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At least 289 records · Page 16Linked to original sources
PubMed2005

Interposition arthroplasty with bone-tendon allograft: a technique for treatment of the unstable sternoclavicular joint.

Sternoclavicular joint instability is an uncommon but challenging clinical problem for the orthopaedic surgeon. Although most cases can be treated nonoperatively with minimal long-term pain or functional limitation, a small percentage may require surgical intervention. This includes chronic anterior instability associated with persistent pain or functional limitation as well as irreducible or recurrent posterior instability. Although numerous procedures have been described for treatment of the unstable sternoclavicular joint, the optimal method for stabilization has not been determined. Here we describe a technique using Achilles tendon allograft to create an interpositional arthroplasty and briefly present 3 illustrative cases in which we performed the procedure. We believe this method effectively stabilizes the joint, restores function, relieves pain, and has applications for traumatic sternoclavicular instability as well as instability related to other etiologies.

Achilles Tendon↗
PubMedDate not supplied

Echographic examination of the stifle joint affected by cranial cruciate ligament rupture in the dog.

Ultrasound is a useful technique for the study of normal and pathologic stifle joints, in particular for soft tissue examination. The aim of this study was to evaluate sonography for examination of stifle joints affected by cranial cruciate ligament rupture. Forty-two medium to giant breed dogs were studied. Tibial compression radiography was performed. A 7.5 MHz transducer with an incorporated 2 cm thick standoff was employed. Sagittal and midsagittal images were collected. The stifle was positioned in maximum flexion during sonography. Sonographic findings were compared with pathologic findings at surgery. Ultrasound was useful in evaluating the presence of fibrous tissue within the joint due to repair processes. It was observed in 70% of stifles with radiographic evidence of chronic osteoarthritis. In 19.6% of the joints it was possible to identify the ruptured cranial cruciate ligament. Ultrasound was not an accurate test for cruciate rupture evaluation, but was specific for the soft tissue pathologic changes which were observed consequent to joint instability.

Animals↗
PubMed2006

Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea.

Trochlear dysplasia is a predisposing factor for recurrent patellar instability. We evaluated the results of an anterior lateral femoral condyle open wedge osteotomy for treating patellar instability. A total of 16 consecutive patients (19 knees) with symptoms of recurrent patellar instability and trochlear dysplasia identified using a true lateral radiograph of the knee underwent an anterior lateral femoral osteotomy. Outcomes were documented at 2 years minimum follow-up using the Lysholm scale, the patellofemoral score, WOMAC score and standard conventional radiographs. In 17 knees, patients reported good improvement in stability (no dislocations) and most patients had a marked improvement in pain and functional scores at follow-up (mean follow-up 51 months). No serious complications occurred. Anterior femoral osteotomy of the lateral condyle appears to be a satisfactory and safe method for treating patients with patellofemoral joint instability caused by trochlea dysplasia. In selected cases this procedure can be used to correct trochlea dysplasia. In our opinion, the key to a successful treatment of patellofemoral instability is to successfully distinguish the anatomic deficiencies and to correct the anatomical abnormality.

Adolescent↗
PubMed2003

S1 pediculoiliac screw fixation in instabilities of the sacroiliac complex: biomechanical study and report of two cases.

OBJECTIVE: A new technique for posterior sacroiliac fixation is described and compared with conventional techniques. PATIENTS/MATERIAL AND METHODS: A patient with sacral alar fracture (zone 1) and another one with sacroiliac joint instability due to tuberculous infection underwent fixation using screws placed in the S1 pedicle and the iliac bone. Vertical stability of the new technique also was investigated using polyurethane pelvic bone analogs and compared with anterior double plating (group P) and iliosacral screw fixation (group ISS) techniques. RESULTS: Healing was obtained and reduction was maintained in both patients on the final follow-up examination at 2 years postoperatively. Vertical loading tests revealed that failure loads within the first 10 mm of displacement of the new pediculoiliac screw fixation technique (group PIS) was higher than plating (P = 0.03) and lower than ISS techniques (P = 0.002). Ultimate failure load of the PIS technique was slightly higher than plating (P = 0.277) and lower than ISS techniques (P = 0.003). With the addition of an iliosacral screw to the pediculoiliac screw construction (PIS+ISS), the PIS technique became more stable in early (P = 0.110) and ultimate failure loads (P = 0.003). CONCLUSIONS: Pediculoiliac screw fixation for sacroiliac joint disruptions and zone I sacrum fractures using iliac and S1 pedicle screws is a new and effective alternative for obtaining and maintaining anatomic reduction.

