extrinsic factors. In spite of better diagnostic equipment and conservative methods of treatment, some of these overuse injuries do not heal and a structural damage of the tissue remains. Thus, surgery is often the only way to relieve the symptoms and to restore normal function. This article provides a basic overview of the epidemiology, anatomy, biomechanical factors, stress responses and therapeutic principles regarding overuse injuries of the soft tissues.

Athletic Injuries↗
PubMed1997

Quantitative gait analysis in patients with medial patellar instability following lateral retinacular release.

Medial patellar instability is a known possible complication following lateral retinacular release. Insufficient passive structures, muscle imbalance and an over-release of the lateral retinaculum with resection of the vastus lateralis tendon have been implied as a major cause of this problem. We report about the findings of quantitative gait analysis consisting of video recordings, three-dimensional motion analysis, dynamic electromyography and sampling of the ground reaction forces in two patients with medial patellar subluxation. Documentation of the gait functions together with observation of the patellar translation revealed the timing of the occurrence of the instability during level gait: a normal gait pattern with a sufficient quadriceps mechanism and a centred patella was seen during loading (weight acceptance), while the quadriceps muscle was active. Abnormal medial translation of the patella was observed during unloading of the leg while the knee was bending in preparation for the swing phase. This is a phase in the gait cycle when the quadriceps muscle is silent and the patella position is guided by the passive structures only. This finding weakens the argument of muscle imbalance as a cause for the patellar instability and stresses the importance of well balanced passive structures. This explains why a muscular rehabilitation programme is likely to fail as long as the passive structures allow the instability to occur.

Adult↗
PubMed1996

Occurrence and distribution of free nerve endings in the distal iliotibial tract system of the knee.

Free nerve endings (FNE) are nociceptive sensory elements transmitting information on pain and inflammation from the connective tissues to the brain. They form an important part of the proprioceptive sensory system of the knee. We present a qualitative and quantitative analysis of FNEs in the distal iliotibial tract (ITT), documenting their occurrence in this structure as well as their specific distribution pattern. FNEs were found in all elements of the distal ITT, with their maximum density in the fixation sites of the distal ITT to the femur and the tibia. This finding correlates well with anatomical and biomechanical studies and stresses the importance of the deep ITT fibre system for lateral knee stability. The relative number of FNEs in the distal ITT ranges from 5 to 10 per 50 mm2 and is comparable to the frequency found in the synovial sheath of the cruciate ligaments. These findings have clinical implications for surgical procedures on the lateral side of the knee. The distinct anatomy of the distal ITT should be respected in all procedures, since extensive operations in this area may cause pain and loss of range-of-motion due to alterations of proprioceptive function.

Adult↗
PubMed1996

[Femoropatellar pain syndrome: which operation is still sensible?].

The generalized use of some few operative treatments (medialization and advancement of the tuberosity of the tibia, abrasion and forage, lateral retinacular release) for most of patellofemoral pain syndromes without regard to the pathology might cause severe secondary problems. Therefore, a more conservative approach is often preferred. Nevertheless, there exist specific indications for surgical interventions after accurate evaluation of the etiological pathology. Some typical examples are described in three groups [mechanical disorders, malalignment, dysplasias], considering the causing factors.

Arthralgia↗
PubMed1993

Which investigations are required in stress fracture of the great toe sesamoids?

For the athlete a stress fracture of the great toe sesamoid is an injury of fundamental significance. As radiographic findings and bone scintigraphy are not specific, these fractures have the longest delay between first symptoms and definitive diagnosis. Apart from magnetic resonance imaging, the only accurate investigation for early diagnosis is the longitudinal bone scan.

Adolescent↗
PubMed1993

[Statistical deviations in high-performance athletes].

Between 1978 and 1984, 1323 high level athletes were tested at the Sports sciences institute of the Swiss federal sports school. During these investigations, several characteristic variations of body statics were measured. Analysis of the pooled data reveal a link of statistical significance between certain sports and several abnormalities of lower limbs static. As it was a retrospective investigation, we cannot be sure of a causal relationship between the reported effects. Our principal aim however was to publish this somewhat extensive set of data, in view of the general dearth of such scientific results. In addition to the type of movement the athletes perform during their sports activity, it is the duration of the exertion which seems to be an important determinant for the presence of an increased number of static abnormalities in certain sports. Endurance running presents an elevated risk of developing both flat foot and splay foot. For football (soccer) and tennis players however, only a subnormal transverse foot arch appears frequently. Alpine skiers on the other hand have an increased risk of longitudinal foot arch insufficiency. The knowledge as to which abnormalities are increasingly present in a given sport is instrumental to enabling an early detection and prophylaxis of these ailments.

