Biomedical subjects

René Verdonk

Publications and source records attributed to René Verdonk.

At least 19 recordsLinked to original sources

PubMed2006

Anterior fracture displacement in Colles' fractures after Kapandji wiring in women over 59 years.

The aim of this study was to assess the radiological results of Colles' fractures treated with Kapandji wiring and to determine the frequency of postoperative anterior fracture displacement. The X-rays of 89 fractures in women over 59 years of age were evaluated. Five weeks after injury, palmar shift of the distal fracture fragments and/or palmar tilt of more than 20 degrees were observed in 26 patients. In ten wrists dorsal tilt was not sufficiently corrected and measured more than 10 degrees . Increase in ulnar variance was more than 2 mm in 37 wrists and more than 5 mm in six wrists; this was more pronounced when the palmar tilt was not corrected properly or when anterior fracture displacement was present. We conclude that Kapandji wiring may not be able to prevent anterior fracture displacement in almost one-third of Colles' fractures in osteoporotic elderly patients.

Age Factors↗

PubMed2006

Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations.

Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts were transplanted. Eleven of the medial allograft procedures were associated with a high tibial osteotomy. The patients were evaluated clinically at the time of transplantation and at the final follow-up using the modified HSS scoring system. The knee injury and osteoarthritis outcome score (KOOS) was used as an evaluation tool for patient-related outcome at the final follow-up. Joint space width narrowing and Fairbank changes were radiological outcome parameters, which were available for 32 patients. Femoral and tibial cartilage degeneration, graft extrusion and signal intensity were scored on MRI scans obtained in 17 patients approximately 1 year after transplantation and at the final follow-up (>10 years). For statistical analysis the patients were divided into three groups: lateral meniscal allograft (LMT), medial meniscal allograft transplantation with a high tibial osteotomy (MMT+HTO) and without (MMT). The modified HSS score revealed a significant improvement in pain and function at the final follow-up for all groups. Further analysis also revealed that an MMT+HTO procedure resulted in a greater improvement at the final follow-up when compared to MMT. Nonetheless, the KOOS scores obtained at the final follow-up revealed the presence of substantial disability and symptoms, in addition to a reduced quality of life. Radiographical analysis revealed no further joint space narrowing in 13/32 knees (41%). Fairbank changes remained stable in 9/32 knees (28%). MRI analysis showed no progression of cartilage degeneration in 6/17 knees (35%). An increased signal intensity of the allograft was present, as was partial graft extrusion in the majority of patients at the final follow-up. Seven cases had to be converted to a total knee arthroplasty during the follow-up; the overall failure rate was 18%. Long-term results after viable meniscus allograft transplantation are encouraging in terms of pain relief and improvement of function. Despite this significant improvement, substantial disability and symptoms were present in all investigated subgroups. Progression of further cartilage degeneration or joint space narrowing was absent in a considerable number of cases, indicating a potential chondroprotective effect. Level of evidence is therapeutic study, Level IV and retrospective analysis of prospectively collected data.

Adult↗

PubMed2006

Transplantation of viable meniscal allograft. Surgical technique.

BACKGROUND: Few medium-term or long-term reports on meniscal allograft transplantations are available. In this study, we present the results of a survival analysis of the clinical outcomes of our first 100 procedures involving transplantation of viable medial and lateral meniscal allografts performed in ninety-six patients. METHODS: Thirty-nine medial and sixty-one lateral meniscal allografts were evaluated after a mean of 7.2 years. Survival analysis was based on specific clinical end points, with failure of the allograft defined as moderate occasional or persistent pain or as poor function. An additional survival analysis was performed to assess the results of the sixty-nine procedures that involved isolated use of a viable allograft (twenty of the thirty-nine medial allograft procedures and forty-nine of the sixty-one lateral allograft procedures) and of the thirteen viable medial meniscal allografts that were implanted in combination with a high tibial osteotomy in patients with initial varus malalignment of the lower limb. RESULTS: Overall, eleven (28%) of the thirty-nine medial allografts and ten (16%) of the sixty-one lateral allografts failed. The mean cumulative survival time (11.6 years) was identical for the medial and lateral allografts. The cumulative survival rates for the medial and lateral allografts at ten years were 74.2% and 69.8%, respectively. The mean cumulative survival time and the cumulative survival rate for the medial allografts used in combination with a high tibial osteotomy were 13.0 years and 83.3% at ten years, respectively. CONCLUSIONS: Transplantation of a viable meniscal allograft can significantly relieve pain and improve function of the knee joint. Survival analysis showed that this beneficial effect remained in approximately 70% of the patients at ten years. This study identified the need for a prospective study comparing patients with similar symptoms and clinical findings treated with and without a meniscal allograft and followed for a longer period with use of clinical evaluation as well as more objective documentation tools regarding the actual fate of the allograft itself and the articular cartilage.

