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Biomedical subjects

D Fritschy

Publications and source records attributed to D Fritschy.

At least 19 recordsLinked to original sources
PubMed2005

[Knee replacement].

Total knee replacement is nowadays a surgical technique that has reached maturity and is used as frequently as total hip replacement. It is mainly aimed at patients suffering from knee osteoarthrosis when it becomes invalidating and painful and does not respond anymore to medical conservative treatment and physiotherapy. Long term results are excellent in patients aged over 70 years old. They are still amenable to improvement in young patients who are more active and who put under stress their implants in a longer and more intense way. Infection, loosening and malpositioning of the implants are the most common complications.

Age Factors↗
PubMed2005

Anatomy of the anterior cruciate ligament.

The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia. The ACL is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. When the knee is extended, the ACL has a mean length of 32 mm and a width of 7-12 mm. There are two components of the ACL, the anteromedial bundle (AMB) and the posterolateral bundle (PLB). They are not isometric with the main change being lengthening of the AMB and shortening of the PLB during flexion. The ACL has a microstructure of collagen bundles of multiple types (mostly type I) and a matrix made of a network of proteins, glycoproteins, elastic systems, and glycosaminoglycans with multiple functional interactions. The complex ultrastructural organization and abundant elastic system of the ACL allow it to withstand multiaxial stresses and varying tensile strains. The ACL is innervated by posterior articular branches of the tibial nerve and is vascularized by branches of the middle genicular artery.

Anterior Cruciate Ligament↗
PubMed2005

[Patella dislocation].

Patella dislocation is a classical injury affecting teenagers. In 2/3 of cases, it occurs in sports activities. It is often a benign trauma which happens in a patello-femoral dysplasia context, leading to dislocation and reccurence if nothing is done to correct the defaults. Radiographic and scanner examinations allow to measure the dysplasia parameters and think about its correction. With MRI documentation, capsulo-ligamentous and cartilaginous lesions can be identified and their surgical repair can be discussed. When the dislocation occurs in a normal anatomical context, conservative therapy is still indicated.

Adolescent↗
PubMed2002

Medial meniscectomy in patients over the age of fifty: a six year follow-up study.

PURPOSE: Meniscectomy in the older patient remains a controversial topic. The aim of our study is to assess the mid-term outcome of arthroscopic partial medial meniscectomy in patients over fifty years of age and attempt to retrospectively identify symptoms and/or findings on examination which can differentiate between non-degenerative medial meniscal tears versus degenerative meniscal changes. MATERIALS AND METHODS: Thirty-two patients over the age of fifty who had undergone arthroscopic medial partial meniscectomy, were reviewed. The average age was 60 (51-74 yrs) and the average follow-up was six years (3-7 yrs). Based upon the intra-operative findings, patients were divided into two groups: (1) non-degenerative meniscal tears (NDM; n = 12) and (2) degenerative meniscal changes (DM; n = 20). Our outcome measurements were with the HSS knee score, a satisfaction score, and weight-bearing X-rays. RESULTS: In the NDM group, eleven patients were rated excellent or good, and one was rated poor. In the DM group, three patients were rated as excellent or good, eight as fair, and nine as poor. The HSS score was 97 +/- 4.6 for the NDM group and 85 +/- 9.5 for the DM group. The average satisfaction score was 9.2 +/- 0.7 (very satisfied) for the NDM group and 5.8 +/- 2.6 (fairly satisfied) for the DM group. There was no significant difference between the NDM and the DM groups with regards to pre-operative symptoms and signs, except for the McMurray sign, which was found to be positive in 83% of NDM cases versus 25% of DM cases (sensitivity = 83%). Using only these data, the McMurray sign was 67% specific for NDM. CONCLUSIONS: Arthroscopic medial meniscectomy in older patients provides 90% good results six years after a non-degenerative meniscal tear, but only 20% of good results after a degenerative meniscal tear. However, based on this study, neither symptoms nor physical examination are able to differentiate between traumatic meniscal tears and degenerative meniscal changes in older patients. A positive McMurray's sign favors the diagnosis of a traumatic tear. However, a specificity of this test of only 67% as shown in our data questions its utility in clinical decision-making.

