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Biomedical subjects

T Wredmark

Publications and source records attributed to T Wredmark.

At least 37 records · Page 2Linked to original sources
PubMed1997

Insulin-like growth factor I increases bone formation in old or corticosteroid treated rats.

We studied bone induction in subcutaneous implants of demineralized bone matrix with or without insulin-like growth factor I (IGF-I) in aged or corticosteroid-treated rats. Each rat carried one pair of implants, one control and one experiment implant, containing IGF-I dissolved in a hyaluronan solution for slow release. The rats were killed after 3 weeks and the results were evaluated by measuring the calcium content of implants. Young (6-7 weeks) and old (19-27 months) rats were used. A group of young rats was treated for 1 week with subcutaneous injections of 140 micrograms/kg dexamethasone daily. Old rats produced only approximately 1% as much bone as young rats. Local delivery of IGF-I did not increase bone formation in young rats. In old rats, bone formation was increased by IGF-I, 3000 ng/implant. Corticosteroids reduced bone formation in young rats. This effect was partially reversed by local administration of IGF-I.

Age Factors↗
PubMed1996

A prospective controlled randomized study of arthroscopic lavage in acute primary anterior dislocation of the shoulder: one-year follow-up.

Traumatic primary anterior shoulder dislocation has a very high recurrence rate among young people. This has supplied the motivation for studies to find methods of treatment that might become an alternative to traditional therapy. A prospective controlled study was performed to test the hypothesis that acute arthroscopic lavage might have a positive effect on recurrence rate as well as on shoulder stability, range of motion and mobilization. 30 consecutive patients between 18 and 30 years of age were randomized into 2 groups, 1 control group treated conservatively and 1 group treated with acute arthroscopic lavage within 10 days. Clinical examination was made by an independent observer at 1, 6 and 12 months. Results at 6- and 12-month check-ups showed a statistically significantly lower rate of redislocation and a wider range of motion for the group treated with acute arthroscopic lavage. Functional assessment according to the Lysholm shoulder score also indicated better functioning of the joint. Our 1-year follow-up shows very promising and interesting results.

Adult↗
PubMed1996

Ankle arthroscopy under local and general anaesthesia for diagnostic evaluation and treatment.

Improvements in techniques and instrumentation are extending the diagnostic and therapeutic indications for ankle arthroscopy. We aimed to study the diagnostic and therapeutic benefits and complication rate from 112 consecutive ankle arthroscopies performed between 1991 and 1994 under local and general anaesthesia. One-hundred and twelve outpatient ankle arthroscopies were performed in 72 male and 37 female patients, 16-64 years old. The patients were comparable in terms of gender and age in the arthroscopies done under local (n = 69) and the arthroscopies done under general anaesthesia (n = 43). The indications for surgery were pain in 75%, instability in 15%, limited function in 7% and swelling in 4%, and these criteria were similar in both groups. Antero-medial and anterolateral portals were used in all cases. No tourniquet was used and an external distractor was used in one case only. In 64 cases (57%) surgery was performed and included synovectomy, removal of loose bodies, shaving drilling of osteochondritic or other cartilage lesions, resection of impinging osteophytes, fibrosis and meniscoid lesions. In 95 ankles (85%) a definite diagnosis was established. Comparable diagnostic and therapeutic potentials were found between local and general anaesthesia. The complication rate was low. One patient who was operated on under general anaesthesia sustained a deep infection, and three suffered minor superficial nerve injuries. In conclusion, ankle arthroscopy may be performed under local or general anaesthesia with similar diagnostic value and with a low complication rate.

Adolescent↗
PubMed1996

Knee arthroscopy and venous blood flow in the lower leg.

We conducted a series of duplex ultrasound examinations to evaluate the venous blood flow in the lower leg during arthroscopic knee surgery. All knees were placed in loosely fitted leg-holder, without a tourniquet. The flow velocity in and the diameter and area of one of the posterior tibial veins and the great saphenous vein were measured just above the ankle at 0, 100, and 180 mmHg of intraarticular pressure (IAP). All recordings were done with the lower leg dependent and the thigh both supported and unsupported by the leg-holder. The diameter and cross-sectional area of the veins were not influenced by the IAP or by the position of the thigh in the leg-holder. There was, however, a significant increase in the venous blood flow velocity in the great saphenous vein each time the thigh was placed in the leg-holder. A simultaneous decrease in the flow velocity was seen in the posterior tibial vein and this was statistically significant at 180 mmHg IAP. Our findings indicate an additive effect of external compression of the thigh by a leg-holder and an increased IAP, which causes a redistribution of the venous flow in the lower leg from the deep system to the superficial one.

