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PubMed2005

Meniscus transplantation: indications, techniques, clinical outcomes.

Although many meniscus tears can be successfully repaired, not all are salvageable, especially if considerable tissue damage has occurred. Meniscus transplantation has been shown to be an acceptable procedure for younger patients. The primary candidate is a patient younger than age 50 years who has had a total meniscectomy and who either has pain in the tibiofemoral compartment, arthroscopic evidence of articular cartilage deterioration, or both. Contraindications are advanced knee joint arthrosis with flattening of the femoral condyle, concavity of the tibial plateau, and osteophytes that prevent anatomic seating of the meniscus allograft; axial malalignment; knee joint instability; knee arthrofibrosis; muscular atrophy; and prior joint infection. Prophylactic meniscus transplantation after total meniscectomy is not recommended in asymptomatic patients who do not demonstrate articular cartilage deterioration because long-term predictable success rates are not available. Most clinical studies on meniscus transplantation have reported improvements in knee function and pain, especially in patients who have symptoms affecting daily activities, as there are few if any other available treatment options.

Contraindications↗
PubMed1991

Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome.

Ten patients who had Down syndrome and had had a posterior arthrodesis of the upper cervical spine were studied. The mean age at the time of the operation was 8.9 years, and the patients had been followed for three days to forty-nine months. Complications related to the operation occurred in all patients. They included infection and dehiscence at the site of the wound, incomplete reduction of the atlanto-axial joint, instability of the adjacent motion segment, neurological sequelae, resorption of the autogenous bone graft, and death in the postoperative period. Resorption of the bone graft, which occurred in six of the patients, has not previously been reported in patients who have Down syndrome, to our knowledge. Several theoretical mechanisms for this complication are proposed. We recommend non-operative management for patients who have Down syndrome and atlanto-axial instability without neurological signs or symptoms. If the severity of symptoms necessitates a posterior arthrodesis, a high rate of complications must be anticipated.

Adolescent↗
PubMedDate not supplied

Influence of rotator cuff tearing on glenohumeral stability.

This study hypothesizes that full-thickness tearing of the rotator cuff can lead to joint instability and that the degree of instability depends on the size and location of the tear. Twelve cadaveric shoulder specimens were divided into two groups: group 1 had a circular tear centered at the critical area, and group 2 had a circular tear centered at the rotator interval. Each group was tested at 2.5 cm and 5 cm tear sizes. Unloaded, and with the arm in 90 degrees flexion and full internal rotation, the humeral head shifted posteriorly. With loading, a large and more anteriorly located defect had the most influence on stability. The tear size had the greatest effect on stability in the inferior direction for group 1 and on the anterior direction for group 2. The tear location had the most significant effect on stability in the inferior and anterior directions for the smaller tear and on the anterior direction for a larger tear.

Aged↗
PubMed2005

Continuous passive motion improves shoulder joint integrity following stroke.

OBJECTIVE: In a pilot study of patients with a first stroke and hemiparesis, we sought to determine whether treatment of the upper limb with continuous passive motion (CPM) that was device delivered would alter impairment, disability or the associated adverse symptoms of shoulder joint instability, pain and tone. DESIGN: Patients were randomly assigned to receive daily CPM treatments or participate in self-range of motion groups under the supervision of an occupational therapist. All patients received standard daily poststroke therapy for 3.5 h per day. A blinded evaluator at admission and discharge assessed patients using standardized scales of impairment, disability and adverse symptoms. SETTING: Specialized stroke unit of an acute rehabilitation hospital. SUBJECTS: Two hundred and eighty consecutive patients were screened and 35 of these with a first unilateral stroke, 13 +/- 6 days following the acute event, provided informed consent and were randomly assigned to CPM treatment or supervised group self-range exercise. MAIN MEASURES: Thirty-two completed the study and were evaluated using standardized measures for motor impairment (Fugl-Meyer, Motor Status Scale and Medical Research Council Motor Power), adverse symptoms (gleno-humeral stability, pain and tone), and disability (Functional Independence Measure). RESULTS: CPM-treated patients demonstrated positive trends towards improved shoulder joint stability (p = 0.06, confidence interval -0.03, 2.3) when compared with patients performing therapist-supervised self-range of motion. There were no significant differences in motor impairment, disability, pain or tone. CONCLUSIONS: Device-delivered continuous passive range of motion may offer an enhanced benefit for some adverse symptom reduction in the hemiplegic arm after stroke over traditional self-range of motion exercise.