Anterior Cruciate Ligament↗

PubMed2006

Bicipitoradial bursitis. A case report.

Mass lesions in the antecubital fossa are uncommon and therefore unknown. We report a case of bicipitoradial bursitis, which initially was mistaken for a malignant lesion.

Bone Neoplasms↗

PubMed2005

The popliteal cyst.

A popliteal cyst, originally called Baker's cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?

Diagnostic Imaging↗

PubMed2005

The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis.

One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In four others, a lateral prosthesis was implanted subsequently to a medial one. One of these four was revised to a total knee prosthesis 6 years later. In another four cases, late complications of the meniscal bearing were treated with replacement of this bearing. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded. Since these results compare poorly to the survival of total knee arthroplasty, this prosthesis is not the first-choice implant. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in patients younger than 65. Further research is mandatory to confirm that this prosthesis very rarely needs revision in patients older than 75. It should not be used in osteotomized knees.

Aged↗

PubMed2005

Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.

Adolescent↗

PubMed2005

Influence of burst TENS stimulation on collagen formation after Achilles tendon suture in man. A histological evaluation with Movat's pentachrome stain.

Retrograde or antidromic stimulation of the nociceptive C fibres is known to lead to the release of sensory neuropeptides, such as substance P (SP), by the peripheral endings of sensory unmyelinated C nerve fibres. These neuropeptides play a role in the healing of soft tissues. Burst TENS (Transcutaneous Electric Nerve Stimulation) is known to be most effective in influencing retrograde C fibre-evoked activity. This is why burst TENS was used in a randomised study as a stimulus for the healing of the sutured Achilles tendon in 9 patients, versus 9 others who received no stimulus. Originally, each group consisted of 10 patients, but there was a single drop-out in each group. Six weeks after surgery a needle biopsy sample was obtained, and stained with Movat's pentachrome stain. It showed a statistically significant influence of burst TENS on new collagen production, maturation of newly formed collagen and organisation of collagen. This suggests that burst TENS might positively influence healing of Achilles tendon suture in man.

Achilles Tendon↗

PubMed2004

Normal and transplanted lateral knee menisci: evaluation of extrusion using magnetic resonance imaging and ultrasound.

The aim of the study is to develop a clinically useful and reproducible method for evaluating lateral meniscal extrusion in normal and transplanted knees under different axial loading conditions. Magnetic resonance imaging (MRI) and ultrasound (US) were used to assess meniscal extrusion. Both types of imaging were performed at least 6 months postoperatively (mean 23.5 months). Coronal MR images (DESS-3D sequence) of the lateral compartments of 10 normal knees and 17 transplanted lateral knees were analyzed. Extrusion was defined as the distance measured from the femoral condyle or tibial plateau to the outer edge of the meniscus. Subjects were examined in the supine position. Ultrasound print-outs of the lateral compartment of both knees of ten patients (transplanted side and contralateral normal side) were analyzed. Extrusion cross-sectional area (CSA) and distance were measured just anterior to the lateral collateral ligament: the former was defined as the CSA of the meniscus outside the knee, the latter as the greatest distance from a line connecting the femur and tibia to the outer edge of the lateral meniscus. Patients were examined in the supine position, bipodal stance and unipodal stance. The viable meniscal allograft was securely sutured to a bleeding functional meniscal rim. No bone blocks were used to fix the allograft; instead, the anterior and posterior horn were firmly sutured to their enthesis. The MRI results (tibial) show the transplanted lateral meniscus to be significantly (p<0.005) more extruded in comparison to the normal lateral meniscus. The anterior horn (mean 5.8 mm, SD=2.8) of the transplanted lateral meniscus tends to be more extruded than the posterior horn (mean 2.7 mm, SD=1.48). The posterior horn of the normal lateral meniscus does not (mean 0 mm) extrude, while the mean extrusion of the anterior horn is 0.8 mm (SD=0.92). In the US results, the transplanted lateral meniscus is significantly (p<0.005) more extruded than the normal lateral meniscus in all patient positions. Both cross-sectional surface and distance are equally good parameters to determine meniscal extrusion. There is no statistical difference between patient positions. The transplanted lateral meniscus extrudes, in the supine position, bipodal and unipodal stance 6.43 (SD=1.84), 6.01 (SD=1.93) and 6.99 mm (SD=2.7) respectively. The extrusion surface of the lateral transplanted meniscus is 50.50 mm2 (SD=15.32), 47.24 mm2 (SD=14.35) and 58.61 mm2 (SD=29.65) in the supine position, bipodal stance and unipodal stance respectively. The normal lateral meniscus extrudes in the supine position, bipodal and unipodal stance 3.77 (SD=1.76), 3.94 (SD=1.66) and 3.79 mm (SD=1.79) respectively. The extrusion surface of the normal lateral meniscus is 22.42 mm2 (SD=12.54), 23.24 mm2 (SD=12.74) and 24.79 mm2 (SD=10.18) in the supine position, bipodal stance and unipodal stance respectively. The presented data shows that the transplanted lateral meniscus, without bone block fixation but with firm fixation of the horns to the original entheses, extrudes in the lateral direction significantly more than the normal meniscus. The transplanted lateral meniscus, however, does not extrude more in the lateral direction under axial load. The anterior horn of both normal and transplanted menisci is extruded more laterally than the posterior horn. Both methods are adequate to measure laterally-directed extrusion of the normal and transplanted lateral meniscus, but have distinctive advantages and disadvantages: MRI in this series visualizes the complete-from posterior to anterior-meniscal body, but only in the supine, non-weight-bearing position. Using ultrasound one can evaluate the meniscal extrusion in different conditions of axial loading, but only from a single examination point.