Adult↗
PubMed2000

[Individual isokinetic strength training in patients with gonarthrosis].

PROBLEM: To date, therapy of osteoarthritis of the knee is aimed at relieving pain and changing behavior patterns, which usually leads to reduced activity. The weakening of the quadricep's musculature leads to an increase in both joint instability and arthritis. Walking time is prolonged and the pain-induced reaction of knee angle velocity is onset by increased stress on other joints. The progressive muscle atrophy correlates to the degree of pain. The aim of this study was to demonstrate an improvement in strength and pain based on 4-week isokinetic strength training in gonarthritis patients. METHOD: During a conservative hospitalization period, isokinetic strength training was performed by 19 randomized patients with gonarthritis in addition to regular physiotherapy. Another 19 patients functioned as a control group. The work was examined at 60 degrees/s and 180 degrees/s and rated using a pain questionnaire at the start and end of the investigation. RESULTS: In addition to the expected increase of strength and strength endurance in the test group, the degree of pain could also be statistically significantly decreased compared to the control group. Activities of daily living, such as climbing stairs and standing-up, were also performed more easily. CONCLUSIONS: The therapeutic strategy for patients with osteoarthritis of the knee should be reconsidered to include less expensive therapeutic sport measures. Anglo-american and Scandinavian studies support this statement. Overuse and pain can be avoided by precise and low-dose strength training. Objective and reproducible measurements in the patients are essential to make individual training possible.

Adult↗
PubMed2005

The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb.

We report the results of a new bone-tendon ligamentoplasty for the reconstruction of chronic injuries of the ulnar collateral ligament at the metacarpophalangeal joint of the thumb. The mean follow-up period was 36 months. Using the Glickel grading system, seven patients had excellent results and one patient had good results. The mean loss of pinch strength was 10% compared with the contralateral thumb. The mean loss of motion at the MP joint was 8%. This technique successfully restores the desired long lasting stability while maintaining mobility of the thumb's metacarpophalangeal joint.

Adult↗
PubMed2003

Operative repair of fourth and fifth toe corns.

METHODS: We report a retrospective review of 57 consecutive patients (72 feet) over a period of 20 years who had been treated operatively for either a lateral fifth toe corn or an interdigital corn of the fourth interdigital space more than two years previously. Of these, 51 patients (62 feet) returned for a follow-up evaluation at a minimum of two years (average of over seven years) which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and assessment of the patient's satisfaction with the alignment and results of surgery. Treatment of 31 lateral fifth toe corns involved either a lateral condylectomy and flexor tenotomy or a complete condylectomy. Treatment of 31 interdigital corns comprised either a single condylectomy, double condylectomy of adjacent corns, or a complete condylectomy (hammertoe repair) of a symptomatic corn. Treatment in each case was dependent upon the severity of the deformity. RESULTS: There was found to be no significant difference in comparison of the two major groups (interdigital corns and lateral fifth toe corns) with the measurement of the relative length of the fourth and fifth metatarsals, toe malalignment, angulation of the fourth and fifth toes (MTP-4, MTP-5 angles), and the phalangeal-5 angle. Pain was relieved in 58 of 62 feet (93%) and subjective acceptable alignment was achieved in 54 of 62 feet (87%). At final follow-up 53 feet were rated by patients as excellent, seven as good, one as fair, and one as poor. Complications included numbness of the involved digit (six feet). There were two superficial infections. There were two cases of joint instability due to excessive bone resection. Joint stiffness was commonly observed (34/62 feet, 55%), but was not associated with diminished satisfaction at final follow-up. Mild asymptomatic recurrence of a callosity was noted in 10 feet and moderate or severe recurrence was noted in two feet. Dissatisfaction was associated with moderate or severe recurrence. CONCLUSION: In this retrospective study at an average of more than seven years, we achieved a high level of patient satisfaction treating both lateral fifth toe corns and interdigital corns with a partial and/or complete condylectomy, the choice depending upon the magnitude of the deformity and the callus, and the fixed nature of the lesser toe deformity.

