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Biomedical subjects

B Segesser

Publications and source records attributed to B Segesser.

At least 19 recordsLinked to original sources
PubMed2001

Efficacy and tolerability of escin/diethylamine salicylate combination gels in patients with blunt injuries of the extremities.

The aim of this confirmative, monocentre, double-blind, controlled clinical trial was to investigate whether different escin combinations show differences in comparison to placebo with regard to pain reactions in the topical treatment of sports injuries. A total of 126 patients with blunt injuries of the extremities were randomly allocated to four parallel groups: Reparil-Gel N (n = 32), Reparil-Gel (n = 31), Reparil-Sportgel (n = 32) and a placebo gel (n = 31). All patients were evaluated for efficacy (intention to treat) and tolerability. A per-protocol analysis was also carried out, in which 12 of the 126 patients were excluded due to protocol violations. The intention-to-treat and per-protocol analyses produced similar results. The patients had suffered contusions while participating in soccer, hockey, karate, tae-kwon-do, handball, American football, rugby or tennis. The measured variable was the pressure required at the centre of the lesion to elicit the first pain reaction (tenderness reaction) at measuring time 0 (baseline) and then 1, 2, 3, 4, 6 and 24 h after the injury. The primary variable was the area under the curve (AUC) for tenderness over a six-hour period. The mean AUC differed significantly in the four groups (Kruskal-Wallis test p = 0.0001). Then six pairwise comparisons of two treatment groups each were carried out using the Mann-Whitney test. To control the multiple significance level of 5%, the adjusted p-values according to the Holm-Shaffer method were used in these tests. The three active gels were significantly superior to the placebo gel (Mann-Whitney test, p = 0.0004 in each case) in terms of the AUC. There were no significant differences between the active test substances in terms of the primary variable. The intensity of the pain was also measured on a visual analogue scale (VAS). The pain diminished more rapidly with the Reparil gels than with the placebo. The tolerability of all test substances was good. No adverse events were observed in any of the 126 patients. Escin combination gels are more effective than a placebo and are also well tolerated. Therefore, they can be recommended for the treatment of blunt injuries caused during sports and leisure activities.

Administration, Topical↗
PubMed1999

Asymmetrical loading of the human triceps surae: I. Mediolateral force differences in the Achilles tendon.

An in vitro experiment was designed to identify whether tensile force on different triceps surae components would result in nonhomogenous force distribution across the human Achilles tendon. Medial tendon forces were significantly higher than lateral (23.2 +/- 6.6%; P < or = 0.05) when only the gastrocnemius medialis was subjected to force. Lateral forces were significantly higher when both gastrocnemii (30.6 +/- 16.5%) or all three muscles (20.7 +/- 10.9%) were loaded. Experimental identification of force concentrations in the human Achilles tendon contributes to the understanding of the origin of its injury.

Achilles Tendon↗
PubMed1999

Asymmetrical loading of the human triceps surae: II. Differences in calcaneal moments.

An in vitro experimental study is presented investigating differences in moments calculated at the calcaneus, resulting from tensile forces input in various configurations of triceps surae muscles. Results indicated significantly higher values for plantarflexion moments when forces were input in both gastrocnemii than in the soleus (P < or = 0.05). Tensile force applied solely to the gastrocnemius lateralis produced a mean eversion moment at the calcaneus, whereas all other configurations demonstrated the expected inversion moment. An abduction moment was reported throughout. The presented data provides valuable input for optimizing future biomechanical models.

Biomechanical Phenomena↗
PubMed1996

[Weber fibular ligament-plasty with plantar tendon with Segesser modification].