Adult↗
PubMed1991

Anterior ankle pain in sports medicine: aetiology and indications for arthroscopy.

Persistent pain and swelling in the anterior part of the upper ankle are encountered very frequently in sports traumatology. Classically, in the patient with a long history of typical anterior ankle pain there is no instability, but pinching effects, a sense of impingement, blocking and a feeling of unsteadiness combined with a certain restriction of movement due to the pathology. By analogy with the anatomical structures, various pathologic changes can lead to the classic clinical symptoms: adhesions, cicatrices, meniscoid-type lesions, osteophytes with synovitis, folds, fibrotic subcutaneous fatty tissue, free arthroliths, osteochondral lesions and arthrotic changes. When long-term conservative therapy has not provided a cure for the clinical syndrome surgical intervention becomes necessary. Arthroscopic interventions were carried out in a total of 21 patients, with follow-up times between 6 and 36 months. About two-thirds of all the patients showed good or very good results, while in one-third the results were unsatisfactory, mainly because of degenerative changes. An precise diagnosis is essential, but the significance of a pathologic change as the cause of symptoms can be problematical.

Ankle Injuries↗
PubMed1991

[Functional anatomy in tape bandages of the ankle/foot].

The use of adhesive tape has proved to be a good alternative to treat several types of trauma and overuse syndromes at the upper ankle joint and the foot. According to the different injuries and problems the varied uses are presented. Especially the importance of the functional anatomy is emphasized for initiating a successful taping procedure. The techniques presented are offered merely as recognized methods which have been found effective and which should stimulate to improve this type of treatment.

Ankle Injuries↗
PubMed1991

[Symptoms in area of the Achilles tendon. Etiology and therapeutic considerations].

A number of pathologic conditions can produce posterior heel pain, making it difficult to distinguish the exact cause. Only a careful physical examination allows the probable diagnosis, which is the first and most important step in a successful therapy. Pathologically, the Achilles tendon itself may be inflamed secondary to degeneration owing to a decreased blood supply or the result of a partial rupture. The inflammation can also be accompanied by microtears or calcium deposits. In most cases the tendon sheath and the mesotenon are also involved (tenosynovitis). The retrocalcaneal bursa located between the posterior angle of the os calcis and the Achilles tendon may become inflamed and hypertrophic. It is frequently associated with a prominent superior tuberosity of the os calcis. In a few cases there was also an irritation of the bursa between the Achilles tendon and the skin caused by ill-fitting shoes. Over a 3-year period, 102 patients who engaged in different sports were treated for problems in the Achilles tendon area and retrospectively reviewed with a follow up of 18.8 months. Most of them were runners (48%), followed by soccer players (15.7%) and tennis players (5.9%). The mean age was 36 years. In the vast majority of patients (n = 70, 68.6%) nonoperative treatment was successful. In this group there were 45 cases (65%) with postural abnormalities and excessive pronation requiring correction by means of orthotic appliances. In 19 patients (27%) the problems were caused by a muscular imbalance, and in 15 cases (21%) wrong training methods with overuse had caused the inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗
PubMed1990

[Risk of arthrosis of the upper ankle joint in long distance runners: controlled follow-up of former elite athletes].

To study the potential influence of long-term, high-intensity physical training on premature osteoarthrosis of the ankle joint, we re-examined former members of the Swiss National team from 1973 in retrospective cohort study in 1988. Twenty-seven track and field long-distance runners and orienteers (mean age 42 [95% confidence interval 41-43] years), 9 bobsledders (42 [39-46] years) and a control group of 23 healthy normal men (35 [33-36] years) were investigated. Physiological and exercise characteristics of all subjects had been recorded in 1973, and in 1988 these measurements were repeated together with a rheumatological and radiological examination of the ankle joint. A four-point scale of radiological joint state was used, taking into account the degree of subchondral sclerosis, osteophyte formation and joint space narrowing. In univariate analysis, the long-distance runners, and among them especially the orienteers (n = 10), showed significantly (both p less than 0.05) more radiological signs of degenerative ankle disease than controls. After adjustment for age, this difference disappeared. Age was itself significantly and positively related to radiological degenerative ankle disease (r less than 0.38; p less than 0.01). Orienteers reported significantly more frequently (60 vs 12%; p less than 0,01) functional instability of the ankle joint than track and field runners. Functional and mechanical (clinical) instability were interrelated in our material (r = 0.33; p less than 0.05) but neither of them was significantly related to radiological signs of degenerative ankle disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Osteochondral lesions of the talus].