Adult↗
PubMed1995

Injury incidence and cause in elite gymnasts.

This report describes the incidence, localization, and cause of injuries in Swedish male and female elite gymnasts during 18 active months (three seasons). Thirty-one elite gymnast clubs with all together 437 gymnasts were included in the study, which consisted of a written questionnaire reporting morphometric facts as well as data concerning the injury. There were in total 82 injury reports. The injury incidence was 6.25 per 100 elite gymnasts and season. A majority of the injuries occurred in the lower extremities. The right leg was injured more often than the left. Most of the severe injuries occurred during mounting and dismounting which advocates the need for preventive measures in association with these particular events. Male gymnasts were more prone to sustain severer injuries such as dislocations and fractures. Severe injuries affected the upper extremity in 83%, and the right side was injured more often than the left.

Female↗
PubMed1995

Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction.

In a prospective, randomized study, 34 patients (25 male, 9 female; mean age 27 +/- 8 years) with unilateral anterior cruciate ligament ruptures and arthroscopic reconstruction with patellar tendon grafts were allocated at random to either early active motion only (AM; n = 17) or active motion in combination with continuous passive motion (CPM; n = 17). Range of motion was measured with a goniometer and joint swelling with a tape measure, preoperatively and at 6 weeks postoperatively. Neither associated injuries nor the age of the patients differed in the two groups. There was no difference in the range of motion between the two groups at 6 weeks' follow-up. Joint swelling was more pronounced in the AM group both preoperatively and at 6 weeks' follow-up. In this investigation the range of motion was not improved by CPM. The difference in joint swelling between the two groups may be explained by a persistent preoperative variation in joint effusion due to an imbalanced distribution of acute and chronic cases.

Acute Disease↗
PubMed1995

Treatment of acute ankle sprain. Comparison of a semi-rigid ankle brace and compression bandage in 73 patients.

We randomized 73 patients with grades II and III ankle sprain to treatment with an Air-Stirrup ankle brace or a compression bandage. All patients were instructed to attempt early motion and weight bearing when comfortable. Ankle function was evaluated after 3-5 days and 2, 4, and 10 weeks with a clinical examination, the Sickness Impact Profile questionnaire, Karlsson's scoring scale and recording of sick leaves. The group treated with the Air-Stirrup ankle brace was more mobile in the initial phase of rehabilitation and had a shorter sick leave. Ankle brace treatment resulted in socioeconomic savings.

Acute Disease↗
PubMed1995

Arthroscopic ankle arthrodesis in rheumatoid arthritis.

Several techniques for ankle arthrodesis have been described. Many of them are not suitable in patients with severe rheumatoid arthritis because of multiple joint involvement, osteoporosis, and increased risk of infection caused by poor skin conditions. The arthroscopic technique described in this article has been used in 7 patients with seropositive rheumatoid arthritis and 1 patient with seronegative rheumatoid arthritis (10 ankle joints; 2 patients surgically treated bilaterally). All patients successfully obtained ankle joint arthrodesis. The mean time to fusion was 10 weeks (range, 6-12 weeks). There was a 100% fusion rate without any complication.

Aged↗
PubMed1994

Capsular elasticity and joint volume in recurrent anterior shoulder instability.

It is commonly claimed that unstable shoulders have an altered capsular elasticity and increased joint volume. To find out if there is a correlation between anterior instability and increased joint volume, 20 patients were examined while undergoing arthroscopic surgery of the shoulder. There were four anterior subluxators, 11 anterior dislocators, and five bilateral dislocators, and in all patients the contralateral shoulder was also examined. During continuous saline infusion, a pressure/volume curve was recorded within the range of 0-180 mm Hg. Joint volume was correlated with body surface area. Among the 15 patients with unilateral instability, there was no correlation between joint volume and body surface area. There were no differences in joint volume or capsular elasticity between the healthy and the unstable shoulder in any patient. It is concluded that capsular elasticity and joint volume contribute little to anterior shoulder instability and that instability probably depends more on damage to other stabilising structures in the joint.