UNLABELLED: Ankle joint injuries are one of the most frequently diagnosed sports injuries. In our clinic we observed between 1981-92 18% ankle joint injuries in 11.350 patients. The acute injury was generally handled conservatively by functional treatment with a special shoe; only comminute injuries like fractures, luxations or tendon injuries would lead to the decision to perform surgery. The ratio of acutely performed surgery compared to late surgery was decreasing: 1981 1:3, compared to 1992 1:50. Reconstructive surgery of the lateral ligament complex is indicated under the following conditions: patient suffering from recurrent trauma and feeling of instability and/ or in case of comminuted overuse injuries caused by instability like the entrapment of the tibial nerve in the tarsal tunnel, achilodynia caused by instability of the rearfoot or luxation of the peroneal tendons. Reconstruction of the lateral ligaments of the ankle should be done anatomically, operations with effect of tenodesis should be avoided. TECHNIQUE: We modified the technique of Weber to reconstruct the lateral ligaments. An autograft (plantaris tendon) is used for this procedure. The plantaris tendon is removed through a medial sided minimal incision on the injured leg with a special stripper. Through the lateral incision on the lateral malleolus drill wholes are made at the anatomical ligament insertions of the calcaneus, talus and fibula. The graft is passed through the drill wholes this way the Lcf and Ltfa are anatomically reconstructed. The tendon sheat of the peroneal tendons will be closed if needed with residual plantaris tendon. The postoperative treatment is the same as conservative treatment with full-weight-bearing in a special shoe three days after surgery with 30 degrees (10-0-20) range of motion. ROM will be increased to 50 degrees after three weeks. For the first three weeks the leg will be positioned in a 90 degrees splint over night. Two series of patients altogether 584 patients in the time from 1981-1991 were operated. The difference of the two groups lied in the technique of surgery (in group 2 the calcaneofibular ligament was reconstructed as well as the peroneal tendon sheat) as well as the postoperative treatment was altered (group one removable cast for the first three weeks versus functional treatment after surgery in group 2 as described in the postop treatment). RESULTS: 443 (76%) out of 584 operated patients were followed at least one year after OP. Working ability: 19% (group 1)/25% (group 2) of the patients after two weeks, 31/42% after 2-4 weeks and 79/88% after 4-6 weeks. Full sports activity to previous sport 8/17% after 4-6 weeks, 26/38% after 6-8 weeks, 65/70% after 8-12 weeks. The group 2 achieved full sports activity and working ability on average two weeks before the patients of group one. Personal evaluation: 88/90% felt their ankle joint to be more stable postoperatively, 10/9% as stable as before and 2/1% described it as less stable. Clinical evaluation: The modified Benedetto score showed in 76/81% very good results, in 9/7% good and 13/8% bad results. In conclusion the described reconstruction of the fibular ligaments without damaging the active stabilizing muscles is a valid technique. The reconstruction of the calcaneofibular ligament improved the long term results of surgery. The functional postoperative rehabilitation (special shoe and night brace) does shorten the time for the patients working ability as well as the return to full sports activity. The long term results on the other hand appeared to be similar for both groups. The advantage of our technique using the plantaris tendon as a graft. The use of autograft material having the same tensile strength as the original ligaments anatomically reconstructed. Surgery with tenodesis effects should be abandoned. The good results occurring while performing late surgery leave the chance for primary conservative treatment of lateral ligament injuries.

Adult↗
PubMed1995

[Lesions of the growth plate caused by sports stress].

Besides the positive physiological, psychological and social aspects, sports activities in adolescents bear the risk of injuries and overuse of the locomotor system. Previous examinations have shown that increased stress to the growth plates by sports activities, in relation to the intensity of strain during growth spurts, can influence normal growth. In female gymnasts, hormonal changes can decrease the growth speed and long-term growth. On the other hand, during more intensive phases of growth the column cartilage of the growth plate is the weakest part of the locomotor system because of the influence of somatotropin and low levels of testosterone. This can cause subchondral stress fractures in the growing cartilage that later on, if missed or not sufficiently treated, can cause osteochondrosis dissecans. The apophysis of tendons of big muscle groups can show loosening of the apophysis caused by increased muscle strength and acute or chronic microtrauma. Male adolescents show an incidence of lesions in the relation of 9:1 to female adolescents. The therapy for apophyseal lesions is generally nonoperative. Due to the persistent growth possibility, pseudotumors can occur, which can cause problems in differential diagnosis among skeletal tumors. Too high pressure, pushing and tearing forces can influence growth. Later examinations of previous high-level sportsmen and patients with coxarthrosis with and without a sports history show that blockage of the rotation of the foot during growth, for example caused by soccer shoes, can cause high pushing forces on the femoral epiphysis, which can lead to epiphyseolysis cap. fem. lenta and thereby to pre-arthritic deformities. This is overcorrection of the "physiological" epiphyseolysis, described by Morscher. Knowledge of the reduced strength of the growth plate indicates better adaptation of training and supervision of the adolescent high-level sportsman. A regular check-up of the growing athlete and a reduction in sports intensity during the growth spurts, prohibition of negative training parts and sometimes even prohibition of sports at all, if there is a lesion of the growth plate or hormonal disorders, are sometimes necessary to minimize late defects. In addition to this, a reduction of strain in some sports and, for example, prohibition of rotation-blocking soccer shoes in the adolescent soccer player is necessary.

Adaptation, Physiological↗
PubMed1995

[The Achilles tendon in sports].

