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Biomedical subjects

C A Dodd

Publications and source records attributed to C A Dodd.

At least 19 recordsLinked to original sources
PubMed2001

Hamstrings vs. patella tendon for anterior cruciate ligament reconstruction: a randomised controlled trial.

A randomised controlled trial was performed to evaluate early outcome for two types of anterior cruciate ligament reconstruction. Sixty patients undergoing cruciate reconstruction were randomized into two groups. Group PT underwent reconstruction using a patella tendon autograft, whereas Group (SG) had a semitendinosus/gracilis autograft (SG). IKDC, Lysholm, and Tegner scores, KT1000 values and muscle strength were recorded pre-operatively, at 6 months and 1 year follow up. The functional scores, activity level, muscle strength and anterior tibial translation improved in both groups. No significant difference between groups was found for any measurement at 6 months and 1 year despite adequate study power. The study indicates that the 1 year results for either technique are equally favourable.

Analysis of Variance↗
PubMed2001

Rapid recovery after oxford unicompartmental arthroplasty through a short incision.

Forty Oxford medial unicompartmental arthroplasties (UCAs) were performed through a short incision medial to the patellar tendon, without dislocation of the patella, using updated instruments (Oxford Knee Phase III, Biomet Ltd., Bridgend, UK). The rate of recovery of these knees (measured by the time taken to achieve straight-leg raising, 70 degrees of flexion, and independent stair climbing) was compared with that of 20 Oxford UCAs performed through an open approach with dislocation of the patella. Both groups were compared with 40 AGC (Biomet) total knee arthroplasties performed for osteoarthritis during the same time period. The average rate of recovery after the short-incision UCA was twice as fast as after open UCA and 3 times as fast as after total knee arthroplasty. Accuracy of implantation, assessed from 11 variables seen on fluoroscopically centered postoperative radiographs, was the same after UCA by the short-incision approach as after the open approach, suggesting that the short-term advantage of increased speed of recovery was gained without affecting the long-term results. We now employ the short incision with the phase III instruments for all UCAs.

Aged↗
PubMed2001

Medial unicompartmental arthroplasty after failed high tibial osteotomy.

Satisfactory selection criteria are essential for the successful outcome of unicompartmental knee arthroplasty (UCA). We report the frequency of revision of the Oxford medial unicompartmental arthroplasty in knees previously treated for anteromedial osteoarthritis by high tibial osteotomy (HTO). The combined results from three sources were used to allow statistical analysis of this uncommon subgroup. In the combined series of 631 knees (507 patients) which had medial unicompartmental replacement, 613 were primary procedures and 18 were for a failed HTO. The mean follow-up times of the two groups were similar (5.8 years and 5.4 years, respectively). At review, 19 (3.1%) of the primary procedures and five (27.8%) of those undertaken for a failed HTO had been revised to total knee replacement. Survival analysis revealed the ten-year cumulative survivals to be 96% and 66%, respectively. The log-rank comparison of these survivals revealed a highly significant difference (p < 0.0001). We recommend that the Oxford UCA should not be used in knees which have previously undergone an HTO.

Adult↗
PubMed2001

Reconstruction does not reduce tibial translation in the cruciate-deficient knee an in vivo study.

We have assessed the effectiveness of reconstruction of the anterior cruciate ligament (ACL) in reducing functional tibial translation (TT). The gait of 11 ACL-deficient patients was studied using Vicon equipment before and after surgery. Measurements of the angle between the patellar tendon and the long axis of the tibia were obtained in order to calculate TT in the sagittal plane relative to the uninjured limb during standing and walking. Before surgery, patients did not show abnormal TT on the injured side, but after surgery significant anterior TT was found in the operated limb for every parameter of gait. Abnormal anterior TT occurring during activity does not seem to be reduced by reconstruction; rather, it increases. It may be that the increased translation results from relaxation of excess contraction of the hamstring muscles, since compensatory muscle activity no longer is required in a reconstructed knee. The reduction of TT may not be an appropriate objective in surgery on the ACL.

Adult↗
PubMed2000

Sensorimotor changes after anterior cruciate ligament reconstruction.

The restoration of joint stability is unlikely to be dependent on passive properties of the joint alone, yet the effect of anterior cruciate ligament reconstructive surgery on the sensorimotor system largely remains unexplored. This study evaluated whether surgical reconstruction of the ligament had any effect on one indicator of sensorimotor function, hamstring contraction latency, which previously has been shown to be related to function. Twenty-five patients with unilateral chronic anterior cruciate ligament deficiency had measures of hamstring contraction latency obtained before and after (3 and 6 months) reconstruction. After surgery, the contraction latency difference was found to improve significantly (decrease) in patients who had a preexisting deficit. The mechanism for alteration in response time remains unclear, but an observed relationship between contraction latency and tibial translation supports a mechanical basis for the findings. It was concluded the sensorimotor changes associated with surgical reconstruction of the cruciate ligament may help to restore joint stability. The study highlights the need to appreciate sensorimotor consequences of cruciate ligament surgery.

