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Biomedical subjects

T D Rosenberg

Publications and source records attributed to T D Rosenberg.

At least 19 recordsLinked to original sources
PubMed2001

Quadrupled semitendinosus anterior cruciate ligament reconstruction: 5-year results in patients without meniscus loss.

PURPOSE: The purpose of this study was to determine the mid-term (minimum 5-year) results of isolated primary anterior cruciate ligament (ACL) reconstructions with intact or repaired menisci. TYPE OF STUDY: Case series. METHODS: Of 184 ACL reconstructions from April 1990 to February 1992, 33 initially met the inclusion criteria of primary reconstruction with quadrupled semitendinosus tendon and without extra-articular reconstruction or meniscus removal. Patients with known traumatic rerupture of the graft with revision (1 case) or subsequent meniscectomy (1 case) were excluded from the study. Twenty of the remaining 31 patients were available for follow-up at an average of 5.7 years after surgery. At follow-up, a comprehensive knee examination, KT-1000 arthrometry, radiography, functional testing, and isokinetic strength testing were performed. A subjective questionnaire, Tegner scale, and IKDC evaluation were administered as well. Four patients who were unable to come in for follow-up returned a knee-assessment questionnaire. RESULTS: Arthrometric anterior tibial translation was reduced from a preoperative average of 6.3 +/- 2.8 mm (manual maximum side-to-side difference) to an average of 0.0 +/- 1.3 mm (range, -2.5 to 2 mm). Radiographically, 1 patient experienced mild narrowing in the lateral compartment. Tegner activity level was maintained at the preinjury level in nearly half the patients. Isokinetic strength deficits were less than 10%; 17 (85%) of the patients had a normal or nearly normal result as graded by the IKDC scoring system. CONCLUSIONS: The above data show minimal morbidity, a low reoperation rate, and excellent clinical outcome. Because the stability of the knee persists beyond 5 years after ACL reconstruction, patients are able to maintain preinjury activity levels without reinjury.

Adult↗
PubMed2001

Strain in the human medial collateral ligament during valgus loading of the knee.

The medial collateral ligament is one of the most frequently injured ligaments in the knee. Although the medial collateral ligament is known to provide a primary restraint to valgus and external rotations, details regarding its precise mechanical function are unknown. In this study, strain in the medial collateral ligament of eight knees from male cadavers was measured during valgus loading. A material testing machine was used to apply 10 cycles of varus and valgus rotation to limits of +/- 10.0 N-m at flexion angles of 0 degrees, 30 degrees, 60 degrees, and 90 degrees. A three-dimensional motion analysis system measured local tissue strain on the medial collateral ligament surface within 12 regions encompassing nearly the entire medial collateral ligament surface. Results indicated that strain is significantly different in different regions over the surface of the medial collateral ligament and that this distribution of strain changes with flexion angle and with the application of a valgus torque. Strain in the posterior and central portions of the medial collateral ligament generally decreased with increasing flexion angle, whereas strain in the anterior fibers remained relatively constant with changes in flexion angle. The highest strains in the medial collateral ligament were found at full extension on the posterior side of the medial collateral ligament near the femoral insertion. These data support clinical findings that suggest the femoral insertion is the most common location for medial collateral ligament injuries.

Cadaver↗
PubMed1996

Inside-out meniscal repair using zone-specific instruments.

In the last decade, arthroscopic meniscus repair has become established as the treatment of choice for many meniscal lesions previously managed by meniscectomy. Biomechanical and clinical evidence supports meniscus repair for healable tears, especially in adolescents and young adults, while partial meniscectomy is appropriate for most of the remainder. Meniscus repair is a demanding technique that requires the skill of a dedicated arthroscopist. Special suturing tools and techniques often are required, but these are no substitute for appropriate selection and thorough preparation of specific tears that are likely to heal. Complete rehabilitation and a stable knee are required postoperatively to ensure a successful result.

Adult↗
PubMed1994

[Arthroscopic reattachment of the meniscus].

This article defines the indications for arthroscopic meniscus repair. The inside-out technique is described with special emphasis on healing enhancement by the use of an exogenous fibrin clot.

Adolescent↗
PubMed1991

Anterior cruciate ligament reconstruction with autografts.