Achillodynia is a generic term for various types of ailments in the region of the Achilles tendon. For adequate therapy a specific diagnosis is absolutely necessary. Besides an accurate anamnesis and the right choice of terrain and shoes, as well as a clinical examination where one has to specifically keep an eye on muscular imbalance between the gastrocnemius and the soleus muscle and disorders of the ligamentous control of the calcaneus caused by fibular ligament instabilities, a procedure such as radiology, ultrasound, and MR imaging is inevitable. From the differential diagnosis point of view a distinction between peritendinitis, mechanically triggered bursitis (calcaneal and subachilles), bony alterations of the calcaneus (calcaneus spur, Haglund exostosis persistent nucleus of the apophysis, fatigue fracture, etc) and a partial or total rupture (a one-time occurrence or multiple occurrences) has to be made. Occasionally, entrapment of the ramus calcaneus of the sural nerve causes calcaneal pain. If clinically not confirmed, lumbar pain ought to be taken into consideration (discopathy, Bechterew disease, etc). Metabolic disorders (especially uric acid) and underlying rheumatic diseases must be excluded. The therapy of achillodynia includes local and peroral antiphlogistic medication as a concomitant measure. More important is the causal influence of etiological factors, i.e., the correction of muscular imbalance, ensuring control of the calcaneus through bandages and adjustment of sport shoes, changes in training buildup and exercise intensity, just to mention a few. If necessary, surgically splitting the peritendineum, sanitation of a partial rupture, bursectomy and removal of mechanically obstructive exostosis must be done.

Achilles Tendon↗
PubMed1993

[Rehabilitation after cruciate ligament repair with the middle third of the patellar ligament in the athlete].

Rehabilitation of athletes following surgical reconstruction of complex instabilities of the knee joint focuses on four goals: 1. the restoration of ligament stability, 2. the restoration of muscular stabilisation ability, 3. the restoration of coordinative muscular function in sport specific kinesiology, 4. the retention and improvement of the general state of fitness. These aims can only be reached by a close cooperation between physician, physiotherapist, trainer, and coach. In order not to put the rehabilitation process at risk, everybody involved has to have knowledge about functional anatomy, surgical technique, and biology of the transplant as well as knowledge about the long duration thereof that cannot substantially be shortened by knee ortheses. No athlete should compete until he has demonstrated sufficient fitness, strength, and coordination for his sport under laboratory conditions.

Anterior Cruciate Ligament↗
PubMed1993

[Shoes in sports].

Explore the source record for details and available documents.

Athletic Injuries↗
PubMed1993

[Orthopedic and biomechanical concepts of sports shoe construction].

Based on anatomical, orthopaedic and epidemiological considerations two sets of concepts relevant for sport shoe construction have been proposed and discussed, one for the reduction of excessive load and one for the improvement of performance. The concepts for excessive load reduction are cushioning, support and guidance. These can be achieved by altering the material properties or the construction of the shoe. The concepts for improving performance are, first, that energy should be returned at the right location, at the right time, with the right frequency, and second, that reduction of loss of energy is more important than return of energy.

Athletic Injuries↗
PubMed1993

[The athletic shoes as a therapeutic aid].

Sports shoe research discovered several possibilities of influencing the heel-to-toe walking behaviour of the foot which can be made use in the construction of therapeutic shoes. Early functional therapy aims at imparting moderate load stimuli to the injured and/or surgically reconstructed tissue to ensure quicker orientation of the collagen fibres of the cicatricial structures and an improved blood supply to the tissue. Modified sports shoes with variable mobility restriction and functional heel-to-toe walking support of the foot have become a meaningful therapeutic aid in the treatment of fibular ligament lesions and injuries to the Achilles tendon, both in orthopaedic and neurological problems requiring support of the sequential movements of the foot (arthrodeses, arthroses, peroneal paralyses [dangle foot], etc.) Early functional after treatment ensures that moderate load stimuli are exercised on the tissue while avoiding peak tensions, thus shortening the rehabilitation period with minimal inactivity atrophies and hence enabling quicker return to normal daily activities.

Achilles Tendon↗
PubMed1993

A trial with diclofenac HEP plaster as topical treatment in minor sport injuries.

