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Biomedical subjects

W N Levine

Publications and source records attributed to W N Levine.

At least 19 recordsLinked to original sources
PubMed2003

Templates of the cartilage layers of the patellofemoral joint and their use in the assessment of osteoarthritic cartilage damage.

OBJECTIVE: To develop a methodology for generating templates that represent the normal human patellofemoral joint (PFJ) topography and cartilage thickness, based on a statistical average of healthy joints. Also, to determine the cartilage thickness in the PFJs of patients with osteoarthritis (OA) and develop a methodology for comparing an individual patient's thickness maps to the normal templates in order to identify regions that are most likely to represent loss of cartilage thickness. DESIGN: The patella and femur surfaces of 14 non-arthritic human knee joints were quantified using either stereophotogrammetry or magnetic resonance imaging. The surfaces were aligned, scaled, and averaged to create articular topography templates. Cartilage thicknesses were measured across the surfaces and averaged to create maps of normal cartilage thickness distribution. In vivo thickness maps of articular layers from 33 joints with OA were also generated, and difference maps were created depicting discrepancies between the patients' cartilage thickness maps and the normative template. RESULTS: In the normative template, the surface-wide mean+/-SD (maximum) of the cartilage thickness was 2.2+/-0.4mm (3.7mm) and 3.3+/-0.6mm (4.6mm) for the femur and patella, respectively. It was demonstrated that difference maps could be used to identify regions of thinner-than-normal cartilage in patients with OA. Patients were shown to have statistically greater regions of thin cartilage over their articular layers than the normal joints. On average, patients showed deficits in cartilage thickness in the lateral facet of the patella, in the anterior medial and lateral condyles, and in the lateral trochlea of the femur. CONCLUSIONS: This technique can be useful for in vivo clinical evaluation of cartilage thinning in the osteoarthritic patellofemoral joint.

Adult↗
PubMed2001

Treatment of the athlete with multidirectional shoulder instability.

Treatment of multidirectional instability in the athlete continues to be a challenging problem. Nonoperative treatment remains the initial treatment of choice in most athletes. However, some patients will fail nonoperative treatment and might require operative intervention. An open capsular shift procedure is indicated in nonoverhead athletes, most contact athletes and in most revision situations. However, the advances in thermal treatment of the capsule have made arthroscopic electrothermal capsulorrhaphy increasingly attractive as an alternative to the open approach for the primary treatment of multidirectional instability. Longer follow-ups will be necessary before definitive statements can be made regarding the arthroscopic techniques.

Arthrography↗
PubMed2001

Vertebral sarcoidosis of the spine in a football player.

Osseous involvement is common in sarcoidosis, but most cases of osseous sarcoidosis occur in the long bones of the hands and feet. Vertebral involvement in sarcoidosis is rare. A case of vertebral sarcoidosis in a 19-year-old male football player is presented. The patient had clinical, radiologic, laboratory, and pathologic findings consistent with a case of vertebral sarcoidosis. A review of the literature on sarcoid involvement of the spine is also presented. Although rare, sarcoid infiltration of the vertebrae is a recognized entity. Magnetic resonance imaging can be helpful in making the diagnosis, but biopsy is needed for confirmation.

Adult↗
PubMed2000

Osteolysis of the distal clavicle: long-term results of arthroscopic resection.

PURPOSE: The purpose of this study was to evaluate the outcome of arthroscopic distal clavicle resection by the direct superior approach for treatment of isolated osteolysis of the distal clavicle. TYPE OF STUDY: Case series. MATERIALS AND METHODS: Forty-one shoulders in 37 patients underwent arthroscopic resection of the distal clavicle. Thirty-three patients were male and 4 female, with an average age of 39 years. All patients complained of pain localized to the acromioclavicular joint region. Symptoms began after a traumatic event in 18 shoulders and were associated with repetitive stressful activity in 23 shoulders. RESULTS: At an average follow-up of 6.2 years, 22 shoulders had excellent results, 16 had good results, and 3 were failures. All 3 failures occurred in patients with a traumatic etiology. CONCLUSIONS: Arthroscopic resection for osteolysis of the distal clavicle has results comparable to open excision with low morbidity. Patients with a traumatic etiology had slightly worse results compared with patients with a microtraumatic etiology.

Adult↗
PubMed2000

Rotator cuff tears and associated nerve injuries.

