Biomedical subjects

R D Ferkel

Publications and source records attributed to R D Ferkel.

At least 19 recordsLinked to original sources

PubMed1992

Arthroscopic-assisted anterior cruciate ligament reconstruction with the semitendinosus tendon: comparison of results with and without braided polypropylene augmentation.

Fifteen chronic anterior cruciate ligament-deficient knees were arthroscopically reconstructed with a semitendinosus tendon polypropylene (STP) augmented composite graft. A comparison group of 28 reconstructions with the semitendinosus tendon (ST) but without augmentation was simultaneously reviewed. The mean follow-up in the STP group was 31 months (range of 24-42 months) and in the ST group it was 34 months (range 26-54 months). Both patient groups had similar age, sex, preinjury functional sports level, injury-to-surgery interval, and associated meniscal pathology. Good-to-excellent subjective results were reported in 86% of STP patients and 78% of ST patients, whereas 86% of the STP patients and 88% of the ST patients returned to sports activity. Objective examination revealed 73% of the STP group and 82% of the ST group to have a negative or 1+ Lachman test result. A negative pivot shift was noted at follow-up in 80% of the STP group and in 82% of the ST group. KT-1000 testing revealed 60% of the STP patients and 61% of the ST patients to have less than or equal to 3 mm of side-to-side difference. In the STP group there was no evidence of graft breakage, deep infections, or sterile effusions. Overall subjective and functional results were uniformly better than objective results in both patient groups. Analysis of subjective, objective, and functional results reveal no difference in outcome between the STP and the ST patient groups.

Adult↗

PubMed1991

Partial thickness rotator cuff tears: results of arthroscopic treatment.

Thirty-one patients with arthroscopically documented partial thickness rotator cuff tears treated by arthroscopic debridement of the lesion were retrospectively reviewed. The patients had had symptoms for an average of 20.5 months prior to surgery. Twenty-two of these 31 shoulders also had bursoscopy, with 18 having arthroscopic subacromial decompression. The results were graded by both the UCLA Shoulder Rating Scale and Neer's criteria. Twenty-six (84%) of the patients had satisfactory results with the remaining 5 (16%) patients having unsatisfactory results. A classification system for the size and location of partial thickness rotator cuff tears is presented. The lesion size did not affect the result. Repeat arthroscopy in three patients demonstrated no further deterioration of their rotator cuff. The results with and without subacromial decompression were similar. The need for subacromial decompression is best determined by the arthroscopic finding of a bursal side tear.

Adult↗

PubMed1991

Osteonecrosis of the knee after arthroscopic surgery: diagnosis with MR imaging.

Spontaneous osteonecrosis about the knee typically is a disease of the elderly characterized by an acute onset of pain. The exact cause of this condition has long been debated, although a causative relationship between meniscal tears and spontaneous osteonecrosis about the knee has been postulated. Seven patients with knee pain, meniscal tears, and chondromalacia without initial evidence of osteonecrosis at magnetic resonance (MR) imaging underwent arthroscopic surgery with meniscal recontouring or repair and cartilage shaving. These patients returned within 2-14 months with recurrent pain in the treated knee. MR imaging then demonstrated abnormalities consistent with osteonecrosis. Osteonecrosis of the femoral condyle or tibial plateau may be a late sequela of meniscal injury in association with chondromalacia and arthroscopic surgery. This diagnosis should be suspected in patients with recurrent knee pain after arthroscopic repair of meniscal tears. The precise relationship of this pattern of osteonecrosis to that previously described as spontaneous requires further investigation.

Arthroscopy↗

PubMed1991

Magnetic resonance imaging of the foot and ankle: correlation of normal anatomy with pathologic conditions.

Abnormalities of the foot and ankle can be difficult to diagnose by conventional examination and x-rays. Recently, magnetic resonance imaging (MRI) has emerged as a diagnostic tool for soft tissue and bony imaging. One hundred and ten normal feet and ankles were studied to define normal MRI anatomy. An additional 150 MRI scans were performed to diagnose and characterize various abnormal conditions. MRI demonstrated excellent definition of normal structures and pathologic entities. Surgical correlation with the MRI was done in 42 patients. MRI appears to be a useful examination for patients with certain soft tissue and bony abnormalities. A special oblique view also has been developed to assist in the diagnosis of injuries to the tibialis posterior, flexor hallucis longus, and flexor digitorum longus tendons.