Adult↗
PubMed1998

Home or supervised rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial.

Rehabilitation following anterior cruciate ligament (ACL) reconstruction is varied. Patients are usually prescribed an independent home exercise program, although some patients may attend physical therapy for additional supervised exercise. It is not known whether additional supervised exercise provides any further benefit. The purpose of this study was to compare efficacy for two types of rehabilitation following ACL reconstruction. A randomized controlled trial of 31 ACL-reconstructed patients was used to test the hypothesis that a home program plus supervised rehabilitation (Group S) is more effective than a home program (Group H) alone. Function, activity level, anterior tibial translation, and muscle strength were measured preoperatively and at 3 and 6 months postoperatively. Improvement of function, activity level, muscle strength, and anterior tibial translation was evident in both groups, but no significant differences were found between groups even though the sample size was sufficient to detect small treatment effects. It was concluded that supervised exercise, in addition to a home program, has minimal extra benefit for patients who have undergone ACL reconstruction.

Activities of Daily Living↗
PubMed1996

MRI diagnosis of partial tears of the anterior cruciate ligament.

In an attempt to define the magnetic resonance imaging (MRI) features of partial tears of the anterior cruciate ligament (ACL) we retrospectively analysed the MRI scans of 30 patients with a recent arthroscopic finding of a normal, a partial or a completely torn ACL. On review of the original reports MRI correctly predicted 9/9 (100 per cent) complete ACL tears, 11/12 (92 per cent) normal ACLs but only 1/9 (11 per cent) partial ACL tears. On analysis of the MRI there were four features which helped to differentiate partial ACL tears from either complete ACL tears or normal ligaments. These were the appearance of some intact fibres, thinning of the ligament, a wavy or curved ligament and the presence of an inhomogeneous mass posterolateral to the ACL. We propose that these findings may be indicators of partial ACL tear.

Adolescent↗
PubMed1994

Reflex hamstring contraction latency in anterior cruciate ligament deficiency.

Decreased dynamic stability of the knee joint associated with functional disability is a feature of anterior cruciate ligament deficiency (ACLD). The purposes of this study were to examine the between-limbs difference in reflex contraction latency of the hamstring muscles in patients with unilateral ACLD and to investigate its relationship with instability and function. Fifty patients with arthroscopically diagnosed unilateral ACLD were measured bilaterally for reflex hamstring contraction latency (RHCL), and 20 normal volunteers were similarly tested. The subjects were measured in a position of single-limb full weight-bearing with the knee flexed 30 degrees. An anteriorly directed shear force was applied to the tibia, and surface electromyographs (EMGs) recorded the activity of the hamstrings in response to the applied force. The latency of contraction was defined as the time from initial tibial movement, identified by accelerometry, to the onset of increased hamstring EMG activity. Both legs were tested and a between-limbs difference was computed. A significant difference in RHCL was found between the limb with ACLD and the control limb. The mean RHCL of the limb with ACLD was nearly double that of the unaffected limb, for a significant mean between-limbs difference (p < 0.05). The mean between-limbs difference for the control subjects was not statistically significant. The conclusion is that patients with ACLD have an increased RHCL of the injured leg. As the RHCL is dependent on proprioceptive activity around the joint, it can be used as a measure of proprioceptive ability. The loss of the neurophysiological protective reflex involving the anterior cruciate ligament and hamstrings in patients with ACLD is likely to be a contributory factor in the decreased joint stability experienced by these patients.

Adult↗
PubMed1994

Proprioception enhancement for anterior cruciate ligament deficiency. A prospective randomised trial of two physiotherapy regimes.

We performed a prospective, double-blind, randomised, clinical trial to investigate the efficacy of two regimes of rehabilitation for knees with anterior cruciate ligament deficiency (ACLD). Fifty ACLD patients were randomly allocated to one of two treatment groups: a programme of muscle strengthening (T) or a programme designed to enhance proprioception and improve hamstring contraction reflexes (P). An indirect measure of proprioception, the reflex hamstring contraction latency (RHCL), and a functional scoring system were used to record the status of the knee before and after the 12-week course of physiotherapy. Sagittal knee laxity was also measured. There was improvement in mean RHCL and in the mean functional score in both groups after treatment. The improvement in group P was significantly greater than that in group T. There was no significant change in joint laxity after treatment in either group. In both groups there was a positive correlation between improvement in RHCL and functional gain.

Adolescent↗
PubMed1993

Can MRI of the knee affect arthroscopic practice? A prospective study of 58 patients.

We made a prospective study of 58 patients with suspected internal derangement of the knee. They were examined by magnetic resonance imaging using 3-D gradient echo intermediate-weighted studies before having an arthroscopy. The preoperative clinical assessment was found to have a diagnostic sensitivity of 77% and a specificity of 43%, compared with 100% and 63% respectively for magnetic resonance imaging. Comparison of magnetic resonance imaging and arthroscopy confirmed the accuracy of magnetic resonance imaging in the diagnosis of internal derangement but the results for articular cartilage lesions were much less good, with a sensitivity of only 18% but a specificity of 100%. Acceptance of the magnetic resonance imaging findings could have resulted in a 29% reduction in the number of arthroscopies without missing any significant meniscal lesion.

