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D W Altchek

Publications and source records attributed to D W Altchek.

At least 19 recordsLinked to original sources
PubMed2005

In vivo healing after capsular plication in an ovine shoulder model.

Traditionally, arthroscopic management of shoulder instability has been reserved for patients with isolated Bankart lesions without any capsular laxity or injury. To date, there are no animal studies evaluating the healing potential of capsular plication and/or capsulo-labral repair. The purpose of this in vivo animal study was to determine if the histological capsular healing of an open capsular plication simulating an arthroscopic plication is equivalent to the more traditional open capsular shift involving cutting and advancing the capsule. Twenty-six skeletally mature sheep were randomized to either an open capsular plication simulating arthroscopic plication (n = 13), or an open traditional capsular shift (n = 13). A sham operation (n = 4) was also performed involving exposure to visualize the capsule. Normal non-operated control shoulders were also analyzed. A pathologist blinded to the treatment evaluated both hematoxylin and eosin (H&E) sections and polarized light microscopy. Qualitative scoring evaluated fibrosis, mucinous degeneration, fat necrosis, granuloma formation, vascularity, inflammatory infiltrate and hemosiderin (0 to 3 points). Both the capsular plication and open shift groups demonstrated healing by fibrosis at the site of surgical manipulation. There were no statistical differences in the capsular healing responses between the two groups with regard to fibrosis, granuloma formation and vascularity. The open shift group demonstrated significantly more mucinous degeneration (p = 0.038). Fat necrosis was present in 4/13 specimens in the open shift group and none in the capsular plication specimens. Both groups demonstrated disorganized collagen formation under polarized light microscopy. There were no differences between non-operated control specimens and sham surgery specimens. Our findings support the hypothesis that histologic capsular healing is equivalent between the plication group and the open shift group. In addition, the open shift group demonstrated significantly more changes indicative of tissue injury. This basic science model confirms capsular healing after simulated arthroscopic plication, providing support for arthroscopic capsular plication in practice.

Animals↗
PubMed2001

Evaluation and management of shoulder instability in the elite overhead thrower.

The elite throwing athlete places significant forces on the soft-tissue stabilizers of the shoulder with every pitch. Anterior translation forces can be as high as 40% of body weight and distraction forces as high as 80% body weight during the act of throwing. Injury to the static and dynamic stabilizers can lead to significant pain and loss of function in these athletes. To successfully treat the injured thrower, it is important to accurately diagnose the pathologic process. This article reviews the biomechanics of throwing and pathologic processes seen in the elite thrower. We cover the essentials of the history and physical in this population and conclude with a discussion of the various treatment regimens.

Baseball↗
PubMed2001

Valgus instability of the elbow in athletes.

Valgus instability of the elbow in athletes is uncommon among athletes in general, but has a higher incidence in individuals who throw repetitively. When valgus overload injury results in disabling symptoms for the athlete, surgical reconstruction of the anterior band of the ulnar collateral ligament may be indicated. This procedure has been successful in getting athletes back to premorbid levels of competition. The authors provide a comprehensive review of valgus instability of the elbow and offer their preferred method of treatment.

Athletic Injuries↗
PubMed2001

Reliability, validity, and responsiveness of four knee outcome scales for athletic patients.

BACKGROUND: Many patient-based knee-rating scales are available for the evaluation of athletic patients. However, there is little information on the measurement properties of these instruments and therefore no evidence to support the use of one questionnaire rather than another. The goal of the present study was to determine the reliability, validity, and responsiveness of four knee-rating scales commonly used for the evaluation of athletic patients: the Lysholm scale, the subjective components of the Cincinnati knee-rating system, the American Academy of Orthopaedic Surgeons sports knee-rating scale, and the Activities of Daily Living scale of the Knee Outcome Survey. METHODS: All patients in the study had a disorder of the knee and were active in sports (a Tegner score of 4 points). Forty-one patients who had a knee disorder that had stabilized and who were not receiving treatment were administered all four questionnaires at baseline and again at a mean of 5.2 days (range, two to fourteen days) later to test reliability. Forty-two patients were administered the scales at baseline and at a minimum of three months after treatment to test responsiveness. The responses of 133 patients at baseline were studied to test construct validity. RESULTS: The reliability was high for all scales, with the intraclass correlation coefficient ranging from 0.88 to 0.95. As for construct validity, the correlations among the knee scales ranged from 0.70 to 0.85 and those between the knee scales and the physical component scale of the Short Form-36 (SF-36) and the patient and clinician severity ratings ranged from 0.59 to 0.77. Responsiveness, measured with the standardized response mean, ranged from 0.8 for the Cincinnati knee-rating system to 1.1 for the Activities of Daily Living scale. CONCLUSIONS: All four scales satisfied our criteria for reliability, validity, and responsiveness, and all are acceptable for use in clinical research.

