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Biomedical subjects

R S Paterson

Publications and source records attributed to R S Paterson.

11 recordsLinked to original sources
PubMed2005

Loose intra-articular body following anterior cruciate ligament reconstruction.

We report a case of intra-articular fracture of a bioabsorbable fixation device from the femoral tunnel in an anterior cruciate ligament reconstruction using a bone-tendon-bone graft. Thirteen months after successful reconstruction surgery, the patient experienced episodes of locking and medial joint pain. There was no history of trauma and no symptoms of instability or swelling. On revision arthroscopy, a fractured tip of a bioabsorbable RIGIDfix cross pin (Mitek, Westwood, MA) was identified in the medial compartment of the knee. There was a broad area of chondral erosion affecting the medial femoral condyle and a small defect to the medial tibial plateau where the loose body had been lodged. The bone-tendon-bone graft was intact without disruption. After arthroscopy, the patient was symptom free for 3 weeks but then developed further symptoms of locking. Magnetic resonance imaging showed another loose body within the knee. A repeat arthroscopy was performed 6 weeks after the earlier procedure and another piece of the polylactic acid RIGIDfix cross pin was removed, this time from the lateral gutter. This case raises concern about the potential for breakage and resultant loose body formation that may occur after bioabsorbable cross-pin fixation and, particularly, the associated chondral damage that can occur if early intervention is not conducted.

Absorbable Implants↗
PubMed1999

Plantar fascia release through a transverse plantar incision.

A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty-seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively.Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery. It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve.

Adult↗
PubMed1997

Oblique menisco-meniscal ligament of the knee.

Anomalies of the intra-articular anatomy of the knee can be confusing to the unwary arthroscopist. The case that follows shows a variant of the anterior intermeniscal ligament, which was not previously appreciated by the authors yet had been previously described. Awareness of this variant will be especially pertinent in anterior cruciate ligament reconstruction, where its identification is more likely.

Adult↗
PubMed1995

Mechanical properties of the human anterior cruciate ligament.

The aim was to measure the stiffness and strength of the femur-anterior cruciate ligament-tibia complex tested in a physiological manner with a force exerted anteriorly on the tibia, at knee joint flexion angles of 0 degrees, 10 degrees and 30 degrees and at speeds of 50 and 500 mm/min. Ligaments were preconditioned by cycling five times, with data from the fifth cycle used to determine the stiffness of the ligament in a low-load range. The ligaments were then tested to failure with the knee at 30 degrees flexion. The specimens were divided into two groups, middle-aged (40-60) and old (>60). For each group no statistical difference was observed between stiffness of the ligament at different joint flexion angles or speeds. Seven of the 21 specimens in the older age group failed by avulsion at the bone-ligament interface. All the other specimens failed by tears in the substance of the ligament. Ultimate failure load was found to have a significant correlation with bodyweight. It was 1.6 and 1.3 times bodyweight for the middle-aged and older age groups respectively. This study has highlighted the importance of identifying different modes of failure, of making corrections for bodyweight and testing in a physiological manner. The results allow a better understanding of the mechanical behaviour of the anterior cruciate ligament and provide design data for anterior cruciate ligament grafts and prostheses. RELEVANCE:--Our clinical experience indicates that the anterior cruciate ligament is frequently ruptured during uncoordinated contraction of the quadriceps mechanism. The results of this study, in which the mechanical properties of the anterior cruciate ligament have been measured with force exerted anteriorly on the tibia, allow a more complete understanding of the mechanical behaviour of the anterior cruciate ligament and provide design data for anterior cruciate ligament grafts and prostheses.

Journal Article↗
PubMed1992

A new femoral drill guide for arthroscopically assisted anterior cruciate ligament replacement.

There are an increasing number of drill guides and methods of selecting the most isometric femoral attachment site for reconstruction of the anterior cruciate ligament (ACL); some of these are complex and time-consuming. The senior author (R.P.) has developed a simple "inside-out" arthroscopic femoral drill guide, which is designed to reliably locate the optimal femoral attachment site. The accuracy and reliability of this guide was assessed in 10 cadaver knees. The isometry of semitendinosus tendon (ST), then patellar bone-tendon-bone (BTB) grafts was assessed in each knee. In no instance, for either reconstruction, was there greater than 3 mm graft movement through a full range of knee motion. Based on this study, we therefore conclude that this very simple drill guide is a useful tool in arthroscopic ACL reconstruction to quickly, easily, and reliably select the optimal femoral attachment site. It also negates the need for a lateral incision when using a BTB graft, thus reducing morbidity and improving cosmesis.

Anterior Cruciate Ligament↗
PubMed1987

Advances in arthroscopic surgery.