Achilles Tendon↗

PubMed1991

Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients.

Magnetic resonance images of the knee were made for 1014 patients, and the diagnosis was subsequently confirmed arthroscopically. The accuracy of the diagnoses from the imaging was 89 per cent for the medial meniscus, 88 per cent for the lateral meniscus, 93 per cent for the anterior cruciate ligament, and 99 per cent for the posterior cruciate ligament. The magnetic resonance examinations were done at several centers, and the results varied substantially among centers. The accuracy ranged from 64 to 95 per cent for the medial meniscus, from 83 to 94 per cent for the lateral meniscus, and from 78 to 97 per cent for the anterior cruciate ligament. The results from different magnetic-resonance units were also compared, and the findings suggested increased accuracy for the units that had a stronger magnetic field. Of the menisci for which the magnetic resonance signal was reported to be Grade II (a linear intrameniscal signal not extending to the superior or inferior meniscal surface), 17 per cent were found to be torn at arthroscopy.

Adolescent↗

PubMed1990

SLAP lesions of the shoulder.

A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.

Accidental Falls↗

PubMed1990

Evaluation of patients with persistent symptoms after lateral retinacular release by kinematic magnetic resonance imaging of the patellofemoral joint.

The arthroscopic lateral retinacular release is typically performed to treat patellar pain and instability. This procedure was previously considered to be relatively benign with a low associated complication rate. However, a high incidence of medial subluxation of the patella was recently reported in patients with persistent symptoms after lateral retinacular release. Because the use of physical examination criteria may not always be sufficient to assess patellar alignment, 40 patients (43 knees) were evaluated by the newly developed technique of kinematic magnetic resonance imaging of the patellofemoral joint. One (2%) patellofemoral joint had normal patellar alignment, 10 (23%) had lateral subluxation of the patella, 1 (2%) had excessive lateral pressure syndrome, 27 (63%) had medial subluxation of the patella, and 4 (9%) had lateral-to-medial subluxation of the patella. Seventeen of 40 patients (43%) with unilateral arthroscopic lateral retinacular releases had medially subluxated patellae on the unoperated joints. Because patellar malalignment commonly affects bilateral joints, medial subluxation of the patella may have been present before the lateral retinacular release but was not recognized in these patients.

Adult↗

PubMed1990

Acute anterior cruciate ligament reconstruction. Analysis of complications.

One hundred fifty-six patients treated with intraarticular anterior cruciate ligament (ACL) reconstruction were analyzed to determine the incidence of complications. The study group of 31 patients (Group I) was treated with repair or reconstruction of an acute ACL injury. A comparison group of 125 patients had reconstruction for chronic ACL instability (Group II). The patients were evaluated clinically and by roentgenograms. The average follow-up time for the study group was 52.2 months. In Group I, 35% developed fibroarthrosis postoperatively that required arthroscopic lysis of adhesions and manipulation to restore motion. In Group II, only 12% developed this complication. However, developing this complication did not affect a patient's long-term clinical result when properly recognized and promptly treated.

Adolescent↗

PubMed1989

Torsional strength of the ankle in vitro. The supination-external-rotation injury.

Nineteen fresh-frozen anatomic specimens of the ankle were mounted in an experimental test device with the foot in supination. Torque versus rotation curves were recorded as each foot was rotated externally to failure. The mean failure torque was 45.3 Nm, the mean rotation to failure was 41.4 degrees, and the mean energy absorbed to failure was 10.6 Nm. Twelve specimens failed by fracture of the fibula, five by failure of lateral ligaments with no fibular fracture, one by a subtalar dislocation, and one by fracture of the calcaneous through a fixation screw hole. There were no statistically significant differences in torque or energy to failure between those specimens that failed by fibular fracture and those with ligamentous failure alone. Rotation to failure was 6 degrees greater in the ligamentous failure group. Ankles with less initial rotatory laxity tended to fail at higher torque levels. The mean ankle fracture torque measured in this study is similar to previously reported mean ligamentous failure torque for the knee flexed to 20 degrees and rotated externally to failure. In a prior in vivo study, approximately 10 Nm of external foot torque and 20 degrees of foot rotation could be tolerated prior to the initiation of pain. The present study indicates that these in vivo pain threshold levels represent approximately 50% of the rotation to failure and 25% of the torque to failure.