Adolescent↗
PubMed2000

Surgical management of posterior shoulder instability in a ten-year-old boy: a case report and literature review.

Posterior shoulder instability is an uncommon clinical entity. It is even more rare in the pediatric population. We report the case of a 10-year-old boy who experienced recurrent posttraumatic posterior shoulder instability that eventually required surgical intervention. A review of the literature revealed no previous report of surgical management of nonobstetrical posttraumatic posterior glenohumeral instability in a skeletally immature individual.

Accidental Falls↗
PubMed2000

Shoulder injury in the throwing athlete.

Successful nonoperative management of shoulder injury in the throwing athlete requires a comprehensive team approach. The cornerstone of management is physical therapy to restore strength, balance, and endurance to the shoulder girdle musculature followed by a return to a throwing program. The return to competitive throwing is usually a lengthy process requiring patience from the medical team and the athlete.

Athletic Injuries↗
PubMed1997

Arthroscopic acromioplasty. Current status.

Impingment is a chronic syndrome characterized by microtrauma, which causes progressive injury to the rotator cuff tendon. In recent years, arthro- scopic subacromial decompression/acromioplasty has been frequently used for the treatment of impingement syndrome and is quickly becoming the preferred surgical treatment when conservative modalities fail. Arthroscopic acromioplasty offers many benefits over open acromioplasty, including better cosmesis, lessened preoperative morbidity, a more complete intraoperative examination, and a hastened, early rehabilitation program.

Acromion↗
PubMed1997

The rotator cuff. Commentary.

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.

Adult↗
PubMed1997

The elbow.

Elbow disorders in the athletic population comprise a wide range of injuries from acute trauma to those caused by chronic overuse of the joint. Certain injuries are orthopedic emergencies that must be recognized immediately by the team physician to avoid potential complications. Other overuse injuries need to be accurately diagnosed and treated so further injury can be prevented and the athlete can return to competition as expediently as possible. Finally, the decision to refer an athlete for surgical treatment often rests with the team physician; only with an adequate understanding of the elbow disorders in the athlete can these decisions be made.

Adolescent↗
PubMed1997

Biomechanical evaluation of the medial collateral ligament of the elbow.

UNLABELLED: Anatomical dissection and biomechanical testing were used to study twenty-eight cadaveric elbows in order to determine the role of the medial collateral ligament under valgus loading. The medial collateral ligament was composed of anterior, posterior, and occasionally transverse bundles. The anterior bundle was, in turn, composed of anterior and posterior bands that tightened in reciprocal fashion as the elbow was flexed and extended. Sequential cutting of the ligament was performed while rotation caused by valgus torque was measured. The anterior band of the anterior bundle was the primary restraint to valgus rotation at 30, 60, and 90 degrees of flexion and was a co-primary restraint at 120 degrees of flexion. The posterior band of the anterior bundle was a co-primary restraint at 120 degrees of flexion and a secondary restraint at 30 and 90 degrees of flexion. The posterior bundle was a secondary restraint at 30 degrees only. The reciprocal anterior and posterior bands have distinct biomechanical roles and theoretically may be injured separately. The anterior band was more vulnerable to valgus overload when the elbow was extended, whereas the posterior band was more vulnerable when the elbow was flexed. The posterior bundle was not vulnerable to valgus overload unless the anterior bundle was completely disrupted. The intact elbows rotated a mean of 3.6 degrees between the neutral position and the two-newton-meter valgus torque position. Cutting of the entire anterior bundle caused an additional 3.2 degrees of rotation at 90 degrees of flexion, where the effect was greatest. CLINICAL RELEVANCE: Physical findings in a patient who has an injury of the anterior bundle may be subtle, and an examination should be performed with the elbow in 90 degrees of flexion for greatest sensitivity. As the anterior bundle is the major restraint to valgus rotation, reconstructive procedures should focus on anatomical reproduction of that structure. Parallel limbs of tendon graft placed from the inferior aspect of the medial epicondyle to the area of the sublimis tubercle will simulate the reciprocal bands of the anterior bundle. Temporary immobilization with the elbow in flexion may relax the critically important anterior band of the reconstruction during healing.