Adolescent↗

PubMed2004

Magnetic reasonance imaging of the surgically repaired meniscus: a 13-year follow-up study of 13 knees.

BACKGROUND: This study was initiated to evaluate the long-term outcome of meniscal sutures and to correlate clinical findings with MRI findings. We were interested to see if a clinically healed meniscus also showed as such on MRI and if degenerative changes were present PATIENTS AND METHODS: We studied prospectively 13 patients (7 men) aged between 29 and 50 years, who had undergone closed meniscus repair between 1985 and 1988 using an inside-out technique, clinically and with MRI, with a mean follow-up time of 13 years. RESULTS: Meniscal suture gave good clinical long-term results: all patients got a Hospital for Special Surgery score of more than 75%. In all patients the site of the previous suture was still visible on MRI, mainly from small metal artefacts in the meniscus. 4 of 7 patients with an unrepaired ACL lesion had signs of arthrosis and cartilage degeneration. MRI showed signs of mucoid degeneration or scar tissue in 6/13 of the patients. INTERPRETATION: We believe that asymptomatic meniscal tears produce abnormal MR signals even though they have stable unions, and that MR signals at the site of repair represent edematous scar tissue, not true nonunions.

Adult↗

PubMed2004

Tibial ultrasound velocity in women with wrist fracture.

The aim of the study was to determine whether cortical midtibial speed of sound (Soundscan 2000, Myriad Ultrasound Systems, Israel) was able to discriminate women who sustained a fracture of the distal radius from normal women and to compare the performance of tibial speed of sound with dual-energy X-ray absorptiometry (DXA) of the distal radius, hip, and lumbar spine. The study population consisted of 40 women with a wrist fracture and 41 healthy age-matched controls. Tibial ultrasound velocity correlated with bone mineral density of the distal forearm (rS = 0.64, p < 0.001), the hip (rS = 0.46, p < 0.001), and the lumbar spine (rS = 0.51, p < 0.001). The mean speed of sound value at the mid-tibia of the wrist fracture patients (3873 m/s) was lower than that of the controls (3913 m/s), but the difference was not statistically significant (p = 0.12). All DXA values were significantly lower in fracture cases. Receiver operating curve analysis showed that mid-tibial ultrasound velocity was less effective than DXA of the distal forearm to discriminate wrist fracture patients from age-matched controls.

Absorptiometry, Photon↗

PubMed2004

Nocardia farcinica arthritis of the knee. A case report.

Nocardia is a gram positive, aerobic branched actinomycete; it is an ubiquitous soil saprophyte. As an infecting agent it has been increasingly identified in humans, especially in immuno-suppressed hosts. Nocardia as a cause of septic arthritis is very unusual. The described genus was Nocardia asteroides in nearly all previously reported cases. We report an unusual case of spontaneous Nocardia farcinica septic arthritis of the left knee in a 68-year-old man, who was under systemic corticosteroids for chronic obstructive pulmonary disease. The diagnosis was rapidly made by Gram and acid-fast stains and later confirmed by culture. PCR was used to identify the subtype. The patient was treated successfully with sulphametaxazole-trimethoprim for six months. Our case re-emphasises, especially in the immuno-compromised patient, the importance of performing fungal and acid-fast bacilli cultures, besides the most common bacterial cultures for aerobic and anaerobic organisms, in order to identify less common organisms and to initiate early and adequate treatment.

Aged↗

PubMed2003

Arthroscopic meniscus repair: inside-out technique vs. Biofix meniscus arrow.