Ankle Injuries↗

PubMed1989

Intraarticular versus intraarticular and extraarticular reconstruction for chronic anterior cruciate ligament instability.

One hundred twenty-seven patients were evaluated for the results of surgical stabilization in chronic anterior cruciate ligament instability. Eighty-four patients had been treated with intraarticular reconstruction alone, while 43 patients had been treated with a combination of intraarticular and extraarticular stabilization. Patients were evaluated by questionnaire to assess subjective and functional status by clinical examination of objective findings, and by roentgenograms and instrumented ligamentous stability testing. The follow-up interval averaged 45.2 months for the entire group (range, 24-90 months). Using a 200-point scale, the rating for the group treated with intraarticular reconstruction alone was 169.1, while the average rating for the group treated with combined intraarticular and extraarticular stabilization was 166.2. Overall, an excellent or good result was obtained in 67% of patients in the intraarticular only group and in 70% of the patients in the combined reconstruction group. There were no significant differences between the two groups in terms of changes seen on roentgenograms or in terms of residual laxity measured by instrumented testing. Thus, there is no demonstrable benefit derived from combined intraarticular and extraarticular stabilization procedures for chronic anterior cruciate ligament instability, provided that a well-placed intraarticular substitute of sufficient strength is functional.

Adolescent↗

PubMed1989

Progress in ankle arthroscopy.

Ankle arthroscopy is rapidly gaining in popularity as an important diagnostic and therapeutic procedure. Indications for this technique include pain, swelling, stiffness, instability, hemarthrosis, and locking of the ankle. The anteromedial, anterolateral, and posterolateral portals are most commonly used. The use of a short, 30 degrees oblique arthroscope, with an ankle holder and distractor, permits visualization of the entire joint. Operative treatment is facilitated by small joint shavers, burrs, knives, and baskets. Intraarticular problems such as chondromalacia, osteophytes, loose bodies, synovitis, osteoarthritis, fracture, and instability all can be addressed arthroscopically. Prior to this technique, the cause of chronic ankle pain was poorly understood. Now, lateral ankle impingement is a well-recognized entity that responds well to arthroscopic treatment. Ankle arthroscopy provides a safe, effective method of diagnosis and treatment with few complications. Further advances in equipment and technique should expand indications for this procedure.

Adolescent↗

PubMed1988

Reconstruction of the anterior cruciate ligament using a torn meniscus.

In eighty of 100 patients, reconstruction of the anterior cruciate ligament using a torn meniscus was successful in restoring stability. The length of follow-up ranged from two to six years and the mean interval from injury to operation was two years. Preoperatively, all but one patient had a positive (2+ or 3+) Lachman test and a positive pivot-shift test. Only ten patients had evidence of major instability, as seen on either test. The result was the same regardless of whether the patient had had a concomitant extra-articular (Ellison) procedure. The results of arthroscopic biopsy in eleven patients did not support the hypothesis that the meniscus underwent metaplasia to ligamentous tissue. Although this procedure yielded results similar to those of other procedures in which autogenous tissues are used to reconstruct the ligament, the meniscus should rarely, if ever, be used for reconstruction of the anterior cruciate ligament. The procedure is indicated only for patients who, in addition to needing reconstruction of the anterior cruciate ligament, also have a torn meniscus that would otherwise have to be totally excised.

Adolescent↗

PubMed1987

Failed arthroscopic meniscectomy: prognostic factors for repeat arthroscopic examination.

The authors have reviewed 44 patients retrospectively who failed arthroscopic partial meniscectomy. The study attempts to define the chances for success and to identify prognostic factors as these patients return for reoperation. Each patient had a repeat arthroscopic examination from 2 to 60 months after partial meniscectomy (average 19 months). They were reviewed an average of 31 months after reoperation (6 to 60 months), and each completed a subjective questionnaire evaluating the efficacy of their repeat arthroscopic surgery. Seventy-one percent of the patients had improvement with reoperation and were classified as good or excellent. Twelve patients (29%) did not improve and were rated poor. Ten parameters, as recorded before repeat arthroscopic examination, were investigated in an attempt to correlate each with success and to find those that are significant prognostic factors. Age of the patient, number of surgeries on the involved knee, time between arthroscopic examinations, nature of history (acute or chronic), workers' compensation or private insurance status, range of motion on physical examination prior to repeat arthroscopy, and degree of chondromalacia as seen at the first surgery were not found to correlate with the ultimate success of the patient. The presence of mechanical complaints before reoperation was a statistically significant parameter that led to a good or excellent result in 86% of the patients at follow-up. Lateral meniscal pathology seen at first partial meniscectomy gave more favorable results than medial meniscal pathology even if the patient had nonmechanical complaints. A history of reinjury between arthroscopic surgeries is helpful only if positive. In the absence of such a history, no conclusion can be drawn.

