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Biomedical subjects

R J Tregonning

Publications and source records attributed to R J Tregonning.

9 recordsLinked to original sources
PubMed2001

Delay in diagnosis of anterior cruciate ligament injury in sport.

AIMS: To determine the rate and timing of diagnosis of anterior cruciate ligament (ACL) injuries and to identify the diagnostic features. METHODS: 70 patients injured in sport with isolated ACL tears, who had received or were awaiting reconstruction, answered a telephone questionnaire about the history of injury and timing of diagnosis. RESULTS: 55 (79%) presented to a doctor within 24 hours of their injury. Eleven (16%) reported that their ACL injury was diagnosed correctly at initial presentation by the first doctor they saw. 34 (49%) saw two doctors, and 25 (36%) saw three or more doctors before the diagnosis was made. The mean time to correct diagnosis was two months after the injury. Specific questioning revealed that at the moment of injury 54 (77%) felt that the knee had been disrupted, 30 (43%) sensed a snap, and 26 (37%) a pop. 41 (59%) reported that when correctly diagnosed, little or no advice had been given to them about modifying their sport. CONCLUSIONS: Despite the injured athletes presenting early, diagnosis was usually made late. Most often, multiple doctors were consulted. Even when correctly diagnosed, patients were usually not given clear advice about sports modification to prevent recurrent ACL instability. The history of injury was commonly strongly suggestive of ACL tear. Popping and snapping are known to be commonly associated, and a sense of knee disruption was even more common than either in this series. These characteristic sensations should be sought by doctors by specific questioning to increase diagnosis rates.

Adolescent↗
PubMed1993

Nine-year follow-up results of two methods of MacIntosh anterior cruciate ligament reconstructions.

Forty-seven MacIntosh anterior cruciate reconstructions using iliotibial band were performed in patients with chronic instability symptoms and positive pivot shift jerk. In 22 knees, a lateral substitution technique alone was used. In 25 knees, the technique was supplemented with an intraarticular component. After an average of follow-up of nine years, 62% of knees had an excellent or good Lysholm score; 83% of patients remained active in sports. Subjectively, there was no deterioration of stability with time, and no return of the jerk on pivot shift testing, although a slide persisted in one third of the patients. The addition of an intraarticular component did not alter the subjective result. Objectively, the trend was toward improvement in functioning. The lateral tenodesis was the major determinant in the improvement of subjective stability and control of pivot shift jerk.

Adult↗
PubMed1983

Closed and open partial meniscectomy for bucket handle tears: a comparative evaluation.

Two groups of patients with bucket-handle tears of the meniscus were treated by open operation (27) and by closed operation (29). Pre-operative arthroscopy was carried out on all. Those treated by closed operation had much shorter recovery time and returned to work earlier that those with open operation. Symptomatic relief was obtained by all.

Adolescent↗
PubMed1983

Diagnosis and Macintosh substitution for chronic anterior cruciate insufficiency.

Of 45 consecutive knees undergoing MacIntosh fascia lata anterior cruciate substitution, only five had accompanying collateral ligament laxity. Over a third of cases (16) had more than ten episodes of major instability causing falls to the ground pre-operatively. The initial injury caused haemarthrosis, usually without external trauma (36), was often accompanied by a sensation of knee disruption (18), and was always associated with immediate disability. The results of 26 lateral substitution operations with minimum 12 month follow-up show abolition of pivot shift jerk in all patients. Incomplete control of objective and functional instability postoperatively in four patients may have been related to soft tissue stretching associated with early mobilization in a cast-brace or generalized ligamentous laxity.

Adolescent↗
PubMed1983

Closed partial meniscectomy. Early results for simple tears with mechanical symptoms.

A review is presented of early results of a consecutive series of 45 bucket-handle or flap tears of a meniscus treated by closed partial meniscectomy over a two-year period. The mean operating time was 45 minutes. All patients were treated in hospital and 39 of 41 assessable patients were discharged within 24 hours of operation. The mean time to return to work was 12.9 days. One patient later required arthrotomy to excise a residual nubbin of meniscal tissue which had been incompletely removed and caused pain. At follow-up at a mean of eight months after operation only one patient had temporary mechanical symptoms not explained by further injury or degenerative change. Seven patients who had undergone previous open meniscectomy reported improvement after closed meniscectomy in relation to both pain and disability. It is concluded that closed partial meniscectomy for these common meniscal tears is successful in the early relief of symptoms if all unstable fragments are excised. The technique is difficult to learn but is associated with rapid rehabilitation and a high rate of acceptance by the patient.

Adolescent↗
PubMed1981

Diagnostic arthroscopy of the knee joint: meniscal findings in a prospective study of 200 examinations.

The arthroscopic techniques and meniscal findings in a prospective study of 200 consecutive arthroscopic examinations are presented. In 52 cases of arthrotomy-proven meniscal tears there were three arthroscopic false negatives giving an accuracy rate for the procedure of 93 percent. Intra-articular instrumentation via multiple puncture sites allowing manipulation of menisci under direct vision was used in 74 cases. Arthroscopy is safe and is an accurate adjunct to clinical examination in the diagnosis of meniscal pathology.

Adult↗
PubMed1980

Knee ligament injuries.

Better knowledge of pathomechanics and clinical features together with more widespread use of stressing the knee under anaesthesia and arthroscopy makes easier the diagnosis of acute knee ligament and associated injury. Careful analysis of the symptoms of chronic instability points to the hitherto neglected anterior cruciate ligament rupture as a significant knee ligament injury often causing giving-way of the knee. Prompt treatment of knee ligament rupture may offer the only hope against the irreversible injury to other knee structures caused by continuing instability.

Adult↗
PubMed1977

99Tcm-diphosphonate scanning as an aid to diagnosis of infection in total hip joint replacements.

Local infection following total hip joint replacement is often difficult to diagnose. Bone scanning with 99Tcm-diphosphonate has been used in an attempt to detect such infection by assessing uptake of 99Tcm in the hip. Posterior view dot scans of patients with total hip joint replacements were analysed quantitatively to determine the ratios of dots in regions around the acetabular, trochanteric and femoral parts of the prosthesis compared with normal bone. The scans were also assessed visually. Patients with definite evidence of infection showed higher uptake than control patients. The clearest distinction in uptake between the two groups was in the femoral shaft region. The data from these two groups of patients were used to propose diagnostic criteria for detecting abnormalities on scans. These criteria were applied to scans of a third test group of patients who had painful hips, but no definite evidence of infection. The numerical method of analysis is less subjective and may therefore be preferable as a means of providing evidence for or against a diagnosis of infection in patients with painful hip replacements.

Hip Joint↗