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Biomedical subjects

B R Bach

Publications and source records attributed to B R Bach.

68 records · Page 4Linked to original sources
PubMedDate not supplied

Outcomes of anterior cruciate ligament reconstruction in patients with Workers' Compensation claims.

SUMMARY: A general perception exists that outcomes of orthopaedic procedures in patient's with Workers' Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction. Twenty-two patients with Workers' Compensation claims representing 5% of patients who underwent ACL reconstruction at our institution between 1987 and 1995 were included in the current study. All reconstructions were performed by the senior author (B.R.B.) using arthroscopic-assisted techniques (single and double-incision) with bone-patellar tendon-bone autografts followed by an accelerated rehabilitation protocol. Postoperative follow-up physical examinations revealed a negative anterior drawer in 19 patients (91%), a negative Lachman in 15 patients (68%), and a negative pivot shift in 21 patients (96%). The KT-1000 arthrometric evaluation at follow-up showed a mean maximum manual difference of 1. 9 mm with 15 patients (68%) having a maximum manual difference of </=3 mm and 7 patients (32%) from 3 to 5 mm. The mean postoperative scores for the Hospital for Special Surgery scoring scale was 86, Noyes Sports activity scale 81, Noyes ADL score 36, Noyes Problem with Sports 75, Noyes Sports Function score 87, Lysholm score 82, and the Tegner score 5.9. The Noyes Occupational rating system increased from preoperative 48 to 60 postoperatively and the Noyes Job Title rating system score remained at 5 after surgery. Functional testing revealed mean deficits of no more than 9% between the reconstructed and normal knees. SF-36 testing revealed significantly higher scores in the Role Physical and General Health categories and a significantly lower score in the Mental Health category when compared with United States norms. Subjective evaluation revealed that 95% of the patients would undergo a similar procedure if faced with a similar injury to the contralateral knee in the future. The results of the current study show that ACL reconstruction leads to predictable functional and occupational results in those patients with work-related injuries. All of our patients were able to return to work. The hypothesis that Workers' Compensation compromises the results of ACL reconstruction was not observed in this study.

Accidents, Occupational↗
PubMedDate not supplied

Bone graft procurement for patellar defect grafting in anterior cruciate ligament reconstruction.

Bone grafting of the patellar defect from harvest of the central third bone-patellar tendon-bone autograft in anterior cruciate ligament (ACL) reconstruction has been advocated by some authors to decrease the risk of patellar fracture from the existing stress riser as well as decrease postoperative donor site pain. We present a method of harvesting bone reamings during ACL reconstruction that is simple, efficient, and maximizes the amount of bone that can be collected.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Surgical resection of the distal clavicle.

Distal clavicle resection is frequently performed for persistent acromioclavicular pain. However, patient outcome after this procedure has not been well described. The results of subjective and objective retrospective analysis of 23 open distal clavicle resections in 21 patients are reported. Patients were evaluated with a questionnaire, roentgenographs, physical examination, and isokinetic muscle strength testing at an average of 30 months after surgery. Eighteen of 23 shoulders had good or excellent postoperative ratings. All patients had normal motion. No significant weakness of the operated shoulder was seen on objective muscle testing when compared with the unoperated shoulder. The average preoperative Hospital for Special Surgery score was 34, and the average postoperative score was 84. Age and hand dominance were unrelated to postoperative outcomes. Less predictable results were obtained in patients with workmen's compensation and in those patients involved in litigation. Open distal clavicle resection yields good to excellent results in properly selected patients and does not create significant subjective or objective weakness.

Acromioclavicular Joint↗
PubMedDate not supplied

Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon.

The purpose of this study was to dynamically assess the functional outcome of patients who had undergone successful anterior cruciate ligament reconstruction using an autologous patellar tendon technique and to determine whether their dynamic knee function was related to quadriceps and hamstring muscle strength. The knee kinematics and kinetics of 22 subjects who had undergone anterior cruciate ligament reconstruction (mean age, 27 +/- 11 years) and of 22 age- and sex-matched healthy control subjects were determined during various dynamic activities using a computerized motion analysis and force plate system. The differences in the sagittal plane angles and external moments between the two groups during light (walking), moderate (climbing and descending stairs), and higher-demand (jogging, jog and cut, jog and stop) activities were related to isokinetic strength measurements. Although patients who are asymptomatic and functioning well after anterior cruciate ligament reconstruction can perform normally in light activities, higher-demand activities reveal persistent functional adaptations that require further study.

Adolescent↗
PubMedDate not supplied

The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency.

