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D J Dandy

Publications and source records attributed to D J Dandy.

At least 19 recordsLinked to original sources
PubMed1995

Some clinical aspects of reconstruction for chronic anterior cruciate ligament deficiency.

A total of 250 patients was reviewed 71.8 months (range 49-105 months) after anterior cruciate ligament (ACL) reconstruction for disabling instability that had not responded to conservative treatment or correction of internal derangements. Knees that had undergone previous operation or had damage to other ligaments were excluded. Four techniques were used; MacIntosh extra-articular lateral substitution alone (n = 18), extra-articular reconstruction plus intra-articular carbon fibre (n = 29), extra-articular reconstruction plus a free graft from the medial third of the patellar tendon (n = 74), or extra-articular reconstruction plus a Leeds-Keio prosthesis (n = 129). The knees were assessed 1, 3 and 6 years after reconstruction using the Lysholm score and clinical examination for the anterior drawer, Lachman and pivot shift signs. The mean Lysholm score after 6 years was 77.4 (range 31-100) in the extra-articular group; 74.4 (range 34-100) in the carbon fibre group; 95.4 (range 43-100) in the patellar tendon group; and 91.2 (range 45-100) in the Leeds-Keio group. The patellar tendon group had the highest scores (P < 0.003). The pivot shift sign returned in 39% of the extra-articular group; 48% of the carbon fibre group; 1% of the patellar tendon group, and 36% of the Leeds-Keio group. The pivot shift returned least often in the patellar tendon group (P < 0.001). There were 44% satisfactory results (pivot shift negative and Lysholm score 77 or more) in the extra-articular group; 55% in the carbon fibre group; 92% in the patellar tendon group; and 60% in the Leeds-Keio group. The patellar tendon group had the most satisfactory results(P < 0.001).ACL reconstruction using the medial third of the patellar tendon supplemented with a MacIntosh extra-articular reconstruction is a reliable technique for correcting chronic instability and allows most patients to return to their former level of activity,including professional sport. No support could be found for the use of prosthetic ligaments or the arthroscopic placement of ACL substitutes.

Adolescent↗
PubMed1994

Problems in regaining full extension of the knee after anterior cruciate ligament reconstruction: does arthrofibrosis exist?

A total of 194 patients was reviewed after ACL reconstruction using a patellar tendon graft or Leeds-Keio prosthesis supplemented with a MacIntosh lateral substitution. There were five groups of patients: patellar tendon with cast immobilisation in flexion (n = 34); restricted extension but no cast (n = 40); immediate full extension (n = 40); 40); immediate full extension with notch widening (n = 40); Leeds-Keio ligament prosthesis (n = 40). The incidence of a click or a block to extension requiring operation ranged from 59% following cast immobilisation to 2.5% with the Leeds-Keio ligament. The incidence was significantly less when a Leeds-Keio prosthesis was used, and these problems may be associated with biological materials only. Restricting extension after operation significantly increased the loss of extension, confirming the work of others. Loss of extension was due to a mechanical block in all cases examined arthroscopically. All were relieved by arthroscopic surgery, and no case of flexion contracture or arthrofibrosis was encountered. A simple mechanical block to extension caused by a Cyclops lesion should be clearly distinguished from flexion contracture and arthrofibrosis, conditions which are probably extremely rare and overdiagnosed.

Adolescent↗
PubMed1994

The results of arthroscopic lateral release of the extensor mechanism for recurrent dislocation of the patella after 8 years.

We reviewed 41 knees at a mean of 4 years after arthroscopic lateral release of the extensor mechanism. The operations were performed for recurrent complete dislocation, not for subluxation, maltracking, or lateral pressure syndrome. Thirty-three of these knees were reviewed again 8 years after operation. There were 39% excellent results according to the criteria of Crosby and Insall at 4 years and 30% at 8 years. Patellar stability improved between 4 and 8 years (p < 0.01). The results in patients with subluxation of the patella on extension of the knee or generalized ligament laxity were poor; five of seven patients with these conditions were worse and had undergone another operation. With these conditions excluded, the excellent results decreased from 50% after 4 years to 37% after 8 years. The results of lateral release are better than those reported after other procedures. It is concluded that arthroscopic lateral release is the procedure of choice for patients with recurrent complete dislocation of the patella unless there is abnormal ligament laxity or subluxation on extension. The operation should not be performed in the presence of these conditions.

Adolescent↗
PubMed1994

Anterior cruciate ligament reconstruction with the Leeds-Keio prosthesis plus extra-articular tenodesis. Results after six years.