Adolescent↗

PubMed1987

Patellar instability: treatment by arthroscopic electrosurgical lateral release.

We reviewed the results of arthroscopic lateral release using electrosurgery in 39 patients (45 knees) with a history of recurrent patellar subluxation or dislocation. The average follow-up time was 28 months (range, 24-36). At follow-up, the patients had decreased swelling, instability, and pain. There was an improvement in flexion activities, sports participation, and overall functional ability. Only 20% of the knees had completely normal physical findings: 11.1% of the knees were rated as excellent; 64.4% were improved; and 24.5% were poor. Dislocators had more frequent poor results. The complication rate was 4.4%. There were no postoperative hemathroses. One patient was considered a surgical failure. The technique yields results comparable with those of open extensor realignment procedures and avoids the complications inherent to lateral release in general. The place for this procedure in patellar instability is well-documented.

Adult↗

PubMed1987

Treatment of the anterior cruciate ligament-absent knee with associated meniscal tears. Instrumented testing and clinical evaluation of two patient groups.

The UCLA instrumented clinical testing apparatus was used to measure postoperative stiffness and laxity for two groups of patients with documented chronic absence of the anterior cruciate ligament (ACL) and associated meniscal tears. Group 1 consisted of 76 patients (average age, 25 years) who had undergone anterior cruciate substitution using the torn meniscus, and a second group of 34 patients (average age, 31 years) who had partial meniscectomy alone without ACL substitution. Subjective and objective evaluations were significantly higher and symptoms of pain and buckling significantly lower in the substitution group. In addition, 29% of Group 1 and only 7% of Group 2 patients were able to return to their preinjury sports without limitations, while 5% of the former and 12% of the latter could not return to any sport. At 90 degrees of flexion, there were no significant differences in stiffness or laxity between the patient groups. At 20 degrees of flexion and neutral foot rotation, the meniscal substitution group had an average of 1.4 mm less side-to-side laxity difference than the partial meniscectomy patients; 51% of the substituted patients still had an injured knee laxity that was at least 2 mm greater than the uninjured knee, as contrasted to 67% of the partial meniscectomy patients who exceeded this upper limit of the normal range. At 20 degrees, anterior stiffness of the injured knees of the substitution patients was 28% greater than the injured knees of the partial meniscectomy group; 42% of the substituted patients had an injured knee stiffness within the normal range, while only 18% of the partial meniscectomy patients fell within normal limits. There were no statistical correlations of stiffness or laxity values with clinical scores or patient symptomatology in either group.

Adult↗

PubMed1987

Measurements of anterior laxity in normal and anterior cruciate absent knees with two instrumented test devices.

A new portable model of the University of California at Los Angeles (UCLA) instrumented clinical knee testing apparatus and the KT-1000 knee arthrometer were used to measure anterior laxity in normal and anterior cruciate absent knees. Normal ranges for both devices were established for a control group of 48 normal subjects. With the UCLA device at 200 N of applied tibial force, 95% of normal knees have an anterior laxity less than 8.0 mm and a side to side difference less than 2.0 mm; corresponding values for the KT-1000 at 89 N are 9.0 mm and 2.0 mm. Both devices showed that anterior laxity of 19 anterior cruciate absent knees was approximately double that for normal knees. Measurements taken with these two testing instruments do not have a one-to-one correlation, as the method of femoral constraint and the amount of applied tibial force will influence the magnitude of the recorded laxities. Proper interpretation of laxities measured with each device requires consideration of right-left scatter in a normal population tested with that particular device. Both devices were 90%-95% accurate in correctly classifying an anterior cruciate absent knee outside the normal range.

Adult↗

PubMed1986

Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases.

In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.

Adolescent↗

PubMed1985

Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results.

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.

Adult↗