Diclofenac HEP plaster was tested in an open study in the treatment of different traumatic sport and overload injuries, to confirm the results of efficacy and tolerability already shown in other clinical studies. A total of 101 patients were assigned to treatment and were eligible for the evaluation of results at the end of a 14-day treatment period. The average score of spontaneous pain, assessed by means of a verbal scale and a visual analogical scale, showed a clear difference in pain rating between the beginning and end of treatment. In general 60% pain reduction was observed. The difference in analgesic activity was already apparent on the 7th day of treatment (-28%). The reduction of pain was confirmed by changes in another subjective sign related to the injury: provoked pain. This symptom decreased in a manner comparable to spontaneous pain: 61% pain reduction after 2 weeks of treatment. Global assessment of efficacy, performed by the investigator at the end of treatment, showed the clear therapeutic activity of local treatment with diclofenac HEP plaster. Satisfactory results were obtained and only 18% of the patients (most of them with chronic and persistent pain) experienced ineffective pain relief at the end of the 2-week treatment. The beneficial effects of diclofenac HEP plaster on pain are confirmed by the patients' assessment, since almost identical scores were obtained. It is striking that the overall tolerance of diclofenac HEP plaster, applied topically twice a day for 2 weeks, was "good" or "excellent" in the 101 patients treated. Any side effect was reported on the patient's card and all the patients completed the study.

Administration, Cutaneous↗
PubMed1992

[Biomechanical considerations of the load on the ankle joint].

The biomechanical approach to the characteristics of load on the ankle joint and the surrounding structures allows a better understanding of the cause and effect of externally acting forces in human movement (walking, running, jumping). This detailed understanding of the mechanics involved (not only in the functional anatomical sense) makes preventive measures possible that can reduce the risk of distortion at the ankle. With the same mechanical models, clinically applicable methods allow biomechanically monitored rehabilitation. The case studies reported here illustrate that therapeutic success can be measured objectively, leading to improvement in therapy and in the ability to make decisions in the clinical environment.

Achilles Tendon↗
PubMed1992

Biomechanical and orthopedic concepts in sport shoe construction.

Two sets of concepts for sport shoe construction are discussed, based on anatomical, orthopedic, and epidemiological considerations: one for the prevention of excessive load and related injuries, and one for the improvement of performance. The proposed concepts for prevention of excessive load and related injuries in the foot and the lower extremities are cushioning, support, and guidance. The goals outlined in the concepts can be achieved by altering the material properties or the construction of the shoe. It is suggested that the concept "cushioning" is not well understood yet and needs further research. The discussed concepts for improving performance are first, that energy should be returned at the right location, at the right time, with the right frequency, and second, that loss of energy should be minimized. Reduction of energy loss is an important concept for performance. The concept "return of energy" seems inappropriate for sport shoes.

Athletic Injuries↗
PubMed1989

[Torsion --a new concept in construction of sports shoes. Motion excursion of the foot in athletic stress--anatomical and biomechanical observations and their effects on construction of sports shoes].

In recent years several construction elements resulted in an increasing stiffening of the sport shoe so that the foot was partly forced to make its own movements inside the shoe. A new sport shoe concept is presented basing on the results of anatomic and biomechanical studies, its innovative feature being decoupling of the foot movement between the calcaneal part of the foot and the metatarsus (= torsion). The foot is given an opportunity to transmit its freedom of movement in the longitudinal axis of the foot to the shoe without the shoe acting as a lever, this goal being achieved by a limited liberation of the metatarsal pronation/supination and a controlled uncoupling of the metatarsus from the calcaneal part of the foot.

Ankle Joint↗
PubMed1988

The influence of playing surfaces on the load on the locomotor system and on football and tennis injuries.

The purpose of this paper is to discuss the influence of playing surfaces on the forces and moments acting on the human body and the injuries they may cause for 2 selected sports activities, American football and tennis. The review is based on data from the literature and from our own investigations. A review of the effect of sports surfaces on injuries in American football leads to the conclusion that surfaces with artificial turf produce non-severe injuries more frequently than surfaces with natural grass. However, severe injuries seem to occur as frequently on natural grass as on artificial turf. It has been speculated that the shoe-surface combination which determines the frictional forces is connected with the injury frequency, i.e. the higher the frictional resistance the higher the injury frequency. Tennis surfaces have been shown to influence the occurrence and frequency of tennis injuries dramatically. The injury frequency on 'clay' and 'synthetic sand' is significantly lower than on other selected artificial surfaces. It is speculated that the differences in injury frequency are directly related to the differences in the frictional properties of the surfaces. Surfaces with low frictional resistance are assumed to cause fewer injuries than surfaces with high frictional resistance. In general, it can be concluded that the frictional property of a surface is one of the main factors to be considered when studying the aetiology of acute and/or chronic pain and injury in sports. Compliance or stiffness of surfaces, surprisingly, could not be related to the frequency of injuries on particular playing surfaces. However, it is speculated that compliance properties of surfaces are a factor which must be considered when studying chronic injuries.

Ankle↗