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S T Donell

Publications and source records attributed to S T Donell.

At least 19 recordsLinked to original sources
PubMed2006

Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis.

We performed two independent, randomised, controlled trials in order to assess the potential benefits of immediate weight-bearing mobilisation after rupture of the tendo Achillis. The first trial, on operatively-treated patients showed an improved functional outcome for patients mobilised fully weight-bearing after surgical repair. Two cases of re-rupture in the treatment group suggested that careful patient selection is required as patients need to follow a structured rehabilitation regimen. The second trial, on conservatively-treated patients, provided no evidence of a functional benefit from immediate weight-bearing mobilisation. However, the practical advantages of immediate weight-bearing did not predispose the patients to a higher complication rate. In particular, there was no evidence of tendon lengthening or a higher re-rupture rate. We would advocate immediate weight-bearing mobilisation for the rehabilitation of all patients with rupture of the tendo Achillis.

Achilles Tendon↗
PubMed2005

Regional migratory osteoporosis: a review illustrated by five cases.

Regional migratory osteoporosis is an uncommon self-limiting disease characterized by an arthralgia which migrates between the weight-bearing joints of the lower limb. The radiological features of the disease obtained by conventional radiography, CT, MRI and radionuclide scintigraphy are illustrated by means of five case reports. These range from the most common presentation of sequential, proximal to distal spread in the lower limb to the rare intra-articular form, and disease involving the axial skeleton is also recognized. Clinical and radiographical features often overlap with those of diseases such as transient osteoporosis of the hip and transient bone marrow oedema syndrome, which is reflected in confusing terminology. Histological sampling is usually unnecessary; the radiological features are characteristic and the histological findings are not specific. Regional migratory osteoporosis is associated with systemic osteoporosis. This association is probably under-recognized, and has implications for the pathophysiology of the disease and for treatment.

Adult↗
PubMed2005

Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial.

UNLABELLED: Shock wave therapy has been used for treatment of several soft tissue disorders that are characterized by chronic pain. We sought to determine if shock wave therapy reduces chronic Achilles tendon pain. Forty-nine patients were enrolled in a double-blind randomized placebo-controlled trial. Each patient was treated once a month for 3 months. The primary outcome measure was a reduction in Achilles tendon pain during walking. At the end of the trial, we found no difference in pain relief between the shock wave therapy group and the control group. There were two patients (62 years and 65 years) with tendon ruptures in the treatment group, suggesting caution when treating older patients. These results provide no support for the use of shock wave therapy for treatment of patients with chronic Achilles tendon pain. However, the confidence intervals include the potential for a clinically relevant treatment effect. LEVEL OF EVIDENCE: Therapeutic study, Level I (systematic review of Level I RCTs-and study results were homogenous). See the Guidelines for Authors for a complete description of levels of evidence.

Achilles Tendon↗
PubMed2005

The Elite Plus total hip arthroplasty: the need for radiological surveillance.

We prospectively studied 217 patients who underwent 234 Elite Plus total hip arthroplasties. At a mean of 6.4 (SD 0.7) years post-operatively, 39 patients had died and 22 were either lost to follow-up or had no radiographs available. Clinical (Oxford hip score) and radiological assessments were performed on 156 patients (168 hip arthroplasties) who had a mean age of 67.7 (SD 9.7) years at operation. In the assessed group, 26 of 159 (16.4%) of femoral stems which had not already been revised and 19 of 159 (11.9%) of acetabular cups were definitely loose. In total, 52 of 168 (31%) of hips had either been revised or had definite evidence of loosening of a component. We could not establish any relationship between clinical and radiological outcomes. Despite the fact that the clinical outcome and rate of revision for the Elite Plus appeared to meet international standards, our findings give us cause for concern. We believe that joint registries should include radiological surveillance in order to provide reliable information about medium-term outcomes for hip prostheses.

Age Factors↗
PubMed2005

Gait abnormalities following rupture of the tendo Achillis: a pedobarographic assessment.

One of the factors that influence the outcome after rupture of the tendo Achillis is abnormality of gait. We prospectively assessed 14 patients and 15 normal control subjects using an in-shoe plantar pressure measurement system. There was a significant reduction in peak mean forefoot pressure in the early period of rehabilitation (p < 0.001). There was a concomitant rise in heel pressure on the injured side (p = 0.05). However, there was no difference in cadence, as determined by the duration of the terminal stance and pre-swing phases as a proportion of total stance. The forefoot pressure deficit in the group with tendon ruptures was smaller when assessed six months after the injury but was still significant (p = 0.029). Pedobarographic assessment confirms that there are marked abnormalities within the gait cycle. Rehabilitation programmes which address these abnormalities may improve outcome.

Achilles Tendon↗
PubMed2004

Screening time for extra-capsular proximal femoral fracture fixation; the difference between extra-medullary and intra-medullary implant usage.