Adolescent↗
PubMed1993

Spinal posture, sagittal mobility, and subjective rating of back problems in former female elite gymnasts.

This study analyzed posture, spinal sagittal mobility, and subjective back problems in former female elite gymnasts in comparison with matched control subjects. The former gymnasts had less thoracic kyphosis than the control subjects. No difference in thoracic range of motion was found. In the lumbar spine there was no difference as to either posture or sagittal motion. The former gymnasts did not report a higher frequency of current back problems. In the former gymnasts 27% had subjective back problems. In the control subjects the corresponding value was 38%. We did not find any correlation between posture or range of motion and subjective rating of back problems in either of the groups. In conclusion, former female elite gymnasts did not have more back problems than an age matched control group.

Adult↗
PubMed1993

Knee function after anterior cruciate ligament ruptures treated conservatively.

Thirty-nine patients with ruptures of the anterior cruciate ligament (ACL) were treated conservatively and were subsequently examined at an average of 5.7 years after injury, the uninjured leg acting as a control. The Tegner activity score was significantly lower than the desired activity level. No patients were free of symptoms and only two could take part in sport which involved pivoting. The isokinetic knee extensor and flexor torques, as well as the one-leg-hop and instrumented knee joint laxity tests, were significantly impaired at follow-up. Functional impairment was not related to tests of knee joint laxity. Few patients were pleased with their subjective knee function after an ACL rupture despite thorough initial rehabilitation.

Acute Disease↗
PubMed1993

Arthroscopic surgery of the knee in local anaesthesia. An analysis of age-related pathology.

Arthroscopy of the knee joint was performed in 356 consecutive outpatients in local anaesthesia and without premedication. A continuous pressure-irrigation system was used with 0.2% lidocaine chloride solution in the irrigation fluid, following administration of 5-7 ml prilocaine with epinephrine in each portal. All patients had clinical symptoms of internal derangement of the knee, such as meniscal, cruciate ligament injury or osteoarthritis. Associated intra-articular pathology was registered. Intra-articular surgery was performed in 228 cases. This included partial or subtotal meniscectomy in 207 cases and meniscus suture in 3 cases. In 18 of 228 cases (8%) the operative procedure had to be terminated due to patient discomfort. Of the meniscal injuries 84% were medial and 16% lateral. The age distribution of the medial meniscus tears was as follows: bucket handles 33 +/- 9 years; flap tears 42 +/- 10 years and degenerative tears 53 +/- 10 years. For the lateral meniscus the age distribution was: bucket handles 34 +/- 9 years, cleavage and radiating tears 37.5 +/- 12 years, flap tears 29 +/- 7 years, peripheral tears 32 +/- 9 years and degenerative tears 48 +/- 11 years. Osteoarthritis was observed in 52% of all medial degenerative tears, whereas a low frequency was found in the remaining tears. The majority of patients tolerated the procedure well. In summary, 64% of the consecutive arthroscopies were operative, including 3 meniscal sutures. Only 8% of these procedures had to be abandoned due to patient discomfort. Thus, arthroscopic surgery in local anaesthesia with no premedication is an efficient and well-tolerated method in outpatient practice.

Adult↗
PubMed1993

Five-year results of anterior cruciate ligament reconstruction with the Stryker Dacron high-strength ligament.

Forty-two consecutive patients (27 male and 15 female, with a mean age of 26 years) suffering from unilateral chronic anterior cruciate ligament insufficiency underwent surgical reconstruction with a Dacron high-strength ligament (Stryker). In 32 patients the synthetic ligament was used as a reinforcement in an iliotibial band intra-articular procedure and in 10 patients as an intra-articular prosthesis without biological reinforcement. There were 24 concomitant injuries such as meniscal tears, status post-meniscectomy or medial collateral ligament insufficiency at the time of reconstruction. The initial injury occurred during soccer in 23 patients and other pivoting sports in 16 patients. Two and 5 years after reconstruction, the patients underwent clinical examination, including the instrumented knee laxity test (OSI), and performed subjective evaluation. The anterior tibial translation was 6.3 +/- 2.6 mm greater than in the healthy knee, the mean Lysholm score was 78 points, and the Tegner activity score was lower than its pre-injury level. Radiography revealed that 31 of 37 ligaments had ruptured and another 2 ligaments showed more than 5 mm side-to-side increased laxity. The Stryker Dacron high-strength ligament ruptured in more than 80% of the cases and patients could not return to their pre-injury physical performance activities.