Adolescent↗
PubMed1993

Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery?

Failure of conservative treatment is the usual indication for the reconstruction of a knee with deficiency of the anterior cruciate ligament (ACL) and this depends on subjective judgement. The ability of muscles to protect the subluxing joint by reflex contraction could provide an objective measurement. We have studied 30 patients with unilateral ACL deficiency by measuring the latency of reflex hamstring contraction. We found that the mean latency in the injured leg was nearly twice that in the unaffected limb (99 ms and 53 ms respectively). There was a significant correlation between the differential latency and the frequency of 'giving way' indicating that functional instability may be due, in part, to loss of proprioception. Measures of proprioception, including reflex hamstring latency, may be useful in providing an objective assessment of the efficacy of conservative treatment and the need for surgery.

Adult↗
PubMed1993

Septic arthritis in haemophilia.

Septic arthritis has been regarded as rare in haemophiliacs, but its incidence may have increased since HIV infection has become widespread in these patients. We describe six cases treated at one haemophilia unit over a two-year period and discuss their investigation, diagnosis and treatment. Four of the patients were seropositive to anti-HIV.

Anti-Bacterial Agents↗
PubMed1991

Revision total hip arthroplasty for aseptic failure. A review of 276 cases.

The results of 276 cemented revision total hip arthroplasties performed for aseptic failure between 1977 and 1986 have been reviewed. The mean time between revision and review was 75 months (range 30 to 144). Of 220 cases available for review, 159 were assessed clinically and radiographically, and 32 by postal questionnaire. Eighteen hips required further revision, 12 for loosening, two for sepsis, two for persistent pain, and one each for fracture and recurrent dislocation. A further six hips were radiologically and symptomatically loose. Pain was mild or absent in 83%. Over half were able to walk a mile or more; 70% flexed more than 70 degrees; 15% had a flexion deformity, but in only 7% was this more than 10 degrees. The mean Harris hip score was 74. Survival at five years was 95% and at 10 years, 77%.

Activities of Daily Living↗
PubMed1990

Total knee arthroplasty fixation. Comparison of the early results of paired cemented versus uncemented porous coated anatomic knee prostheses.

The results of 18 matched pairs of Porous Coated Anatomic knee prostheses were studied to compare the early clinical and functional performance of cemented versus uncemented fixation with an average five-year follow-up period for both. The knee score improved from a preoperative average of 35 points to a postoperative average of 90 points in the cemented group, and from 38 points to 93 points in the uncemented group. In particular, the individual pain scores and the range-of-motion values were well matched at the three-, six-, and 12-month follow-up visits and showed a steady improvement. Subjectively, all patients were pleased with the results of surgery; one-third preferred the cemented side, one-third preferred the uncemented side, and one-third found no difference in the performance of either knee. The clinical and functional performance of knee prostheses in patients who had one cemented knee and one uncemented knee were comparable and possibly unrelated to the type of fixation method.

Bone Cements↗
PubMed1989

Sliding hip screws: modes of failure.

The modes of failure of the sliding hip screw devices were investigated by reviewing 223 cases. There were 35 mechanical failures. Two of these occurred when the components separated in highly comminuted fractures. The use of the locking screw is recommended to prevent this. The other 33 occurred when the device had lost its sliding action. The reasons for this included jamming, insufficient slide being available and additional fixation. To reduce the complication rate it is recommended that any additional fixation (such as cerclage wires) should be used with care to ensure that they do not block the barrel. For patients with short femoral necks, a shorter barrelled version of the device should be used as it would have a greater sliding capacity. Guidelines for its use are given.

Bone Screws↗
PubMed1988

Allograft versus autograft bone in scoliosis surgery.

The results of a study of the use of autograft versus allograft bone in the surgery of idiopathic adolescent scoliosis are presented. Two groups of patients, matched for age, sex, level and angle of curve, received bone grafts, 20 patients having autogenous bone from the iliac crest and the other 20 having donor bone from a bone bank. Both groups had otherwise identical posterior fusions and Harrington instrumentation. There was no difference between the two groups in a blind, radiographic assessment of bone graft mass at six months, nor in maintenance of the curve correction over the same period. No major operative complications nor failures of instrumentation were encountered. There was, however, a marked reduction in operative time and blood loss in the patients receiving donor bone and also a much lower incidence of late symptoms relating to the operative sites. We conclude that, even in the presence of adequate iliac crest, the use of bank bone is superior for grafting in idiopathic scoliosis surgery.

Adolescent↗
PubMed1987

Triple dislocation in the upper limb.

A case of dislocation of the elbow and index finger PIP joints, in association with a fracture dislocation of the radiocarpal joint in the same limb, is presented. We found no previous reports of this combination of injuries. There were no neurovascular complications.

Adult↗