Age Factors↗
PubMed2000

[AT-TG (anterior tuberosity-trochlear groove): interobserver variability in CT measurements in subjects with patellar instability].

PURPOSE OF THE STUDY: Measurements between the anterior tuberosity of the tibia and the trochlear groove of the patellar surface of the femur AT-AG) are recognized parameters for exploring patellar instability. Interobserver variability should be less than 4 mm and reproducibility should be greater than 85 per cent for valid measurements. We assessed interobserver variability with CT measurements. MATERIAL AND METHOD: The radiography files (left and right knee) of thirteen patients with patellar instability were examined by six radiologists working in private practice after training in our university center. RESULTS: The results demonstrated major variability with acceptable reproducibility in only 15% of the measurements. Differences greater than 5 mm were observed for 14 groups of values (54 per cent) and greaterd than 8 mm in 5 groups (19 per cent). The spread was mainly related to determinations of the TG point in case of major dysplasia and in defining the precise contour of the tibial tuberosity. Surgical decisions made on the basis of these millimetric values should be made prudently.

Humans↗
PubMed1998

Nine cases of osteonecrosis in elderly patients following arthroscopic meniscectomy.

We report nine cases of osteonecrosis of the knee after arthroscopic meniscectomy between 1992 and 1996. In five women and four men aged between 58 and 82 years (mean 69 years), magnetic resonance imaging (MRI) demonstrated a meniscal tear for which arthroscopic meniscectomy was performed. MRI was done between 3 days and 72 weeks after the onset of symptoms. Signs of osteonecrosis were not present on the initial MRI scan. Postoperatively, all patients experienced persistent knee pain and joint effusion. A repeat MRI scan 6-48 weeks after meniscectomy confirmed the diagnosis of osteonecrosis. In eight patients osteonecrosis was located on the medial, in one patient on the lateral femoral condyle. Our report supports the results of recent studies which have related osteonecrosis to arthroscopic meniscectomy. Further studies need to be undertaken to determine the aetiology of the osteonecrosis related to this procedure in the elderly. Until the results of these studies are available, we recommend considering carefully before performing arthroscopic procedures in the elderly.

Aged↗
PubMed1997

Can we predict the outcome of a partial rupture of the anterior cruciate ligament? A prospective study of 43 cases.

The concept of partial rupture of the anterior cruciate ligament (ACL) has been confirmed by arthroscopic examination and palpation. We present a prospective study of 43 patients who were diagnosed arthroscopically as suffering from a partial rupture of the ACL by the same surgeon. The patients followed a rehabilitation protocol and were examined by an independent observer after 5 years. Twenty-five patients had a stable knee, whereas 18 eventually suffered a complete ACL rupture. ACL partial rupture is easily recognizable with arthroscopy, but the quantity and state of the still intact fibres is difficult to assess.

Adolescent↗
PubMed1997

[Aseptic osteonecrosis of the femoral condyle after meniscectomy by the arthroscopic approach].

Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prothesis, the other 7 patients were treated medically.

Aged↗
PubMed1997

[Arthroscopic removal of intra-articular loose foreign bodies of the elbow].

PURPOSE OF THE STUDY: We have retrospectively studied the results of arthroscopic removal of loose bodies in the elbow. The aim of the study was to determine if the etiology of the loose bodies could be considered as a criteria for technical difficulty and clinical prognosis. MATERIAL: 16 patients (11 men and 5 female) had an elbow arthroscopy for loose bodies removal. Their average age was 29.5 years (range: 16-49). The post-operative results were recorded in their medical files with an average follow-up of six months. METHODS: In each case we have determined the etiology of the intra-articular loose bodies. The results were analyzed according to technical difficulty and clinical outcome. RESULTS: The etiology of the loose bodies was 8 chondromatosis, 4 osteochondritis dissecans and 4 post-traumatic osteoarthritis. The removal of the loose bodies was possible in 13 cases. Three arthroscopies were interrupted because of arthritic joint space narrowing. Twelve patients with primary chondromatosis and osteochondritis dissecans were improved. We did not find any significant clinical improvement in osteoarthritic elbows. A correlation between the results and the etiologies could therefore be shown. DISCUSSION: In arthroscopic removal of elbow loose bodies, technical difficulties and clinical results are correlated to the etiology of the loose bodies and also to the statement of the osteochondral surfaces.

