[Diagnosis and treatment of anterior cruciate ligament tears].
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Anterior Cruciate Ligament↗
Biomedical subjects
A Harilainen
Publications and source records attributed to A Harilainen.
Chronic unilateral low-back pain. Predictors of outcome of facet joint injections.
One hundred nine patients with chronic (3-36 months; mean, 13.4 months) unilateral low-back pain and no signs of sciatica were subjected to facet joint injection, randomized in three therapy groups: cortisone and local anesthetic injected intra-articularly, the same mixture injected pericapsularly, and physiologic sodium hydrochloride injected intra-articularly into two facet joints. To evaluate the results, three outcome variables were formed: work, subjective, and disability outcome. The inappropriate signs (IAS) recorded before injections had the best predictability for a good outcome. The mode of injection or duration of symptoms had no significance as a predictor. It was concluded that the outcome after facet joint injection depends on the patient's biopsychosocial chances of self-facilitated improvement. If abnormal illness behavior and distress are found, it helps to estimate the response for treatment and to choose a realistic method of treatment.
Adult↗
Colloid osmotic and hydrostatic pressures and energy metabolism in high-protein joint swelling. A preliminary study of traumatic effusions of the knee.
In 10 patients referred to arthroscopy with traumatic effusions of the knee, the protein concentration of the synovial fluid (SF) correlated to its colloid osmotic pressure (pi SF). The pi SF did not correlate to the poorly determined hydrostatic pressure (PSF) in extended or slightly flexed joints or to the SF volume (VSF). SF hypoxia correlated to pi SF and to the number of intra-articular erythrocytes, but not to the determined PSF or VSF. SF hypoxia correlated to increase in lactate and decrease in pH, fitting enhanced anaerobic glycolysis. In addition, SF erythrocyte counts correlated to lactate increase. During a 5-min period of high PSF induced by flexion, the PSF decreased, and even more markedly so after the joints had been rinsed with saline. The results suggest that rinsing of joints in order to lower the pi SF and to remove erythrocytes is of benefit in cases of traumatic effusion.
Cell Count↗
Does joint cartilage require energy?
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Cartilage, Articular↗
Lumbar facet joint syndrome. A randomised clinical trial.
A group of 109 patients with unilateral low back pain for over three months were randomised to receive one of three types of injection treatment: cortisone and local anaesthetic injected into two facet joints (28), the same mixture around two facet joints (39), or physiological saline into two facet joints (42). The effect of the treatment was evaluated in relation to work attendance, pain, disability and movements of the lumbar spine. Patients were examined one hour and two and six weeks after treatment and also completed a questionnaire after three months. A significant improvement was observed in work attendance, pain and disability scores, but this was independent of the treatment given and movements of the lumbar spine were not improved. Of the 70 patients with initial pain relief after injection, 36% reported persisting benefit at the three month follow-up, independent of the mode of treatment given. We conclude that facet joint injection is a non-specific method of treatment and the good results depend on a tendency to spontaneous regression and to the psychosocial aspects of back pain.
Adult↗
[Lumbar facet joint syndrome. Significance of non-organic signs. A randomized placebo-controlled clinical study].
One hundred and nine patients with chronic (greater than 3 months) unilateral low back pain had less than or equal to 2/5 or greater than or equal to 3/5 inappropriate signs (IAS) in 65 and 44 cases, respectively. The patients were randomized in three therapy groups: cortison and local anaesthetic injected intra-articularly into two facet joints (28 patients), the same mixture injected pericapsularly around two facet joints as well (39 patients) and injection of physiologic sodium hydrochloride intra-articularly into two facet joints (42 patients). The effect of the treatment was evaluated within an hour, two and six weeks after the treatment with work status, pain scale, disability score and movements of the lumbar spine. In addition, the patients returned a questionnaire three months after the treatment. Although similar improvement was observed during the follow-up the pain scales and disability scores were, however, in the beginning and at the end of the study more pathological in the group scoring greater than or equal to 3/5 IAS. It is suggested that persistent high levels of IAS depend more on psychosocial factors than on anatomical disorders and therefore explain why the somatic treatment does not work. Identification of these patients may also prevent the doctor from a burn-out syndrome after many failed treatments. This study also shows that if a biological effect of a treatment is to be studied the patients with multiple IAS should be excluded from the material. There was no difference in the results when either intra-articular or pericapsular cortisone and local anaesthetic or saline intra-articularly was used.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The significance of arthroscopy and examination under anaesthesia in the diagnosis of fresh injury haemarthrosis of the knee joint.