Aged↗
PubMed1985

Carbon fiber replacement of the ligaments of the shoulder girdle and the treatment of lateral instability of the ankle joint.

A normal active human being will not accept chronic instability or persistent luxation of any joint. Many attempts have been made to stabilize a damaged joint with autogeneic and allogeneic materials and by various surgical techniques. In animal and clinical trials, carbon fibers are reported to be a promising material for ligament replacement in chronic joint instability. The authors are investigating carbon fibers not only for repair of chronic instability of knee joints but also for chronic luxations and subluxations of the sternoclavicular, acromioclavicular, and ankle joints. For long-term stability of the new ligament, carbon fibers must be implanted in cancellous bone channels. Ingrowth of connective tissue and newly formed bone produces a secure ligament anchorage. A temporary tension band wire loop immobilizes the sternoclavicular or acromioclavicular joint. The ankle ligament replacements are immobilized with a weight-bearing plaster boot for six weeks postoperation. The use of carbon fibers as a ligament replacement in the sternoclavicular, acromioclavicular, and ankle joints produces favorable functions and stability. Reconstruction of the normal ligament insertions of a joint is essential, particularly with respect to supination and free range of movement. Of 56 cases with lateral chronic instability of the ankle, 51 with a mean average postoperative follow-up period of two years, 49 had subjectively good results. Stable joints were demonstrable in 48 cases; supination was limited in four cases.

Acromioclavicular Joint↗
PubMed2004

Essentials of shoulder MR arthrography: a practical guide for the general radiologist.

Lesions of the glenoid labrum and ligamentous structures commonly occur secondary to shoulder trauma and are a frequent cause of shoulder joint instability. Numerous eponyms, acronyms and subclassifications are used to describe the often confusing array of bony and labro-ligamentous abnormalities of the shoulder. This aim of this review is to illustrate the relevant features of these lesions and to provide a systematic and practical approach to imaging of the shoulder using MR arthrography.

Humans↗
PubMed2001

Management of anterior cruciate ligament disruptions in skeletally immature patients.

Proper treatment of anterior cruciate ligament injuries in skeletally immature patients is a highly debated topic. More aggressive surgical approaches have been explored as a consequence of the potential long-term detrimental intra-articular effects of nonoperative treatment. Concerns of growth disturbances secondary to physeal injury have been reduced as a result of various alternative surgical techniques. Estimates of the amount of growthplate disruption necessary to induce changes in osseous development have also been attempted. Ultimately, the final decision to intervene surgically is influenced by joint instability and by the patient's symptoms and compliance with nonoperative treatment. Long-term repercussions of severe intraarticular destruction with nonoperative treatment should be compared with the potential detrimental effects of surgery. If more advanced techniques are combined with an increase in clinical awareness of these risk factors, then an earlier surgical approach may be a suitable option.

Adolescent↗
PubMed2002

Dual Articular Knee in demanding primary and revision replacements in patients with rheumatic diseases.

We report the results of 25 total knee replacements in 24 patients with rheumatoid arthritis (RA) using the Dual Articular Knee prosthesis. There were four primary and 21 revision procedures. The main indication was severe joint instability. In four infected arthroplasties a two-stage revision procedure was used. Four patellar tendon avulsions and one deep infection were encountered. Results were excellent in 18 patients. Dual Articular Knee proved to be favourable in both demanding primary as well as revision arthroplasties in patients with RA.

Adult↗
PubMed1986

Serum relaxin and pelvic pain of pregnancy.

Serum relaxin immunoreactivity was measured by means of a porcine relaxin radioimmunoassay in 35 patients with severe pelvic pain and pelvic joint instability during late pregnancy. Results were compared with a control group of 368 samples obtained throughout pregnancy from normal singleton pregnancies. Most of the relaxin concentrations in the study group were above the 95% confidence limits of the median for the corresponding gestational age in the control group. The difference in relaxin levels between the study and control groups in the third trimester was highly significant. Relaxin levels in patients with pelvic pain were close to normal non-pregnant levels by the third postnatal day. The highest relaxin levels during pregnancy were found in the patients who were the most incapacitated clinically. The results suggest that there may be an association between high serum relaxin levels and pelvic pain and joint laxity during late pregnancy.

Female↗
PubMed1987

Proximal femoral allografts in revision total hip arthroplasty.