We describe 129 patients with disabling instability of the knee due to deficiency of the anterior cruciate ligament. They were treated by replacement of the ligament with a Leeds-Keio prosthesis supplemented by an extra-articular MacIntosh lateral substitution reconstruction. After an average period of 71 months a satisfactory outcome was found in only 60% of knees. Nine had required revision because of recurrent instability and the pivot-shift sign had become positive in 40% of patients. In our opinion the long-term results are unsatisfactory when compared with those obtained using a graft from the medial third of the patellar tendon supplemented with a MacIntosh extra-articular tenodesis.

Adolescent↗
PubMed1994

Patellar tendon length after anterior cruciate ligament reconstruction.

We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligament using either the medial third of the patellar tendon as a graft (n = 40) or a Leeds-Keio artificial ligament (n = 40). Both types of ligament replacement had been supplemented with a MacIntosh extra-articular lateral substitution. The mean change in length in the tendon graft group was 6% (SD 5.39); in the Leeds-Keio group it was 2.4% (SD 4.93). The change in length was significant in both groups, but shortening was more frequent and more severe in the tendon graft group. There was shortening of 10% or more in 25% of knees after patellar tendon graft and 7.5% after use of a Leeds-Keio prosthesis.

Adolescent↗
PubMed1992

Arthroscopic resection of chondroblastoma of the knee.

We present a case of chondroblastoma of the upper tibia treated by complete arthroscopic excision. The diagnostic difficulties raised by the case are discussed. This method of treatment has not, to our knowledge, been reported in the literature.

Adolescent↗
PubMed1992

Arteriovenous fistula after arthroscopic synovectomy in a patient with haemophilia.

Arteriovenous fistula is a rare complication of arthroscopy. We report a human immunodeficiency virus-positive person with haemophilia who 19 months after an arthroscopic synovectomy of the knee presented with increasingly frequent haemarthroses and a palpable thrill over the knee. Angiography confirmed an arteriovenous fistula. The patient was successfully treated by surgical ligation of the communicating vessels. The literature regarding vascular injuries after arthroscopy of the knee is reviewed.

Adolescent↗
PubMed1991

Reconstruction of the anterior cruciate ligament with an intra-articular patellar tendon graft and an extra-articular tenodesis. Results after six years.

We describe 74 patients with disabling instability of the knee due to isolated anterior cruciate deficiency. None responded to conservative measures or correction of internal derangements. All patients were treated by replacement of the anterior cruciate ligament with the medial third of the patellar tendon as a free graft, supplemented by an extra-articular MacIntosh lateral reconstruction. A satisfactory outcome was found in 93% of knees after an average of 70 months follow-up. Cast immobilisation after operation, the interval between injury and reconstruction, the age of the patient and the severity of symptoms before reconstruction had no significant effect on the final outcome.

Activities of Daily Living↗
PubMed1991

Graft length for anterior cruciate reconstruction.

We measured on the radiographs of 100 knees the length of the patellar ligament and the anterior cruciate ligament, and the distance between the tibial tubercle and the femoral insertion of the anterior cruciate. The length of the patellar ligament was always greater than that of the anterior cruciate ligament, but shorter than the distance between the tibial tubercle and the femoral insertion of the anterior cruciate by a mean of 14.2 mm (3 to 22). We conclude that anatomical, isometric replacement of the anterior cruciate is possible using a free graft, but not by the technique of retaining the tibial attachment originally described by Jones (1970).

Adolescent↗
PubMed1990

Anatomy of the medial suprapatellar plica and medial synovial shelf.

The anatomy of the medial suprapatellar plica and medial synovial shelf was studied arthroscopically in 500 knees. The medical suprapatellar plica extended up to one third of the way across the suprapatellar pouch in 64.2% of knees, between one and two thirds in 4%, and two thirds or more in 31.6%. The medial synovial shelf was absent or vestigial in 36% of knees and broader than 1 cm in 13.2%. When both knees were examined arthroscopically, the similarity between the appearances of the plica and the shelf in the two knees was statistically significant. No relationship between age and the pattern of plica or shelf could be found. There was no association between large plicae and large shelves, but the shelf was absent significantly more often in knees with a narrow plica.

Adolescent↗
PubMed1990

The impact of arthroscopic surgery on the management of disorders of the knee.

Five hundred consecutive arthroscopies were studied and the management proposed after initial clinical and radiological assessment was compared with the final management after arthroscopy. The differences were analysed. Open operation was deferred in 96% of 312 patients in whom it would have been performed, and had no influence on management in the remaining 4%. A condition was found and treated arthroscopically in 63% of 188 knees thought unlikely to have a treatable disorder. The findings are compared with those of an earlier series, and the impact of arthroscopic surgery was found to be more far reaching than diagnostic arthroscopy alone. The indications for arthrotomy during the period of study were confined to ligament reconstruction, patellectomy, and joint replacement.

Arthroscopy↗