Arthroscopy and examination under anaesthesia were performed for 328 consecutive knee injuries with haemarthrosis. These examinations were grouped according to a modified classification (Jackson and Abe, 1972) into very useful (117/328, 36 per cent), useful (98/328, 30 per cent) and useless (113/328, 34 per cent) categories. The probability of arthroscopy being useful was estimated mathematically. The factors which made this procedure useful were knee pain on exertion before the injury (P = 0.0561), the mechanism of the injury (P less than 0.0001) and the clinical stability of the patella (P = 0.0007). On arrival in the emergency department it was first decided whether the leg should be mobilized, immobilized in a plaster cast, operated on or, if a definitive diagnosis could not be reached, arthroscopy was deemed necessary. This resulted in the treatment following arthroscopy, and examination under anaesthesia, being altered from conservative to operative (P less than 0.0001). Results suggest that arthroscopy and examination under anaesthesia should always be considered to help in the diagnosis of acute injury haemarthrosis of the knee especially after a valgus or varus strain.
Adolescent↗
Treatment of fresh tears of the anterior cruciate ligament. A comparison of primary suture and augmentation with carbon fibre.
Early results after a follow-up of 1 year of primary suture and carbon fibre augmentation in the treatment of fresh anterior cruciate ligament tears in 57 consecutive and randomized patients are presented. There was no statistical difference between the two groups in the postoperative course. At an average of 13 months follow-up, complete stability was achieved regarding the pivot shift sign in 16 (55 per cent) and 18 (75 per cent) of the sutured and augmented groups respectively. There were 3/29 obvious pivot shifts in the sutured and 1/24 in the augmented knees. Seventeen carbon fibre reinforced knees were postoperatively arthroscoped at the 1-year follow-up. A structure resembling a 'neoligament' was observed in 8/16 knees. In 11 knees there were no signs of carbon material, in 4 knees subsynovial microparticles were scattered around the anterior compartment and in 3 knees the carbon fibre tow was bare in the joint despite careful covering within the ligament remnants at the time of the operation. Although no statistical difference was obtained between the two groups the augmentation procedure seemed to improve stability at the 1-year follow-up.
Adolescent↗
Evaluation of knee instability in acute ligamentous injuries.
The stability on clinical examination (CE) and examination under anaesthesia (EUA) was evaluated in 350 consecutive acute knee injuries. Valgus instability in knees with a medial collateral tear was observed on CE in 62 and on EUA in 67 cases (p less than 0.05). The anterior drawer sign was positive in 55 patients on CE and in 110 patients on EUA (p less than 0.0001), the corresponding figures for the Lachman test were 66 and 126 respectively (p less than 0.0001). The pivot shift-test was positive in 13 cases on CE and in 87 under anaesthesia (p less than 0.0001). Fresh total tears of the anterior cruciate ligament (confirmed at arthrotomy, n = 79) were detected by the Lachman test in 48 per cent on CE and in 96 per cent on EUA. Of the nine fresh, total tears of the posterior cruciate ligament three were disclosed by the posterior drawer test on CE and all nine on EUA. Anteromedial rotatory instability was observed on CE in 10 patients and on EUA in 47 (p less than 0.0001). In these patients 41 medial collateral tears, 23 posteromedial capsular tears, 21 medial meniscus and 40 anterior cruciate lesions were found. On CE only one anterolateral rotatory instability was found, whereas EUA disclosed 9 cases. Posteromedial rotatory instability was not confirmed on CE, though on EUA four cases were found. CE and EUA detected 2 and 3 posterolateral instabilities respectively. In conclusion, the use of EUA with an adequate mode of stability evaluation in acute knee injuries is strongly advocated. Clinical examination is considered highly unreliable with many false negative findings.
Acute Disease↗
Cortical bone pegs in the treatment of osteochondral fracture of the knee.
Cortical bone pegs have been used in osteochondritis dissecans to fix the loosened or loose fragment. In osteochondral fractures of the knee the fragment has either been removed or reattached usually with headless pins or ASIF screws and only occasionally with cortical bone pegs. We report on four patients with osteochondral fractures of the knee, where cortical bone pegs were used as the means of fixation, with good results.
Adolescent↗
Diagnosis of acute knee ligament injuries: the value of stress radiography compared with clinical examination, stability under anaesthesia and arthroscopic or operative findings.
A consecutive series of 85 stress radiographic examinations was performed in order to evaluate the clinical reliability and use of stress radiography in disclosing acute knee ligament injuries. Eighty-three examinations were performed within one week of the injury. Sagittal stress examination discovered 27% of the 37 anterior cruciate ligament (ACL) tears and all four posterior cruciate tears. Valgus stress detected 56% of the medial collateral tears. The specificity of stress radiography was even reduced by the number of false positive stress results (n = 25) in posterior drawer or valgus-varus examinations. An ACL tear was, however, an isolated or major ligament injury in twenty (80%) of the false positive results. Clinical examination revealed all the medial collateral tears whereas only 40% of the anterior cruciate tears. The most reliable method for diagnosing acute knee injuries where clinical examination has failed in disclosing instability is examination under anaesthesia supplemented by acute arthroscopy.
Adolescent↗