Patients with total hip arthroplasty (THA) and aseptic loosening associated with severe bone deficiency were treated with freeze-dried bone allografts of the proximal one-third of the femur. Twenty-two of the first 25 patients were available for review with an average follow-up period of 28 months. Significant functional improvement was obtained in 16 patients (73%). The following complications occurred with allograft revisions: dislocation, wound hematoma, joint instability, nonunion, implant failure, and acetabular loosening. Nine patients required additional surgical procedures. There have been no infections or rapid lysis indicative of an allograft rejection phenomenon. The 73% success at the two-year postoperative interval of incorporation of freeze-dried allografts for salvage situations has been encouraging. However, the long-term durability of these grafts is not known and will require further follow-up study.

Adult↗
PubMed1989

[Lesions of the acetabular rim. Clinical manifestations, therapeutic strategies and perspectives].

Partial rupture of the acetabular rim have usually been described as accompanying traumatic or dysplasic dislocations of the hip. The five cases reported here are in favor of a specific pathology of this fibrocartilage as it is in the knee or the shoulder. Besides, the functional symptoms are not without reminding that of these two joints with sudden onset of cracks, jerks, blockings and even a real joint instability. The pain is never isolated, but may accompany other disorders. The cases were selected in order to evaluate the clinical manifestations and the therapeutic consequences of such a lesion according to the articular history. The diagnosis can only be confirmed with arthrography, which, in addition, permits to evaluate the size of the rim and the condition of the cartilage. The three patients who underwent surgery presented the lesions shown on arthrography. The problem lies in the possible arthrogenic potential of a tear, left in place because minimally disabling for the patient.

Acetabulum↗
PubMed1999

Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities.

BACKGROUND: We treated 20 cases of craniovertebral junction lesions via a transoral approach. Developmental abnormalities of the craniovertebral junction accounted for 15 cases; there were 3 cases of tumor, 1 case of osteomyelitis, and 1 case of rheumatoid arthritis. METHODS: The transoral transpharyngeal approach was used in all cases. In 17 non-tumoral patients the anterior margin of the atlas and the odontoid process were resected. In one patient with a ventral clivus chordoma, both a transoral and a transnasal transsphenoidal approach was used for partial resection of the tumor mass. In two cases the median transpharyngeal approach was combined with a jaw-facial incision. In one case a metastatic adenocarcinoma, and in another a neurinoma of the accessory nerve straddling the posterior fossa and the pharyngeal region were removed. RESULTS: After operation four cases developed craniovertebral joint instability and required posterior cervical fusion or external fixation with a halo brace. Follow-up ranged from 2 to 44 months. In most patients neurologic function slowly improved. One worsened, and one died of respiratory failure after operation. Two patients with malignant tumors died during the follow-up period. CONCLUSION: In patients with developmental malformations, transoral decompression will result in some neurologic improvement and arrest the progress of symptoms. Patients with tumors are likely to show a good neurologic outcome when transoral surgery is performed in the early stage of the condition.

Adolescent↗
PubMed1983

The avoidability of soccer injuries.

One hundred eighty players in a male soccer division were followed prospectively for 1 year to assess etiologic factors in soccer injuries. Range of motion and muscle strength in the lower extremities were measured in a preseason test. All injuries during 1 year were examined by the same orthopaedic surgeon. 42% of the injuries were considered to be due to player factors, such as joint instability, muscle tightness, inadequate rehabilitation, or lack of training. Ankle sprains were commoner in players with previous ankle sprains or clinical instability. 35% of the moderate (absence from practice greater than 1 week, less than 1 month) or major (absence greater than 1 month) injuries were preceded by minor (absence less than 1 week) injuries, reflecting inadequate rehabilitation. Players sustaining knee sprains not due to collision had reduced muscle strength in the injured leg. No other strength differences between injured and uninjured players were found. 63% of players had tight muscles. Strains more commonly affected players with muscle tightness. 71% of the injuries proved to be explicable by and associated with player factors, equipment, playing ground, or rules.

Adult↗
PubMed1997

Laxity of knee cruciate ligaments during pregnancy.

Pregnancy-related increase in ligament laxity may cause joint instability. The purpose of this study was two-fold: 1) to assess knee laxity changes during pregnancy and 2) to evaluate the effect of exercise on knee laxity due to a typical prenatal fitness program. The subjects were healthy pregnant women. One group (N = 27) participated in exercise classes designed according to national guidelines. The second group (N = 38) was more sedentary. A clinical arthrometer, KT-1000, was used, and anterior and posterior drawer tests were performed. The results were added and averaged for the two knees. Laxity was constant in the second half of pregnancy and had significantly decreased by 14% 4 months after birth. No influence of parity or exercise was detected. The exercise program employing minimal to moderate weight bearing did not result in any measurable increases in knee laxity and, therefore, appears to be appropriate with regard to knee stability. These results should not, however, be extended to different types of exercise programs without additional research.