Adult↗
PubMed1988

Fractures and dislocations of the distal radioulnar joint.

Fractures and dislocations of the distal radioulnar joint are frequently visualized as a secondary problem in comparison to the more apparent radius fractures. Frequently, in the long-term follow-up of patients with radius fractures, ulnar wrist pain secondary to distal radioulnar joint incongruity is the final outcome. Therefore, in the evaluation of the injured forearm the distal radioulnar joint must be assessed clinically and radiographically. In this assessment if distal radioulnar joint instability or incongruity is present then joint stabilization or reduction, respectively, must be attained.

Adolescent↗
PubMed1999

Sports participation, sports injuries and osteoarthritis: implications for prevention.

There is increasing concern that too much physical activity may lead to osteoarthritis. The continuous stress that physical activity places on the joints can result in microtrauma and degeneration of the articular cartilage. However, the onset of osteoarthritis appears to depend on the frequency, intensity and duration of physical activity. Research has shown that individuals of all ages can tolerate moderate amounts of exercise without adverse consequences or accelerated development of osteoarthritis. However, excessive participation in high impact sports, particularly over a long period of time and at an elite level, can increase the risk of developing osteoarthritis. Participants may also be at risk if they have abnormal joint anatomy or alignment, joint instability, underlying muscle weakness or imbalance, or if they are overweight and engage in significant amounts of exercise. Individuals who have experienced sports injuries to joints, or macrotrauma, may also be at risk of accelerated development of osteoarthritis. Certain types of surgery for the treatment of severe sports injuries, particularly to the knee, also appear to be associated with an increased risk. If surgery to the knee is required, continuous passive motion is an ideal form of rehabilitative treatment, as it promotes healing of the articular cartilage, ligaments and tendons. Moreover, athletes who have undergone surgery should return slowly to sporting activities to ensure they do not place too much stress on their injured joint(s). Further research into the causes of osteoarthritis is required; in particular, prospective and retrospective cohort studies are needed to confirm the association between exposure to risk factors and the development of osteoarthritis.

Animals↗
PubMed1993

[Surgical treatment of soccer player's ankle joint].

In experienced football players spurring and calcifications of the ankle joint's capsule attachments may be found more often than in other sportsmen. Basing on functional and sometimes already established ankle joint instability pain may develop. Out of 374 football players throughout 1989-1992 with injuries to the ankle joint 49 were operated on. These showed chronical instability and radiologically visible alterations in accordance with the imaging of footballer's ankle joint. 40 of these patients could be followed up. 16 exact fibular ligament repairs and 19 reconstructions were performed, 15 tibioventral, 6 talodorsal, 12 fibular and three medial capsule calcifications and spurs were excised, 8 loose bodies removed, three cases of osteochondritis dissecans drilled. After an average follow up of 25.6 months we saw stable ankle joints in all patients with resting local pain in 15 patients, among them 7 load dependent and 6 with slight limitation of dorsiflexion. Sport activity level showed 25 patients improved, 11 equal, one worse and three with changed disciplines.

Adult↗
PubMed1999

Bone abnormalities in the surgical treatment of patients with rheumatoid arthritis.