A series of 15 patients with concomitant rotator cuff tears and infraclavicular brachial plexus injuries treated between 1980 and 1989 were reviewed. There were 6 men and 9 women with a mean age of 65 years. Seventeen nerve injuries were identified, including 12 axillary nerves, 4 suprascapular nerves, and 1 musculocutaneous nerve. One patient had an injury to all three nerves. Thirteen patients underwent operative repair of the torn rotator cuff, and 2 patients who refused surgery were treated conservatively. The average time from injury to surgery was 7.7 months. Follow-up averaged 5.5 years (range: 2-10 years). Clinical results were graded according to pain, range of motion, and strength. Postoperatively, mean active forward elevation was 137 degrees and mean active external rotation was 40 degrees. Clinically, 8 patients achieved complete nerve recovery and 7 had an incomplete recovery. Satisfactory pain relief was achieved in 87% of patients with 60% having excellent or good function. Overall, the results of rotator cuff repair with concurrent nerve injury are less favorable than those of isolated cuff repairs. Careful preoperative assessment of concomitant nerve injury should be performed to better predict outcome.

Adult↗
PubMed1996

Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty.

Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.

Adult↗
PubMed1994

Escherichia vulneris osteomyelitis of the tibia caused by a wooden foreign body.

A new species in the family Enterobacteriaceae, Escherichia vulneris, was characterized by the Centers for Disease Control and Prevention in 1982. It has been shown to have a predilection for human wounds, and several case reports have described superficial wound infections with this rare organism. Until now, however, there have been no reports of osteomyelitis occurring secondary to E vulneris infection. The authors present the case of a 13-year-old boy who fell on a stick and sustained a penetrating injury to his right knee. Radiographs and magnetic resonance imaging revealed a lytic lesion with a foreign body in the tibial epiphysis. On culture, only E vulneris was found, and histologic examination showed the foreign body to be surrounded by acute and chronic inflammation, abscess formation, and foreign-body giant-cell reaction. Although a recent study questioned the pathogenicity of this organism after reviewing the cases of 12 patients in whom there was concurrent heavy growth of Staphylococcus aureus, the present case supports the finding that E vulneris is a human pathogen that should be treated when obtained from human wound cultures.

Adolescent↗
PubMedDate not supplied

Arthroscopic distal clavicle resection from a bursal approach.

We retrospectively reviewed 117 consecutive patients who underwent arthroscopic acromioclavicular joint (ACJ) arthroplasties. Only patients who underwent ACJ arthroplasties from a bursal approach in conjunction with subacromial decompression were included. Patients with isolated ACJ arthrosis treated with resection of the distal clavicle from a superior approach, isolated impingement with only undersurface distal clavicle debridement, prior surgery, or other shoulder pathology were excluded. Twenty-four patients met these rigid criteria for inclusion in the study. After an arthroscopic subacromial decompression, the distal clavicle was visualized and resected through a standard bursal approach. In addition, an anterosuperior portal was used in 50% of the patients to confirm adequate clavicle resection. Postoperative follow-up averaged 32.5 months (range, 24 to 70 months). Preoperative and postoperative pain were rated subjectively on a 5-point scale (1, incapacitating pain; 5, no pain). Operative reports and postoperative radiographs were reviewed to determine technical factors that may have influenced outcome. Seventeen patients had excellent results (71%), 4 good (16.5%), and there were 3 failures (12.5%). Average preoperative pain rating was 1.8 and was improved to 4.3 postoperatively. The average amount of clavicle resection was only 5.4 mm. Given smooth, even, and complete bone removal, the amount of bone resected did not correlate with outcome. Arthroscopic distal clavicle resection performed in conjunction with subacromial decompression gave excellent results, comparable to isolated ACJ procedures. In this series, additional use of an anterosuperior portal for more direct shaver placement and complete ACJ viewing allowed consistent bone resection and excellent results in a high percentage of patients.

Acromioclavicular Joint↗
PubMedDate not supplied

Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear.

Thirty patients (31 shoulders) were retrospectively reviewed after hemiarthroplasty for glenohumeral osteoarthritis. Ten shoulders had primary osteoarthritis, and 21 shoulders had secondary osteoarthritis. Glenoid surface wear was evaluated and classified as either type I, concentric, (15 shoulders) or type II, nonconcentric, (16 shoulders). Postoperative results were reviewed with the American Shoulder and Elbow Surgeons' evaluation form, Neer classification, and the Constant score. Overall, 23 (74%) shoulders achieved satisfactory results, and 8 (26%) shoulders had unsatisfactory results. Results were similar in the primary and secondary osteoarthritis groups. Outcome correlated most significantly with the status of posterior glenoid wear. Patients with concentric, type I glenoids achieved 86% satisfactory results, whereas patients with nonconcentric, type II glenoids had only 63% satisfactory results. Although pain relief was similar in both groups, the unsatisfactory results were attributed to loss of forward elevation and external rotation in patients with type II glenoids. On the basis of these results hemiarthroplasty can be an effective treatment for both primary and secondary arthritis but should be reserved for patients with a concentric glenoid, which affords a better fulcrum for glenohumeral motion.

Adult↗
PubMedDate not supplied

Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases.