Removal of the whole meniscus from the knee has been shown to be associated with a high incidence of degenerative change. The degeneration is proportional to the amount of meniscus removed. After meniscal injury, retention of the meniscus in part (partial meniscectomy) or in whole (meniscal suture) is preferable. Replacement of a previously removed meniscus (meniscal transplantation) may be feasible in the future. Fifty patients had arthroscopic partial meniscectomies performed alternately by standard mechanical techniques or by electrosurgical techniques. The latter group was found to have less pain and swelling. Another 46 patients had meniscal sutures performed on one or more menisci. Twenty-one of these patients had a follow-up arthroscopy for recurrence of symptoms and only one meniscus had not healed. Another single patient had a meniscal transplant, and a follow-up arthroscopy six months after surgery revealed the meniscus to be largely intact.

Adult↗
PubMed1984

Increased corrosion of stainless steel implants in infected plated fractures.

Correlation has previously been observed between the incidence of metal hypersensitivity (Ni, Cr, Co) and the incidence of infection after internal fixation of bone fractures. As there is no doubt that exposure to high concentrations of metal can cause allergy, metal levels (Cr, Ni, Mo, Co) were analyzed in implant contact tissues by ASS. Both the absolute concentration of the ions and the Ni:Cr ratio in the tissues adjacent to metal implants is greater in infected cases than in non-infected. Thus infection as a cause of allergy has to be considered. In view of the resulting problems perhaps consideration could be given to the use of a different alloy for metal implants.

Chromium↗
PubMedDate not supplied

The posteromedial impingement lesion of the ankle. A series of six cases.

We report on a series of six cases of posteromedial impingement lesion of the ankle operated on during a 3-year period with excellent or good results and a return of the patients to preinjury levels of activity. This lesion occurs, on occasion, after a severe ankle-inversion injury in which the deep posterior fibers of the medial deltoid ligament become crushed between the medial wall of the talus and the medial malleolus. Initially, posteromedial symptoms do not predominate, compared with the symptoms of the lateral ligament disruption, and they usually resolve without specific treatment. Occasionally, however, thick, disorganized fibrotic scar tissue persists and impinges between the medial wall of the talus and the posterior margin of the medial malleolus. Clinically, the patient has persistent medial to posteromedial activity-related ankle pain after a severe inversion injury, despite a sound ankle rehabilitation program. There is deep soft tissue induration immediately behind the medial malleolus with localized tenderness and reproduction of symptomatic pain on provocative testing by palpating this site while moving the ankle into plantar flexion and inversion. The posteromedial impingement lesion has a distinct pathologic picture and can coexist with other ankle lesions that cause pain after lateral ligament injury.

Adult↗
PubMedDate not supplied

Acute repair of the anterior cruciate ligament with lateral capsular augmentation.

Forty-seven patients had primary repair and extraarticular augmentation with a lateral loop of the iliotibial tract for acute rupture of the ACL. (All of these patients had anterolateral rotatory instability (ALRI) preoperatively as diagnosed by a positive jerk test.) Of these 47 patients, 36 were available for follow-up evaluation. Followup ranged from 6 to 68 months (average, 21.6 months). Twenty-three of the patients (64%) were rated as excellent or good. Ten of the patients (27.8%) were rated as fair, and three patients (8%) were rated as poor. Thirty-three of the 36 patients (91%) were objectively free of ALRI as tested by the jerk test and had 1+ or less result in a Lachman test, with a firm end point. Only one patient felt his knee to be unstable (he had a positive pivot jerk). More than 90% of the patients returned to sport, and 72% returned at their preinjury level.

Acute Disease↗
PubMedDate not supplied

The natural history of meniscal tears in anterior cruciate ligament insufficiency.

We reviewed the meniscal status of 176 consecutive patients undergoing anterior cruciate ligament reconstruction acutely (less than 6 weeks from injury), subchronically (6 weeks to 12 months from injury), and chronically (more than 12 months from injury). The commonest tear was the single longitudinal vertical split of the medial meniscus. There was an increasing incidence of meniscal tears as the injury became more chronic, with a significant (P < 0.001) increase in medial meniscal tears; the incidence of lateral meniscal tears remained relatively constant. Seventy-five (43%) of the patients had one or both menisci repaired. Acutely, repair was performed more frequently on the medial meniscus than the lateral (80% versus 24%, respectively). All repaired menisci had single longitudinal tears unstable to probing. The incidence of repair dropped to 46% in the medial meniscus and 14% in the lateral meniscus in the chronic stage. Nineteen (25%) of these 75 patients (26 menisci) underwent a check arthroscopy at a minimum of 6 months from repair. All 21 medial menisci and all 5 lateral meniscal tears had healed; however, 1 lateral meniscus had torn along the line of the sutures. At an average followup of 40 months, 92% of the repaired menisci were still in situ and 8% that had required resection were related to the recurrence of anterior cruciate ligament instability. This study highlights the increasing incidence of meniscal injury in chronic anterior cruciate ligament insufficiency with the meniscal tears becoming more complex and therefore less amenable to suture.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