Clinical evaluation of knee instability is often difficult to reproduce, and several different physical tests have become popular. In an attempt to elucidate reasons for variations in the degree of pivot shift phenomenon seen with the use of the various tests, we have prospectively evaluated a group of 37 patients with surgically documented ACL injuries, noting the effects of hip position and tibial rotation. The patients were examined under anesthesia, and the pivot shift was graded as 0 (absent, or negative), 0.5+ (trace), 1+, 2+, or 3+ (with locking). All knees were tested in hip abduction, neutral, and hip adduction, and with the tibia in external and internal rotation, so that six positions were evaluated. Hip position strongly correlated with the degree of pivot shift regardless of tibial rotation. Overall, abduction produced the greatest degree of pivot shift, followed by neutral and finally adduction. External tibial rotation increased the pivot shift score in abduction and neutral, but not in adduction. A grading system for the subject population showed that abduction/external rotation (ABDER) resulted in the highest pivot shift scores, and that adduction/external rotation (ADDER) and adduction/internal rotation (ADDIR) resulted in the lowest scores. Nine patients out of 20 with a 3+ pivot shift in ABDER were negative in ADDER. The pivot shift score was dampened at least one grade from ABDER to ADDER in 92% of the patients. We conclude that hip position and tibial rotation affect the degree of pivot shift phenomenon, and it is our impression that the iliotibial band plays a significant role in controlling the degree of pivot shift observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Force displacement characteristics of the posterior cruciate ligament.

The percent force changes in the posterior cruciate ligament were calculated using a previously validated computerized knee model after the femoral insertion sites were varied 2.5 and 5.0 mm in an anterior, posterior distal, anterior distal, and posterior distal direction. The tibial insertion sites were also varied 2.5 and 5.0 mm in the medial, lateral, proximal, and distal directions. Percent force changes were measured over a range of 0 degree to 90 degrees. These insertion sites simulated potential surgical placement errors. Results of this study demonstrated that the greatest percent force changes in the posterior cruciate ligament were at full extension. The greatest absolute percent force change between 0 degree and 90 degrees of flexion was with a femoral insertion of the posterior cruciate ligament placed 5 mm anterior to its normal attachment site, which resulted in a 39% change in the posterior cruciate ligament force. Distal femoral site attachment had the least effect (10% at 5.0 mm). Alterations at the tibial attachment site were less sensitive than on the femur; the greatest absolute percent force changes occurred with medial and lateral attachment sites (14% and 15%, respectively, at 5.0 mm). A minimal amount of percent force changes were seen between 45 degrees and 75 degrees of knee flexion in all positions tested for both tibial and femoral attachment sites. This model suggests that, like the anterior cruciate ligament, the force in the posterior cruciate ligament is also sensitive to attachment site position. As in anterior cruciate ligament studies, the femoral attachment site was found to be more sensitive.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMedDate not supplied

Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results.

The purpose of this retrospective study was to evaluate clinically, functionally, and objectively our initial experience using free, autogenous middle third patellar tendon for anterior cruciate ligament reconstruction without extraarticular augmentation in 62 of 75 patients (80% followup) who were available for clinical review at a minimum 2-year followup. Subjective, clinical, functional, Cybex dynamometer, and KT-1000 arthrometer tests were performed along with modified tests of the Hospital for Special Surgery, Noyes Cincinnati, Tegner, and Lysholm knee rating scales. Ninety-two percent had a negative pivot shift at followup. The mean Cybex dynamometer extension deficits postoperatively were 9% and 7% at 180 and 240 deg/sec. Mild patellar pain symptoms were noted in 18%. The reoperation rate was 10% with a mild flexion contracture as the most common reason. The Hospital for Special Surgery scoring scale postoperatively was 88; Noyes, 86; Lysholm, 88; and Tegner, 6. Mean postoperative single-legged and vertical jump indices were 88% and 87%, respectively. The KT-1000 arthrometric evaluation postoperatively revealed a mean maximum manual difference of 0.3 mm; 92% of the patients had a maximum manual difference of < or = 3 mm. Subjectively, 95% indicated that they would undergo the procedure again. Early results demonstrate excellent stability, preservation of motion, and encouraging evaluations by scoring scales and arthrometric evaluation.

Adolescent↗
PubMedDate not supplied

Arthrometric results of arthroscopically assisted anterior cruciate ligament reconstruction using autograft patellar tendon substitution.

Sixty-two patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction with the middle-third patellar tendon autograft without extraarticular augmentation were retrospectively reviewed at a minimum 2-year (mean, 37-month) followup. A postoperative KT-1000 arthrometric evaluation revealed a mean maximum manual difference of 0.3 mm (range, -6 to +16). Ninety percent of the patients had a mean maximum difference of < or = 3 mm. Three patients had a > or = 5 mm mean maximum difference; positive pivot shifts were noted in two of these patients. Despite an early range of motion, early weightbearing protocol without an extraarticular backup, the pivot shift (92% negative) was reliably eliminated at postoperative followup. Arthrometric parameters were statistically reduced (P < 0.0001) from preoperative status and were consistent with the diagnostic criteria established for normal knees. There was no relationship established in the "tighter" knees (those with negative side-to-side arthrometric differences) and the incidence of knee flexion contractures, patellar pain symptoms, Cybex extension deficit (> 20%), functional indices, or postoperative rating scales.