Arthroscopically assisted ACL reconstruction has undergone rapid development in recent years. Although achievement of stability has been well-documented in open ACL reconstructive procedures, improved results may be obtained by reducing operative morbidity. Arthroscopically assisted ACL reconstruction appears to offer significantly diminished morbidity and thus offers more predictable rehabilitation, at least initially, after surgery. Improvements in instrumentation continue to refine the precision of this technique. Proper graft selection is an important issue that is paramount to the evolution of ligament reconstruction surgery. Although the central third patellar tendon is presently the operation by which all new techniques must be compared, the use of nonautogenous grafts may complement arthroscopic reconstruction by allowing further reduction in surgical morbidity. In this article we have expanded on some of the advantages of arthroscopic ACL reconstruction, given an overview of arthroscopic techniques, and described the techniques we prefer.

Anterior Cruciate Ligament↗
PubMed1991

Radiographic assessment of instability of the knee due to rupture of the anterior cruciate ligament. A quadriceps-contraction technique.

We compared the results of a radiographic technique for the measurement of instability of the knee with those obtained with a KT-1000 arthrometer. The study was conducted on both knees of sixty patients who had a ruptured anterior-cruciate ligament in one knee, as well as in ten control subjects. The radiographic technique included the examination of a true lateral radiograph, made while the knee was in full extension and the quadriceps was maximally contracted, with a 66.7-newton downward force produced by a 6.8-kilogram weight suspended from the ankle. As demonstrated by both techniques, the maximum difference between the displacements of the right and left knees in the control subjects was 2.5 millimeters and the mean difference between the displacements in the two knees in the patients was 7.5 millimeters. In fourteen of the sixty knees in which the ligament was ruptured, the injury was acute. The forward translation of the medial side in these fourteen knees was compared with that in the forty-six knees in which the injury was chronic. The mean difference in the displacement of the medial side in the right and left knees was 3.5 millimeters in the fourteen patients who had an acute injury and 5.0 millimeters in the forty-six patients who had a chronic injury. Thirteen of the sixty patients had disruption of the posteromedial corner of the injured knee, and the translation of the medial side in these knees was significantly increased compared with that in the intact knees of the same patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Arthroscopic surgery: meniscus refixation and meniscus healing].

The stabilizing function of the meniscus and the negative effect of a complete or partial meniscectomy have been demonstrated in many studies. On the other hand, it has also been shown that meniscus tears in certain locations can heal very well. The prerequisite is that the torn meniscus can be revascularized from the capsule. Revascularization can be achieved by stimulating the formation of new vessels, but also by the build-up of collagen after induction of fibrochondrocytes and fibroblasts. The requirements for meniscus reconstruction are: careful preparation of the tear, exact repositioning, and precise placement of the sutures. The additional activation of regenerating processes is promoted by using a fibrin clot. In this study, 54 patients underwent meniscus repair, but the results in this group that also received a fibrin clot are not included. In the case of longitudinal-vertical tears of the meniscus inside the 3-mm zone margin, it was decided that the procedure was indicated when tears longer than 1.5 cm were concerned. The inside-out technique was used. Subjective and objective examination of 52 patients showed that the clinical results were good to very good in 92%.

Adolescent↗
PubMed1988

The well-leg support.

The authors present a method of support for the well leg that allows total circumferential access to the knee, especially the medial and posteromedial sides. The method is inexpensive, easy to use, and safe. It appears to relieve stress on the lower back, which can occur with standard support. In addition, hyperextension of the hip and possible femoral nerve traction injury are avoided.

Arthroscopes↗
PubMed1988

Arthroscopic meniscectomy.

Arthroscopic partial meniscectomy is indicated for unstable, irreparable tears. Meniscal repair and partial meniscectomy are not mutually exclusive concepts. These are complementary procedures, with each having specific indications. Larger, more peripheral tears are repaired, whereas smaller, more central irregular or irreparable tears are treated by arthroscopic partial meniscectomy. The emphasis is on leaving a well-contoured stable meniscus while excising only the unstable or damaged portion. The remaining meniscus may still provide some protection for the hyaline cartilage of that compartment.

Arthroscopes↗
PubMed1988

Postsurgical care for arthroscopic surgery of the knee and shoulder.

The use of a consistent, organized, and individualized plan of postoperative care and rehabilitation has aided us in helping our patients achieve an early return to function while minimizing cost and time off work or sport. An integral part of this plan is a home program of therapy outlined by a physical therapist after surgery, but carried out largely by the patient with simple affordable home equipment or easily accessible gymnasium equipment. Well-motivated patients will make optimal use of time and effort in achieving their own goals of return to function with appropriate guidance.

Activities of Daily Living↗
PubMed1988

The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee.