One hundred consecutive stiff shoulders in 93 patients resistant to conservative therapy were treated with surgery and intermittent regional anesthesia via indwelling interscalene catheter. Each patient underwent manipulation and one of several operative treatments to release any additional contracture. The indwelling interscalene catheter remained in place and functioned well for an average of 3 days in 87 shoulders. At an average follow-up of 3.0 years, overall clinical results according to Neer's criteria were excellent in 39 shoulders (39%), satisfactory in 28 (28%), and unsatisfactory in 33 (33%). Patients reported no or mild pain in 83 (83%) of the shoulders in the study. At final follow-up, average gains in motion were 44 degrees of elevation (115 degrees to 159 degrees), 31 degrees of external rotation (22 degrees to 53 degrees), and 5 spine segments of internal rotation (L4 to T11). At final follow-up, 95% of the elevation and 79% of the external rotation achieved intraoperatively were maintained. The best results were obtained in those shoulders with idiopathic stiffness (88% excellent or satisfactory results); the worst results were in the postsurgical shoulders (47% excellent or satisfactory results). There were no catheter-related complications. The use of an indwelling interscalene catheter for postoperative pain control is a safe technique that facilitates early physical therapy in a patient population with a high risk of developing recurrent stiffness.

Adult↗
PubMedDate not supplied

Open revision stabilization surgery for recurrent anterior glenohumeral instability.

Fifty patients (average age, 27 years) who underwent revision anterior stabilization surgery for failed anterior glenohumeral instability procedures were retrospectively reviewed. Failure of the original procedure occurred subsequent to significant trauma in only 17 of 50 shoulders. At revision, 49 shoulders underwent an anteroinferior capsular shift procedure and 23 underwent concurrent repair of a Bankart lesion. One shoulder was treated with a coracoid transfer to reconstruct the anteroinferior glenoid. At an average follow-up of 4.7 years (range, 2 to 10), there were 36 excellent and 3 good results (78%). Eleven shoulders were considered unsatisfactory (22%); 7 of these 11 patients had a diagnosis of voluntary dislocation. All 17 patients who had failed results after significant trauma had excellent results after revision surgery. However, only 22 of the 33 patients (67%) with atraumatic recurrent instability achieved excellent or good results after revision surgery. This difference was statistically significant. No patients had radiographic evidence of osteoarthritis at the most recent follow-up. Range of motion, return to function, and glenohumeral stability can be reliably restored in a high percentage of patients after revision anterior stabilization surgery for glenohumeral instability. However, the results are not as predictable as for primary surgery. Factors associated with poor results of revision repair included an atraumatic cause of failure, voluntary dislocations, and multiple prior stabilization attempts.

Adolescent↗
PubMedDate not supplied

Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League.

The purpose of this study was to assess the safety of intramuscular corticosteroid injection in selected, severe hamstring injuries in professional football players. Clinicians have been reluctant to use corticosteroid injections in or around muscle-tendon units because of concern of incomplete healing or rupture. We retrospectively reviewed the computer database of one National Football League team for all hamstring injuries requiring treatment between January 1985 and January 1998. We found that 431 players had suffered such injury. We developed a clinical grading system to identify hamstring injury severity and to stratify players for treatment. Fifty-eight players (13%) sustained severe, discrete injuries with a palpable defect within the substance of the muscle and were treated with intramuscular injection of corticosteroid and anesthetic. There were no complications related to the injection of corticosteroid. Only nine players (16%) missed any games as a result of their injury. Final examination revealed no strength deficits, normal muscle bulk and tone, and the ability to generate normal power. We believe that the grading system we developed can assist in selection of injury type for injection. Although lack of a control group limits statements of efficacy of injection, our impression is that intramuscular corticosteroid injection hastens players' return to full play and lessens the game and practice time they miss.

Adult↗
PubMedDate not supplied

Portal-extension approach for the repair of small and medium rotator cuff tears.

One hundred ten consecutive cases (110 patients) of arthroscopically assisted rotator cuff repair through a limited, portal-extension approach were retrospectively reviewed. The average age of our patients was 58 years (range, 30 to 79). There were 35 women and 75 men. The dominant shoulder was affected in 67 patients (61%). All patients underwent a standard arthroscopic decompression. Acromioclavicular resections were performed in 15% of patients. The anterolateral portal was extended in the direction of Langer's lines to a total length of no more than 3 cm. The torn tendon was accessed through a small deltoid muscle split and repaired with nonabsorbable sutures. At an average follow-up of 35 months (range, 24 to 86), 106 patients (96%) had achieved excellent or satisfactory results. The average American Shoulder and Elbow Surgeons pain score improved from 7 preoperatively to 2 postoperatively. All but four patients were satisfied with the clinical result and reported significant improvement in active elevation and strength and a significant lessening of pain. Late acromioclavicular joint pain contributed to failure in three of the four patients with unsatisfactory results in this series. The results of this study suggest that, in selected patients with small to medium rotator cuff tears, arthroscopically assisted repair through an anterolateral portal-extension approach can produce excellent results.

Adult↗