Adolescent↗
PubMedDate not supplied

Scoring systems for shoulder conditions.

We evaluated the comparability of four commonly used shoulder scoring systems in the United States. Fifty-two patients had 53 shoulder stabilization procedures. Surgical procedures included 34 open Bankart-type repairs, 15 capsular shifts, and 4 arthroscopic stabilizations. Results were assessed using the following scales: 1) Rowe, 2) modified-Rowe, 3) University of California at Los Angeles, and 4) the pre-1994 American Shoulder and Elbow Surgeons scale. No consensus has been reached on the relative value of these systems. We observed significant variations using these systems. A majority of our patients (85%) had excellent results when the University of California at Los Angeles scoring system was used. However, only 38% of the patients had excellent results when the modified-Rowe scale was used. Overall, good or excellent results were observed in 89% to 95% of the patients using these four scoring systems. The University of California at Los Angeles score correlated poorly with the other systems. Interrater reliability between the four systems was poor. Generalized results of an investigation can be biased based on the selection of a scoring system. The lack of a widely accepted scoring system for the shoulder limits comparison of management for shoulder conditions. Thus, a widely accepted shoulder scoring system is needed.

Adolescent↗
PubMedDate not supplied

Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation.

We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2- to 4-year followup. The postoperative physical examination and KT-1000 arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1+ result in 17% of patients. Seventy percent of patients had < 3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The Tegner activity level was significantly improved from prereconstruction ratings and similar to preinjury ratings. The mean Lysholm score was 87. The modified Hospital for Special Surgery scores resulted in good or excellent results in 82% of the patients (mean, 87 points). The mean Noyes sports function score was 89, and the reoperation rate for a symptomatic knee flexion contracture was 12%. Ninety-seven percent of patients indicated that they would undergo the procedure again. When compared with this same population at 2 to 4 years, we saw no deterioration in scoring scale results.

Adolescent↗
PubMedDate not supplied

Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation.

We conducted a retrospective, minimum 2-year follow-up study to evaluate the effectiveness of a single-incision endoscopic anterior cruciate ligament reconstruction technique using patellar tendon autograft without extraarticular augmentation and followed by accelerated rehabilitation. One hundred three patients were evaluated (mean followup, 36 months; range, 24 to 55). There were significant improvements in physical examination test results (Lachman, anterior drawer, and pivot shift) postoperatively, and 94 patients (91%) had negative pivot shift results. KT-1000 arthrometric testing showed a significant reduction in manual maximum anterior translation and side-to-side differences at followup. Good range of motion was achieved. Patients with asymmetric prone heel heights usually had hyperextension in the contralateral knee. Functional tests showed 4% to 6% differences in side-to-side comparisons for a timed single-legged hop, single-legged hop for distance, and vertical jump. Postoperatively, the results of the Tegner scale were similar to preinjury scores. The mean results of the Hospital for Special Surgery scale (90), Lysholm score (89), and Noyes sport function score (90) were all excellent or good. Only 5 patients (5%) required reoperations for flexion contractures. Ninety-six patients (93%) reported they were "mostly" or "completely" satisfied, and 98 (95%) would recommend the procedure to others. These results demonstrated encouraging outcome using this single-incision technique.

Adolescent↗
PubMedDate not supplied

Suprascapular neuropathy.

Suprascapular neuropathy is an uncommon cause of shoulder pain and weakness and therefore may be overlooked as an etiologic factor. The suprascapular nerve is vulnerable to compression at the suprascapular notch as well as at the spinoglenoid notch. Other causes of suprascapular neuropathy include traction injury at the level of the transverse scapular ligament or the spinoglenoid ligament and direct trauma to the nerve. Sports involving overhead motion, such as tennis, swimming, and weight lifting, may result in traction injury to the suprascapular nerve, leading to dysfunction. The diagnosis of suprascapular neuropathy is based on clinical findings and abnormal electrodiagnostic test results, after the exclusion of other causes of shoulder pain and weakness. Magnetic resonance imaging may provide an anatomic demonstration of nerve entrapment and muscle atrophy. With this modality, ganglion cysts are recognized with increasing frequency as a source of external compression of the suprascapular nerve. Without evidence of a discrete lesion compressing the nerve, nonoperative treatment should include physical therapy and avoidance of precipitating activities. When nonoperative treatment fails to alleviate symptoms or when a discrete lesion such as a ganglion cyst is present, surgical decompression is warranted. Decompression gives reliable pain relief, but recovery of shoulder function and restoration of atrophied muscle tissue may be incomplete.

Humans↗