The aim of this study was to compare the fluoroscopic screening time used for treatment of fractures of the trochanteric region of the femur using two different implant systems. Data were collected from 277 proximal femoral fracture fixations. A dynamic hip screw (DHS) was used in 145, and an intra-medullary hip screw (IMHS) was used in 132. There was no difference between the two groups with respect to age, gender or side. Altogether, there were 42% two parts, 35% were three parts and 23% were four parts extra-capsular neck fractures. There was no statistical difference in ionising radiation exposure in closed reduction of these fractures regardless of the fracture configuration or surgical experience of the surgeon. The mean screening time to implant a DHS in two part fractures was 0.48 min, for three part fractures it was 0.45 min and for four part fractures it was 0.46 min. The mean screening time to implant IMHS was 1.02 min for two part fractures, 0.96 min for three part fractures and 1.03 min for four part fractures. These differences were statistically significant (P < or = 0.05).

Adult↗
PubMed2004

Knee synovial cyst presenting as iliotibial band friction syndrome.

We present the case of a 28-year-old competitive runner with iliotibial band (ITB) friction syndrome associated with a synovial cyst. Magnetic resonance imaging (MRI) did not demonstrate a fluid collection. However, open exploration revealed a large cyst beneath the ITB arising from the capsule of the knee proximal to the lateral meniscus. The cyst disappeared on extension. The pre-operative MRI scan may have revealed the cyst, if it had been taken with the knee flexed.

Adult↗
PubMed2004

Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up.

A retrospective review of 29 patients (30 knees) was carried out who had previously undergone a single-stage combined ACL reconstruction with valgus upper tibial osteotomy for chronic ACL rupture coupled with early medial tibio-femoral arthritis. Of the 30 knees, 19 (63%) had had a previous medial meniscectomy. Major complications occurred in two knees resulting in stiffness. At a mean of 12 years follow-up (6-16 years) only five knees (17%) had progressed one arthritis grade. Fourteen patients (47%) returned to intensive sports, and a further 11 (37%) played moderate sports. The mean difference in anterior tibial translation with the opposite normal knee was 3 mm at review. It was concluded that the combined operation has a low morbidity, controls anterior laxity, allows many patients to return to sports, and does not result in a rapid progression of osteoarthritis.

Adolescent↗
PubMed2004

Comparison of expected vs. actual tunnel position in anterior cruciate ligament reconstruction.

In a prospective blinded non-randomised cohort study, 32 patients were assessed following anterior cruciate ligament reconstruction using autograft middle-third bone-patellar tendon-bone, over a period of 10 months. Two experienced surgeons performed the procedures, one using an arthroscopically assisted technique (16 patients) and the other by mini-arthrotomy (16 patients). A comparison was made between the positions of the tunnels as perceived by the surgeon intra-operatively with the actual position as shown on the post-operative X-ray. An independent blinded observer made the latter assessment. Actual vs. expected tunnel placement was analysed using the coefficient of correlation. The anteroposterior femoral tunnel position indicated perfect correlation (R(2)=1.00, P=0), and on the lateral view showed good correlation (R(2)=0.55, P=0.005). However, the tibial tunnel position anteroposteriorly showed poor correlation (R(2)=0.14, P=0.22), and on the lateral view no correlation (R(2)=0.07, P=0.36). The ideal tibial tunnel position is controversial, and in this study, two tibial tunnels were just anterior to the acceptable position and one was posterior. Altogether these three, and one other, were in very different positions to that expected by the surgeon. Surgeons may consider that before drilling the tibial tunnel, intra-operative confirmation of the guide-wire position would be helpful.

Adult↗
PubMed2004

The optimum knee flexion angle for skyline radiography is thirty degrees.

There is wide variation in practice among orthopaedic surgeons regarding the use of skyline tangential patellar radiographs of the patellofemoral joint in patients with anterior knee pain. Various techniques are available for taking such radiographs and numerous radiologic parameters can be measured from them. There is no information as to which knee flexion angle is superior when taking skyline radiographs. The purpose of the current study was to compare the results of skyline radiographs taken at 30 degrees, 50 degrees, and 90 degrees knee flexion. Sixty-seven knees were studied prospectively. All radiographs were made anonymous and then were studied in random order by two observers. Five recognized patellofemoral parameters were recorded. All the parameters studied were measured most reproducibly when measured from the radiograph taken at 30 degrees knee flexion. The parameters were least reproducible when measured from the radiograph taken at 90 degrees knee flexion. In terms of detecting abnormality of the parameters measured, the radiographs taken at 30 degrees and 50 degrees were similar. The radiograph taken at 90 degrees knee flexion detected the fewest abnormalities. Skyline radiographic examination of the patellofemoral joint should be a mandatory part of the investigation of all knee problems. One radiograph, ideally taken at 30 degrees knee flexion, offers the best means of assessing the patellofemoral joint. There is no benefit to requesting multiple images at different angles of knee flexion.