Adult↗
PubMed2006

[Treatment of medial epicondylar apophyseal avulsion injury in children].

OBJECTIVE: Surgical reduction and retention of apophyseal avulsion injuries at the medial epicondyle to prevent joint instability, lasting malalignment, or pseudarthrosis. INDICATIONS: Absolute: intraarticular apophyseal dislocation of the medial epicondyle, complete lesion of the ulnar nerve. Relative: dislocation of the apophysis (> 4 mm) in children > 5 years of age; the need for intervention increases in children as the degree of dislocation, age, and athletic activity increase. CONTRAINDICATIONS: Dislocation of the medial epicondyle (< or = 4 mm) in children < 5 years of age, provided the fragment location is not intraarticular. SURGICAL TECHNIQUE: Open reduction of the apophysis through a medial approach. Identification of the ulnar nerve. In young children or with small fragments fixation with Kirschner wire. Screw fixation in older children or for larger fragments. POSTOPERATIVE MANAGEMENT: Long upper-arm plaster cast until wound healing is achieved. Subsequently, upper-arm plaster cast for 3 weeks. Removal of Kirschner wires after 4-6 weeks, screw removal after 8-12 weeks. Physiotherapy only if marked reduction of elbow mobility is found 6 weeks after cast removal. RESULTS: From January 1, 1994 to December 31, 2003, 25 children with an average age of 12 years suffering from medial epicondylar avulsion fractures were operated on using open reduction and Kirschner wire fixation. An average of 3 years after the injury 14 of these children underwent follow-up examination using a procedure that took subjective, clinical and radiologic parameters into account. Two children showed a slight reduction in overall strength of the injured extremity when compared with the contralateral extremity. One child had a flexion deficit of 10 degrees, all other children showed movement limitations of < or = 5 degrees compared to the contralateral extremity. In all the cases available to follow-up, there was a slight increase in valgus alignment of the elbow joint compared with the uninjured side (3 degrees on average). All fractures consolidated within 6 weeks.

Adolescent↗
PubMed1995

Early range of motion training after ligament reconstruction of the ankle joint.

Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program, with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5 +/- 1.6 weeks compared with 8.5 +/- 1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5 +/- 2.2 weeks, compared with 12.5 +/- 2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability.

Adolescent↗
PubMed2006

[The influence of laser irradiation of low-power density on an experimental cartilage damage in rabbit knee-joints: an in vivo investigation considering macroscopic, histological and immunohistochemical changes].

In a total of 45 rabbits, knee-joint arthrosis was induced according to the Hulth & Telhag model. Depending on the post-operative survival time, the cartilage was investigated macroscopically, histologically and immunohistochemically (within a period of 10 days to 8 months). Thereafter, the influence of laser irradiation at a wavelength of 692.6 nm and energy densities of 1 and 4 J/cm2 on the cartilage morphology seven days following the exposure was examined. After joint instability surgery it was found out that the cartilage changes in the main stress area (MSA) and in regions outside the main stress area (ROMSA) progressed differently. Various qualitative and semi-quantitative changes were found for collagens I, II, IV and V, and for the glycoproteins fibronectin and tenascin. Immunohistochemically, there was a growing expression of collagen I in the apical layers, collagen II showed a stronger pericellular expression, and collagen IV showed, after an initial growth of the pericellular expression, a reduced territorial expression and a stronger apical-interterritorial expression in the osteoarthrotic cartilage. For fibronectin, the cellular expression turned out to grow in the ROMSA. In the MSA it decreased, but at the same time the interterritorial expression grew. For Tanascin, there was a decrease of the interterritorial expression in the radial zone while the pericellular and interterritorial expression of the apical layers of the osteoarthrotic cartilage grew. Lasing proved to significantly influence the osteoarthrotically changed cartilage when applied at an energy density of 1 J/cm2, i.e., the morphological changes had not yet progressed to the extent the control group had. Both the chondrocyte density and the glucosaminoglycan content turned out to be higher. When lasing was applied at higher energy densities, no significant difference among the control groups was found. Thus, it could be demonstrated in vivo that an arthrotic process decelerates through the influence of laser light of low-energy densities.

Animals↗