Osteochondral lesions occur either as osteochondral fractures (so called flake fractures) or osteochondritis dissecans. Both types of lesions are caused in the most of the cases by an adequate trauma. The injury is sustained during inversion of the ankle. If the foot is dorsiflexed, an anterolateral lesion will result from shearing forces by the fibula. If the inversed foot is plantar flexed and followed by rotation of the tibia on the talus, a postero-medial lesion will result from compression of the medial talar dome by the tibia, secondary to spiralling and shortening of the collateral ligaments. The diagnosis is suspected with the most common complaints of the patients to pain on weight bearing or during sports, swelling, crepitus, giving way or locking ankle after an inversion injury. In case of negative standard X-rays and doubtful clinical findings tomograms in the AP and lateral views or even a scintigraphy of both ankles ar indicated. 15 patients with osteochondral lesions were treated, 7 with an antero-lateral transchondral fracture and 8 with a poster-medial osteochondritis dissecans. The lesions were classified after Berndt and Harty and differentiated between type I-IV. 13 patients have been operated, 4 by arthroscopy. The mean follow-up time of the clinical and radiographic examination was 1 year. The results were evaluated by a point score system. 7 patients (46.6%) had good, 5 (33.3%) a fair and 3 (20%) a poor result.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Arthroscopic revision of the sub-acromial space in impingement syndrome].

Degenerative lesions of the subacromial structures can cause chronic anterior pain and disability of the shoulder. They are most frequently found in patients whose arms are repeatedly exposed to force while raised above head level, e.g. during tennis, volleyball or swimming. This is often due to impingement of the supraspinatus tendon, the subacromial bursa or the biceps tendon against the anterior edge and lower surface of the anterior third of the acromion, the coracoacromial ligament and, in some cases, the acromioclavicular joint. Open anterior acromioplasty as described by Neer is therefore a well-documented treatment for cases refractory to conservative therapy, and its efficacy is unquestioned. Acromioplasty or simple decompression by débridement can now be performed by means of basic arthroscopic techniques. Subacromial decompression is carried out with standard arthroscopic approaches and motorized instruments. The indications are about the same as for the open technique, and the three progression stags of impingement lesions must also be considered in the same way. Arthroscopic decompression was performed in 13 patients with a chronic impingement syndrome that had failed to respond to conservative management over 6 months. All underwent a débridement of the subacromial bursa, 11 shaving of a partial tear of the rotator cuff, and 8 anterior acromioplasty; in 5 patients spurs arising from the acromion or the acromioclavicular joint were also removed. In 2 cases the coracoacromial ligament was released and in 3 patients calcareous deposits were needled. In most cases these procedures were combined. The patients were evaluated postoperatively with reference to the UCLA Shoulder Rating Scale with a follow-up of 12-18 months, particular attention being paid to pain and function.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromion↗
PubMed1988

OAK knee evaluation. A new way to assess knee ligament injuries.

The Orthopädische Arbeitsgruppe Knie (OAK) documentation is based on clinical evaluation during functional knee stability testing near extension and near flexion. Increased compartmental translations and rotations, which result from structural defects because of anatomic lesions in a given knee injury, are clinically evaluated. The synopsis of the clinically detectable abnormal knee motion is graphically documented. A clinically applicable grading system of the true and reversed pivot shift phenomena completes the assessment of compartmental knee instability. Important contributing factors such as the constitutional laxity, the morphotype, and the range of motion are registered on the documentation form. The evaluation form presents four categories that represent subjective, objective, and functional criteria reflecting the overall results of repaired ligaments. This evaluation format establishes selected criteria to compare results from different centers.

Documentation↗