Adult↗
PubMed1993

Multicompartmental pressures in the knee joint during arthroscopy.

It is well known that fast changes of position of the knee joint cause high instantaneous intraarticular pressures. During arthroscopy, rotation and flexion of the leg can create a closed-off compartment, increasing the risk of capsular rupture. To evaluate the risk of compartmentation, a study has been conducted in which the intraarticular pressure in 12 knee joints of three women and nine men was measured with Myopress catheters (ATOS Medical AB, Hörby, Sweden) located in the suprapatellar pouch, and the anteromedial and the posteromedial recesses during arthroscopy. This study showed that a starting pressure of 100 mm Hg causes a significantly higher peak pressure than does 75 mm Hg. The pressure varies simultaneously in all compartments without signs of local compartmentation in any position of the joint within the range of 0-90 degrees of flexion. With a positive pressure in the knee joint, no compartmentation occurs within the suprapatellar pouch or anteromedial posteromedial compartments during an arthroscopic procedure.

Adult↗
PubMed1993

Screw positions in femoral neck fractures. Comparison of two different screw positions in cadavers.

To evaluate the influence of different screw positions on the stability of fixation in femoral neck fractures, 30 cadaveric proximal femora were osteotomized and fixed with 2 cannulated screws. The proximal screw was placed either with a posterior cortical support in the femoral neck or centrally, supported only by cancellous bone. The distal screw rested on the femoral calcar. The specimens were tested in bending, using the force at 2 and 5 mm deflection at the osteotomy site and at fracture, as an expression of the stability of fixation. The test sequences were recorded on a x-y plotter and on videotape. Bone density measurements were made at the femoral neck, Ward's triangle, and the trochanter region. Our findings indicate that a posterior position with cortical support for the proximal screw, compared to a central screw position with only cancellous bone support, increases the stability of femoral neck fractures.

Aged↗
PubMed1993

Patellar tendon or Leeds-Keio graft in the surgical treatment of anterior cruciate ligament ruptures. Intermediate results.

In a prospective randomized study, 60 patients with unilateral chronic anterior cruciate ligament (ACL) rupture were allocated to surgical reconstruction using an autogenous patellar tendon graft (PT) or a synthetic Leeds-Keio graft (LK). Fifty-five patients (26 PT, 29 LK), 32 men, 23 women, fulfilled the criteria to be further tested. The mean time from surgery to follow up was 28 months. Laxity was tested by pivot shift and an instrumented anterior laxity test. Subjective knee function was classified using the Lysholm score, Tegner activity score, and IKDC grading. Muscle performance was analyzed in 49 patients (23 PT, 26 LK. There was no difference between the two groups in anthropometry, activity levels (before trauma; present; desired activity), time from trauma to surgery, or time from surgery to follow-up evaluation. Neither the concentric and eccentric knee extensor peak torque ratio nor the knee extensor endurance and the one-leg hop test differed between the two groups. However, both the pivotshift and the anterior laxity were significantly greater for the LK group. On the other hand, significantly more patients in the PT group had an extensor lag. Although the results are only intermediate, the Leeds-Keio ligament does not fulfill the requirements for a satisfactory result in ACL reconstructive surgery with regard to knee-joint stability.

Adult↗
PubMed1991

Os trigonum syndrome: a clinical entity in ballet dancers.

Thirteen Swedish National classic ballet dancers were surgically treated for an "os trigonum syndrome."Their main symptom was an impingement pain in the hind foot while actively plantarflexing the ankle during ballet dancing. The surgical procedure included excision of an os trigonum or a prominent lateral posterior process of the talus, together with division of the flexor hallucis tendon sheath if it was thickened. This procedure was safe and resulted in return of the dancers to the same level of ballet dancing within 5 to 10 weeks.

Adolescent↗