[Medial gonarthrosis. Comparison between x-ray examination and operative observations].
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Biomedical subjects
Publications and source records attributed to A Lindstrand.
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The validity of predicting the condition of the anterior talofibular ligament from the shape of the lateral compartment of the ankle joint was investigated in patients with recent ankle sprain. The diagnostic value of the method was found to be restricted.
The relation between anterior instability in the ankle joint and rupture of the anterior talofibular ligament was investigated in patients with acute ankle sprains. Various techniques were used to provoke anterior displacement of the talus. The actual condition of the anterior talofibular ligament was assessed at operation. The appropriate radiographic method was defined, and its valve in diagnosing an acute rupture of the anterior talofibular ligament was assessed.
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The analgesic efficacy and safety of ketorolac tromethamine (ketorolac), a potent analgesic with anti-inflammatory and antipyretic activities, were evaluated and compared with Doleron, a combination analgesic, in 115 patients with moderate to severe orthopaedic post-operative pain. This was a randomized, double-blind (double-dummy), parallel-group comparison of a single oral dose of one capsule of 10 mg ketorolac with a single oral dose of two Doleron tablets (each tablet contained 150 mg dextropropoxyphene napsylate, 350 mg aspirin and 150 mg phenazone). During the 6 h following treatment, 80% of ketorolac treated patients and 82% of Doleron treated patients experienced adequate pain relief. There were no statistically significant differences in the overall analgesic efficacy between the treatment groups. Three patients (one on ketorolac, two on Doleron) withdrew because of adverse events (vomiting). Nausea (two patients in each treatment group), vertigo (none on ketorolac, three on Doleron) and sore throat (none on ketorolac, two on Doleron) were the only drug-related adverse events reported by more than one person in a treatment group during the trial. A total of 82% of patients given ketorolac and 76% given Doleron experienced no adverse events. A single oral dose of 10 mg ketorolac was shown to be as effective and safe as two Doleron tablets in the treatment of moderate to severe orthopaedic post-operative pain.
Stabilometry is a technique designed to register postural equilibrium control. This investigation used a computerized strain gauge force plate to measure sway movements in the frontal plane with the patient standing on one leg. Fifty-five young healthy individuals were studied as a reference group and to determine the reproducibility of the method. The clinical population consisted of 14 patients with unilateral injuries to the lateral ligaments of the ankle. These were measured, both with and without an ankle brace. The different parameters used to describe the body sway could well discriminate between the injured and the uninjured leg. When the brace was used the effect was obvious and none of the parameters showed any significant difference compared to the uninjured leg.
The sagittal anterior displacement of the tibia, induced by weightbearing, in chronic anterior cruciate ligament-insufficient knees was measured radiographically in 2 groups of patients. All patients in both groups had an increased laxity when assessed with the Lachman and flexion-rotation-drawer test. Sixteen patients were functionally improved and were relatively asymptomatic after a neuromuscular rehabilitation program, while the second group consisted of another 16 patients with persistent functional instability, despite the same rehabilitation program, who eventually had ligament reconstruction. The mean radiographic anterior displacement during weightbearing in the nonsymptomatic group was 4.3 mm, and 8 patients had a displacement < or = 2 mm. In the symptomatic group, the corresponding value was 8.1 mm (P < 0.05), and 3 patients had a displacement < or = 2 mm. No correlations to meniscal injuries, age, or time from injury were found between the patients having a displacement >2 mm and those with < or = 2 mm. The findings should be explained by differences in neuromuscular control of the increased laxity in the injured knee.
Body sway movements in the frontal plane in a single-limbed stance test were used to assess postural control in 26 patients with chronic anterior cruciate ligament insufficiency. The injured and the noninjured legs were tested before the patients were committed to physiotherapy for 3 to 6 months. Follow-up tests were made after 3, 12, and 36 months. Significant disturbance of the balance of both legs was found before training, compared with a reference group of normal subjects. Values of the noninjured leg were normalized after 3 months of training, but the injured leg still showed an increased body sway. Normal balance parameters on the injured side were found at examination after 12 months. Follow-up examination after 36 months proved persistent normalization of the single-limbed balance on both sides.
Forty patients with traumatic knee hemarthrosis were examined within 1 week after injury and observations made with magnetic resonance imaging, scintigraphy, arthroscopic evaluation, radiography, and physical examination were compared. Thirty-four patients (85%) had anterior cruciate ligament injuries according to the arthroscopic findings and 28 (83%) of these had associated meniscal tears. Magnetic resonance imaging confirmed the arthroscopic findings, especially if only meniscal tears that required surgery were taken into account (sensitivity, 94% for the lateral and 83% for the medial meniscus). However, the specificity of magnetic resonance imaging was only 29% and 27% for the lateral and medial menisci, respectively, and the accuracy was 28% and 50%, respectively. Marrow edemas, or bone bruises, were seen on magnetic resonance imaging in 80% of the patients and were mainly seen in the lateral compartment. Bone scans correlated well with magnetic resonance imaging findings of marrow edemas. Plain radiographs were normal in all but one case. We show that magnetic resonance imaging does not add information on the status of the anterior cruciate ligament compared with the clinical examination, and that it may be as good as arthroscopic evaluation for the diagnosis of meniscal tears that require surgery.
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A total of 32 distal femoral osteotomies performed between 1971 and 1993 were evaluated, with a follow-up of 8 (2-23) years. Indications were lateral gonarthrosis in 23 cases (group I), and there were a variety of other indications in 9 cases (group 2). Twenty-six of the patients were submitted to revision surgery. Eleven operations were performed as a result of complications, such as pseudarthrosis (5), deep infection (3), and stiff knee (3). The remaining 16 were removals of fixation devices and they were not considered complications. Clinical results were evaluated based on different clinical scores (HSS, Lysholm, and Tegner) and NHP (Nottingham Health Profile), and there were 10 cases with good or excellent results. Results were better if the postoperative HKA angle (Hip-Knee-Ankle) was within 0-8 degrees of varus. As accuracy of correction is of importance, and serious complications frequent, it is important to entrust cases such as these to the care of surgeons with a good knowledge of the surgical technique.
Arthroplasty for primary osteonecrosis of the femoral condyle of the knee was performed in 5 patients and the resected pieces of bone were studied histologically. The patients had been given 99 mm-Tc-MDP preoperatively and the scintimetric uptake in the resected bone pieces was determined. All patients had changes typical for osteonecrosis preoperatively on radiographs and scintimetry. In one case MRI investigation was performed. The histological investigation showed necrotic bone with empty lacunae and fatty degeneration corresponding to the osteonecrosis center. A reparative bone formation, osteoblastic activity, cartilage formation and bands of fibrovascular granulation tissue were observed at the borders to intact bone. The scintimetric uptake of the resected bone pieces showed a high uptake corresponding to the osteonecrosis center. The MR examination showed a well demarcated osteonecrotic region. The findings emphasize the localized nature of the osteonecrosis disease.