Profound abnormalities of bone are an important component of the morbidity of rheumatoid arthritis and partly determine the orthopaedic treatment of patients. The principal bone abnormality, which is osteoporosis associated with rapid remodeling, degrades the mechanical properties of the skeleton in juxtaarticular bone, in the diaphyses of long bones, in the pelvis, and in the base of skull. Abnormalities of bone affect clinical decision making in the surgical treatment of patients with rheumatoid arthritis and must be considered for the optimal treatment of these patients. Increased fracture risk and compromised bony fixation complicate fracture treatment. Techniques of surgery must be modified to protect bone from intraoperative fracture. Methods of fixation of implants and other devices must be appropriate to the biomechanics of the bone. Bone healing usually is rapid if not compromised by mechanical instability. Specific patterns of bone deformation and failure can be identified in the evolution of rheumatoid arthritis. Bone graft used in reconstruction of the protruded acetabulum is incorporated rapidly. Bone resorption with joint instability is a common feature of rheumatoid arthritis; however, the opposite pattern of bony ankylosis with stiffness is observed in a smaller percentage of patients. Recognition of the tissue type is necessary for the individualization of surgical procedures to achieve optimal joint stability and mobility. Based on growing understanding of the pathophysiology of bone in patients with rheumatoid arthritis, new pharmacologic therapies may become available for the prevention and treatment of bone abnormalities in patients with rheumatoid arthritis.

Ankylosis↗
PubMedDate not supplied

Glenohumeral joint translation after arthroscopic, nonablative, thermal capsuloplasty with a laser.

The purpose of this study was to determine whether there are changes in anterior and posterior glenohumeral translation after arthroscopic, nonablative, thermal capsuloplasty with a laser. Two anteriorly and two posteriorly directed loads were sequentially applied to the humerus of nine cadaveric glenohumeral joints, and anterior and posterior translation of the humerus on the glenoid was measured. The glenoid was rigidly fixed, and the glenohumeral joint was positioned simulating 90 degrees of shoulder abduction and 90 degrees of external rotation. Using the holmium:yttrium-aluminum-garnet laser, thermal energy was then applied to the anterior capsuloligamentous structures and anterior and posterior translation measurements were then repeated. The results showed a significant reduction in anterior and posterior translation after laser anterior capsuloplasty. Anterior translation decreased from 10.9 +/- 2.0 mm (mean +/- SEM) to 6.4 +/- 1.5 mm with the 15-N load; and from 13.4 +/- 2.1 mm to 8.9 +/- 1.8 mm with the 20-N load. Posterior translation decreased from 7.2 +/- 1.2 mm to 4.4 +/- 0.6 mm with the 15-N load and from 10.4 +/- 1.4 mm to 6.5 +/- 0.9 mm with the 20-N load. These results indicate that the holmium:yttrium-aluminum-garnet laser can be used to decrease glenohumeral joint translation and may be an effective treatment for glenohumeral joint instability.

Aged↗
PubMed2004

[Shoulder instability].

Shoulder instability is a common clinical feature leading to recurrent pain and limited range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging.

Arthrography↗
PubMed1999

Arthroscopic treatment of shoulder instability: current concepts and techniques.

The incidence of glenohumeral joint instability is estimated to effect between 2 and 8% of the population. It represents at least one third of all shoulder related emergency room visits. When one considers the spectrum of shoulder instability, including transient subluxation, the true incidence of glenohumeral instability is probably grossly under-reported. Although any age group can be affected, shoulder instability is primarily a disease of the young. The occurrence of instability is inversely proportional to the age of the patient and the time of original injury. A patient who dislocates for the first time as a teen can expect a redislocation rate approaching 90% in his or her lifetime. Therefore, many authors recommend early surgical treatment to repair the lesion.

Journal Article↗
PubMed1992

Tension band arthrodesis of finger joints: a retrospective review of 76 consecutive cases.

Arthrodesis of finger joints is a reliable method of treating finger joint instability and arthritis. Tension band arthrodesis is an effective method of stable fixation that uses readily available and inexpensive materials. Because fixation is rigid, patients are allowed to move adjacent joints, usually within 1 week after surgery. The results of 76 tension band arthrodesis procedures performed since 1982 in 63 patients were reviewed. Follow-up ranged from 6 to 38 months. The average time to radiographic fusion was 12 weeks (range, 4 to 64 weeks). One joint failed to fuse and developed a stable, asymptomatic nonunion; thus the fusion rate was 99%. Technical problems that occur with the method include nonparallel pin placement and penetration of pin tips, leading to painful impingement of the soft tissues. A pin-placement guide has been developed to minimize these problems.

Arthritis↗