Posteroanterior weight-bearing radiographs, made with the knee in 45 degrees of flexion, were compared with conventional radiographs for fifty-five patients who had surgical treatment for a lesion causing pain in one knee. Narrowing of the cartilage space of two millimeters or more was defined as indicative of major degeneration (grade III or IV). Comparison of the intraoperatively observed degeneration with the narrowing that was seen on the radiographs revealed that the posteroanterior weight-bearing radiographs that were made with the knee in 45 degrees of flexion were more accurate (p less than 0.01), more specific (no false-positives) (p less than 0.01), and more sensitive (fewer false-negatives) than the conventional extension weight-bearing anteroposterior radiographs.

Adult↗
PubMed1987

Discoid lateral meniscus: case report of arthroscopic attachment of a symptomatic Wrisberg-ligament type.

The symptomatic discoid lateral meniscus is a well-known congenital anomaly that is of three different types: complete, incomplete, and Wrisberg-ligament type. The Wrisberg-ligament type has no meniscotibial attachment posteriorly, and in the past has been treated by total (open or arthroscopic) meniscectomy. In this article, we review the literature and report a previously unreported case of arthroscopic peripheral attachment after central partial meniscectomy of a Wrisberg-ligament type discoid lateral meniscus, with documentation of healing at arthroscopic second look 1 year following surgery.

Adult↗
PubMed1987

Pain relief after arthroscopy: naproxen sodium compared to propoxyphene napsylate with acetaminophen.

We compared naproxen sodium (550 mg) and propoxyphene napsylate with acetaminophen (PN/A, 100 mg with 650 mg) for pain relief after arthroscopy or arthroscopic meniscectomy. Fifty-two patients entered this multicenter, double-blind, randomized, parallel trial. In each drug group, pain intensity values dropped consistently throughout this six-hour study from mean baseline levels of approximately 55 on a scale of 0 to 100. Pain intensity values were lower at each hour in the naproxen sodium than in the PN/A group and significantly lower at hour 1 (P = .008). Pain intensity differences (PID, reflecting change from baseline) mirrored this trend: greater mean PIDs were seen in the naproxen sodium group at each hour, and this difference between drug groups was statistically significant at hour 1 (P = .017). One patient in the naproxen sodium group and seven patients using PN/A took a second dose within the six hours. Patients in each drug group reported five complaints.

Acetaminophen↗
PubMed1986

Arthroscopic meniscal repair evaluated with repeat arthroscopy.

Arthroscopic meniscal repair is a technically feasible approach to the treatment of meniscal tears in young active individuals. To evaluate this premise, we repaired 29 minisci in 27 patients and then arthroscoped their knees 3 months later. Repairs were limited to displaceable longitudinal tears. In 16 patients ligaments were intact. Eleven patients were anterior cruciate ligament deficient, six of whom underwent concomitant ACL reconstructions. In two patients, bicompartmental tears were encountered. Under arthroscopic control, using curved cannulae, horizontal mattress sutures of absorbable monofilament were placed across the tear, out through the capsule, and tied over the fascia, deep to the skin. No arthrotomies were performed, and all portions of the menisci could be reached with this method. Twenty-four of 29 repairs healed completely; 5 healed partially (30 to 50% healing). Four of the five failed repairs occurred in unstable anterior cruciate ligament deficient knees.

Adolescent↗
PubMed1983

Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure.

For the past five years we have attempted to correct knee instability due to rupture of the posterior cruciate ligament with a procedure that employs a free graft of one-third of the patellar tendon with its tibial and patellar attachments. This procedure was done for chronic instability in thirty-three patients and was combined with primary repair of an acute mid-substance tear of the posterior cruciate ligament in fifteen patients. Moderate to severe articular injury of the medial femoral condyle was found at operation in 48 per cent of the patients with chronic injury. Seventy-one per cent of the patients for whom the interval between injury and ligament reconstruction was two to four years, and 90 per cent of those for whom the interval was more than four years, showed articular injury of the medial femoral condyle. Only 31 per cent of the patients, however, had preoperative radiographic findings that indicated femoral articular damage. Twenty-three of the twenty-five patients with a minimum follow-up of two years returned for evaluation. All of the ten patients who had had a repair and reconstruction of an acute ligament injury (whose average follow-up was forty-one months) had a static and functional result that was graded as good or excellent. Of the thirteen patients for whom surgery was done for chronic instability (whose average follow-up was thirty-one months), the over-all static and functional result was graded as good or excellent in eleven. These results indicate that the use of one-third of the patellar tendon for reconstruction in patients with acute mid-substance tears as well as in patients with symptomatic chronic instability of the posterior cruciate ligament is an effective procedure for achieving static and functional stability of the knee.

Adult↗