Adolescent↗
PubMed1994

[A rare injury of the ankle in competition skiiers].

Ankle ligamentous injuries have become rare since high and rigid boots are used in alpine skiing because tibio-talar and foot movements are almost impossible. However, in extreme competition conditions, external rotation of the ankle is possible in the ski boot. These are slalom accidents where the leg is forced suddenly in external rotation when straddling a gate. This movement leads to a collision between talus and distal fibula opening the tibio-fibular joint. The anterior tibio-fibular ligament is first torn. We report a series of 13 cases collected in a 17 years experience in the FIS-World Cup.

Adolescent↗
PubMed1993

Bone imaging after acute knee hemarthrosis.

Follow-up evaluations were carried out in 84 patients examined 5-8 years after sustaining an acute traumatic hemarthrosis of the knee. The initial examination performed within 2 weeks of injury had revealed 18 patients with a stable knee and 66 with anterior instability. Twelve of the patients underwent anterior cruciate ligament reconstruction within 3 months of injury and 11 more did so between 1 and 3 years after injury. To document joint deterioration at follow-up, bone scintigraphy and conventional anteroposterior, lateral, and tunnel X-rays were taken. Medial, lateral, patellofemoral and patellar uptake in bone scintigraphy was graded from 0 to 4. Six radiological variables were graded at eight different sites. Sixty-three patients (75%) had a positive bone scan and 69 patients (82%) showed radiological changes. Bone scan and X-ray scores were both significantly higher in the reconstructed knees.

Acute Disease↗
PubMed1993

Surgical treatment of patellar tendinitis.

Patellar tendinitis is an overuse syndrome affecting the origin of the patellar tendon and its underlying part. Ultrasonography is useful to investigate tendinous pathology. It describes the anatomical lesions and their extent. Surgical excision of irreversible lesions, demonstrated on ultrasonography, is a logical attitude which provides good results.

Adult↗
PubMed1993

[Fracture of the femoral neck: therapeutic approach].

The therapeutic approach for treatment of femoral neck fractures is reviewed. The choice of implant is dependent primarily on patient age and amount of fracture displacement. Hemiarthroplasty remains the treatment of choice for displaced femoral neck fractures in older or debilitated patients. Internal fixation is always indicated in healthy and active subjects, whether the fracture is displaced or undisplaced. Internal fixation with three cancellous screws provides good mechanical stability without compromising head vitality when compared to other implants.

Adult↗
PubMed1993

Treating tibial fractures with a modified Sarmiento method.

There is still no unanimous agreement on the appropriate primary treatment of tibial fractures. One fraction advocates conservative treatment, and another advocates open reduction and internal fixation. Between these extremes is the functional treatment developed by Augusto Sarmiento. The authors adopted Sarmiento's method in 1976 and present a prospective study of 317 cases treated between 1976 and 1988 in which the union rate was 98.7%. They describe the Sarmiento method as ideal for closed, spiroid (whether comminuted or not) tibial fractures resulting from low-energy forces.

Adolescent↗
PubMed1991

Discoid lateral meniscus.

Discoid meniscus is uncommon and usually affects the lateral meniscus. We present 16 patients (8 male and 6 female) with tears of a discoid lateral meniscus occurring in 1800 arthroscopies. We carried out an arthroscopic partial meniscectomy leaving an intact peripheral rim. This is biomechanically satisfactory and the early results are encouraging.

Adolescent↗