Adolescent↗
PubMed2003

Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study.

Recent experimental and clinical evidence suggests that early loading and mobilisation for Achilles tendon ruptures may improve functional outcomes. This paper presents the results of a pilot study designed to assess the safety of immediate weight-bearing mobilisation. Twenty-eight operatively repaired patients were randomised to either immediate loading in an orthosis or traditional serial plaster casting. An independent observer, blinded to treatment, assessed the results. Improved clinical, anthropometric, and functional outcomes were noted in the immediate loading group. Ultrasound assessment confirmed no deleterious effects upon the tenodesis. There was one re-rupture of the tendon at a minimum follow-up of 1 year.

Achilles Tendon↗
PubMed2003

Intra-operative tibial plateau fracture during unicompartmental knee replacement: a case report.

Periprosthetic fracture is a recognised complication of joint replacement. Intra-operative fractures of the tibia during total knee replacement have been reported and classified, but there have been no reports in patients undergoing unicompartmental knee replacement. We report a case of intra-operative fracture of the medial tibial plateau during impaction of the tibial component of an Oxford unicompartmental knee replacement. This occurred following a small breach in the posterior tibial cortex during preparation of the tibial plateau for the implant. We therefore advise caution during this stage of the procedure, especially in patients who may already be at risk of intra-operative fracture.

Arthroplasty, Replacement, Knee↗
PubMed2002

The radiologic prevalence of patellofemoral osteoarthritis.

The radiographs of 206 knees from 174 consecutive patients were reported blinded regarding joint space narrowing. Minimum joint space was measured using a millimeter ruler on weightbearing posteroanterior and skyline patellofemoral radiographs. Lateral radiographs were reported solely in terms of presence or absence of patellofemoral arthritis. The results showed objective joint space narrowing to less than 3 mm in the patellofemoral compartment of 32.7% of men and 36.1% of women older than 60 years. This high prevalence of patellofemoral disease in men has not been documented before. Arthritic changes occurred in the patellofemoral compartment in isolation in 13.6% of women and 15.4% of men older than 60 years. The lateral radiograph had poor results for detection of patellofemoral osteoarthritis with a sensitivity of 66% and specificity of 83%. The positive predictive value of an abnormal lateral radiograph was 52%. If requests for skyline radiographs had been confined to patients with abnormal patellofemoral joints as assessed on lateral films then 28 normal joints would have been imaged and 14 abnormal joints would have been missed. Osteoarthritis is more common in the patellofemoral joints of men and women than previously documented and only can be properly assessed using a skyline radiograph.

Adult↗
PubMed1996

The posterior triangle and the painful shoulder: spinal accessory nerve injury.

Forty-three cases of accessory nerve injury referred to the Peripheral Nerve Injury Unit have been reviewed. Accessory nerve injury results in a characteristic group of symptoms and signs. Referral for treatment is usually delayed, the average time being 11.3 months. Surgical treatment resulted in improvement of symptoms in almost all cases.

Accessory Nerve↗
PubMed1994

Osteoarthritis of the knee following meniscectomy.

The relationship between age at meniscectomy and the time to developing OA requiring an operation was studied. A total of 63 patients (7.8% of those presenting for an operation for OA) had had a previous meniscectomy. It was found that there was a strong correlation between the age at meniscectomy and the time delay (r = -0.68, P < 0.0001). The equation for the regression line was y = -0.68x + 41.8, where y = the delay in years between meniscectomy and operation for OA, and x = the age at meniscectomy. It was noted that there were two distinct populations, those < or = 35 yr old with a mean delay of 26 yr (95% CI 20.8-31.4), and those > 35 yr old with a mean delay of 9.8 yr (95% CI 7.5-12.2). The development of OA requiring an operation following meniscectomy depends on the age at meniscectomy and the time delay. To show an increase rate of OA following meniscectomy in a young population would require follow-up of at least 26 yr.

Adult↗
PubMed1994

Extra-articular tenodesis for anterior cruciate ligament rupture in amateur skiers.

Thirty one amateur skiers with 33 knees which had had a symptomatic chronic rupture of the anterior cruciate ligament (ACL) treated with the Lemaire operation were reviewed retrospectively at an average of 4.5 years. Of the patients 23 were women. The operation failed to control symptoms in 17 out of the 33 knees. However the operation did control symptoms in 13 out of 19 knees in patients over 35 years old, compared with only three out of 14 knees in patients under 35 years old. Clinical and objective testing however showed that most knees were still unstable. Despite this 21 patients continued skiing. One patient with a successful result switched to playing tennis. Five patients gave up all sports. Four further patients, all under 35 years old, returned to skiing after an additional intra-articular reconstruction of the anterior cruciate ligament. An isolated extra-articular procedure in amateur skiers under 35 years old with symptomatic chronic ACL rupture is not recommended. They need at least an intra-articular reconstruction to control their symptoms and to stabilize the knee.

Adolescent↗