A retrospective study evaluated meniscal suturing using an inside-out technique vs. an all-inside technique (Biofix meniscus Arrow). Fifty-five knees in 55 patients who underwent closed meniscus repair between 1985 and 1995 were divided in two groups: 20 managed by an inside-out technique; and 35 managed by an all-inside technique. All patients underwent the same postoperative program of partial weight bearing, immediate motion, and rehabilitation of the knee. They were subjected to a clinical examination using Hospital for Special Surgery knee rating system. The mean follow-up was 13 years, 2 months (11 years, 11 months-15 years, 4 months) in the inside-out group and 6 years, 5 months (6 years-6 years 10 months) in the Biofix Arrow group. Sixteen patients also had an anterior cruciate ligament injury, of which six were repaired at the time of meniscus repair and one 6 years after meniscal repair. Thirty-nine patients had an excellent or good result (87% satisfactory outcome), three had a fair result, and three had a poor result. Meniscal suturing thus provides good clinical long-term results. The advantages of an all-inside technique include short operating time, superfluous capsular exposure, easier technique, and potentially lower risk of neurovascular lesions, especially when posterior horns are involved.

Absorbable Implants↗

PubMed2003

The functional importance of malunion in distal radius fractures.

The purpose of our study was to investigate which radiological parameter had the maximal detrimental effect on functional outcome following malunion of distal radius fractures. Sixty-four women over 40 years of age who had sustained low-energy wrist fractures were included in the study. The mean age of the patients was 64 years. We compared the ulnar variance, radial inclination and palmar tilt of the fractured wrist to the non-injured contralateral side on radiographs obtained after fracture healing. The functional outcome was assessed at a mean follow-up of 28 months. Wrist mobility, grip strength, and pain with daily activities were determined and combined to give a final outcome rating. An increase in ulnar variance was found to be the most important radiological parameter affecting functional outcome and the outcome tended to be influenced by age, hand dominance and the presence of articular involvement.

Adult↗

PubMed2003

Distal femoral cortical irregularity in a 13-year old boy. A case report.

Distal femoral cortical irregularity (DFCI) is a benign entity presenting with either an irregular appearance or a focal radiolucency within the posterior cortex of the distal femur. Atypical cases should be differentiated from malignant lesions. The typical location of the lesion at the attachment of the head of the medial gastrocnemius muscle can be visualised using different imaging techniques. We report a case of a DFCI in a 13-year old boy. The diagnosis was based on CT-imaging. Two years later, no radiological abnormalities could be observed. A review of the literature is presented.

Adolescent↗

PubMed2003

Pseudoaneurysm complicating knee arthroscopy. A case report.

Pseudoaneurysm formation is a rare complication after knee arthroscopy. Most pseudoaneurysms complicating knee arthroscopy develop on the popliteal and geniculate arteries. We report a case of a pseudoaneurysm developed on an arterial branch to the medial gastrocnemius muscle, as a complication of an arthroscopic meniscectomy in a 66-year-old patient. The patient was treated successfully by resection of the pseudoaneurysm and ligation of the injured artery.

Aged↗

PubMed2003

Outcome of distal radius fractures in relation to bone mineral density.

The purpose of this study was to determine whether osteoporosis influenced the clinical results of distal radius fractures in women above the age of 40 years. Forty patients underwent bone mineral densitometry of the distal forearm, hip and lumbar spine. Radiographs of both wrists were taken at the time of fracture healing and the difference in ulnar variance, palmar tilt and radial inclination with the contralateral wrist was measured. Wrist mobility, grip strength and pain relief were determined in 35 patients with a follow-up of more than one year. We found that the clinical results correlated better with bone mineral density than with the radiological parameters. Osteoporosis may be one of the factors affecting the outcome of distal radius fractures.

Adult↗

PubMed2003

Influence of burst TENS stimulation on the healing of Achilles tendon suture in man.

Retrograde or antidromic stimulation of the nociceptive C fibres is known to lead to the release of sensory neuropeptides Substance P (SP) and Calcitonin Gene-Related Peptide (CGRP) by the peripheral endings of these ultra-thin nerve fibres. These neuropeptides have, among others, a vasodilatory effect, which explains why they play a role in the healing of soft tissues. Burst TENS (Transcutaneous Electric Nerve Stimulation) is known to be most effective in influencing C fibre-evoked activity. This is why burst TENS was used in a randomised study as a stimulus for the healing of the sutured Achilles tendon in 10 patients, versus 10 others who received no stimulus. There was one drop-out in each group, so that 2 x 9 patients remained available for the study. A needle biopsy, performed after six weeks, showed no significant influence of burst TENS on the histological healing stage, as compared with a rat study. However, a semi-quantitative evaluation of the number of fibroblasts showed a significant advantage for the stimulated group: p = 0.007. This means that burst TENS might influence healing of Achilles tendon sutures in man. But above all, it means that a histochemical study of the influence of burst TENS on the release of substance P and CGRP, after suture of the Achilles tendon in man, would be worthwhile.

Achilles Tendon↗