Biomechanical Phenomena↗
PubMed1997

A self-administered questionnaire for assessment of symptoms and function of the shoulder.

A self-administered questionnaire was designed to assess the severity of symptoms related to and the functional status of the shoulder. It includes domains of global assessment, pain, daily activities, recreational and athletic activities, work, satisfaction, and areas for improvement. Each domain is graded separately and is weighted to arrive at the total score. The over-all scale and each domain were prospectively tested for validity, reliability, and responsiveness to clinical change. One hundred patients who were seen for evaluation of the shoulder were enrolled in the study. The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Questionnaire with those of the Arthritis Impact Measurement Scales 2. Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement. The over-all scale and each domain were internally consistent (Cronbach alpha, 0.71 to 0.90). Reproducibility was evaluated by repeated administration of the questionnaire after a mean of three days to forty patients whose condition was clinically stable. Reproducibility of the over-all questionnaire and individual domains was excellent (Spearman-Brown index, 0.94 to 0.98). Individual questions were reproducible, with a weighted kappa value of more than 0.7 for each. Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder. The over-all Shoulder Rating Questionnaire and each domain were responsive to clinical change as demonstrated by favorable standardized response means (range, 1.1 to 1.9) and indices of responsiveness (range, 1.1 to 2.0). Similar analysis performed for individual diagnostic groups supported the validity, reliability, and responsiveness of the questionnaire in each group. The self-administered shoulder questionnaire was found to be valid, reliable, and responsive to clinical change. These qualities should make it a useful instrument for the prospective assessment of the outcome of treatment of disorders related to the shoulder.

Activities of Daily Living↗
PubMed1996

Arthroscopic assisted rotator cuff repair: results using a mini-open deltoid splitting approach.

Out of 78 patients identified who underwent mini-open cuff repair, 64 were interviewed and returned a detailed questionnaire and 47 returned for a physical examination. Their average age was 64 years (31 to 85 years); and the average follow-up was 29.2 months (range, 12 to 65 months). The average tear size was 8 cm2. Preoperatively, all patients complained of pain and weakness. Ninety-six percent of patients displayed positive impingement signs preoperatively compared with 16% postoperatively. Active elevation increased significantly (P < .05) from 129 degrees to 166 degrees. At the time of follow-up there was no significant difference between active elevation in the operative and contralateral shoulders (P > .05). Weakness was detectable by physical examination in 83% of patients initially, and in 22% at the time of the final examination. The average pain and function scores improved significantly. Eighty-nine percent were satisfied with the results of their surgery. Three patients required further surgery on their shoulder. We found no correlation between cuff tear size and final Hospital for Special Surgery shoulder score.

Adult↗
PubMed1996

Arthroscopic Bankart repair using a degradable tack. A followup study using optimized indications.

Arthroscopic Bankart repair using degradable polymers is a relatively new procedure. Initial reports describing results among the first patients treated for instability of the shoulder using degradable tacks found rates of recurrent instability significantly higher than those for open repair procedures. A 21% postoperative recurrence rate was reported in the initial group of 62 patients studied. Modifications of the operative procedure and, more importantly, the indications for the procedure have led to substantially improved results. Using the following indications, a 2-year followup group of patients was found to have a 10% recurrence of instability rate: (1) traumatic instability, which primarily was anterior, unidirectional; (2) presence of a Bankart lesion; (3) presence of a robust inferior glenohumeral ligament; and (4) minimal to mild amount of bony erosions present at the glenoid. It is concluded that with more precise patient selection, arthroscopic stabilization using a degradable polymeric tack can provide high levels of patient satisfaction with low rates of recurrence.

Adult↗
PubMed1996

Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder.

PURPOSE: To prospectively assess the accuracy of unenhanced magnetic resonance (MR) imaging in the detection and localization of labral injuries. MATERIALS AND METHODS: One hundred three patients with clinically suspected shoulder injuries were prospectively examined with unenhanced MR imaging. A combination of gradient-echo and high-resolution fast-spin-echo axial pulse sequences were used. Surgical correlation was obtained in all patients. RESULTS: At surgery, 37 torn anterior, 36 torn superior, and 19 torn posterior labral were identified. The sensitivity for detection of these tears with MR imaging was 100%, 86%, and 74%, respectively; the specificity was 95%, 100%, and 95%, respectively. Overall, unenhanced MR imaging was 95% accurate in the detection of labral injuries. CONCLUSION: With appropriate pulse sequences, unenhanced MR imaging of the shoulder is an accurate technique for the detection and localization of labral injuries.

Adult↗